Ventricular septal defects
What is ventricular septal defect (VSD)?
Ventricular septal defect (VSD) is a hole between two of the chambers in the heart. It is the most common congenital (from birth) heart defect.
A healthy heart is a strong, muscular pump that pushes blood through the circulatory system to carry oxygen and nutrients to the body. The heart has four chambers -- two on the right and two on the left. Blood is pumped through these chambers and regulated by valves that open and close like tiny doors, so that blood can move in only one direction.
After its trip through the body to deliver oxygen, blood is a blue color because it's no longer oxygen-rich. The blue blood returns to the heart through the right chambers and is pumped through the pulmonary artery into the lungs. In the lungs, it picks up more oxygen and becomes bright red. It then goes back through the pulmonary vein to the left chambers and is pumped through the aorta and out into the body again.
A VSD is a hole in the muscle wall between the two lower pumping chambers of the heart. The hole allows oxygen-rich (red) and oxygen-poor (blue) blood to mix. This overfills the lungs and overworks the heart.
If your baby has a small VSD, it may never cause any problems, and may even close up on its own. A larger VSD, if not treated, may cause a number of disabilities, including:
- Eisenmenger's syndrome: High blood pressure in the lung arteries, leading to permanent damage and lung disease.
- Congestive heart failure: A chronic condition in which the heart can't pump enough blood to meet the needs of the body.
- Endocarditis: A bacterial infection of the heart.
- Stroke: A life-threatening condition that occurs when a blood clot passes through the hole in the heart and goes to the brain.
- Abnormal heart rhythms
- Valve problems
- Lung disease
What causes VSD?
A VSD occurs during the first eight weeks of fetal development, when the heart is forming. A VSD means that a walls between the chambers of the heart is left incomplete, leaving what is commonly called "a hole in the heart."
Most VSDs occur with no clear reason. However, some risk factors have been identified, such as a mother who contracts measles, uses drugs or alcohol, or has diabetes during pregnancy. In addition, some congenital heart defects may have a genetic link, causing heart problems to occur more often in certain families.
VSDs make up 4-6% of all congenital heart defects. They are the most common type of congenital heart defect, occurring in one to three out of every 1,000 live births, and four to seven out of every 1,000 premature births.
What are the signs and symptoms of VSD?
The size of your baby's VSD will affect when and how symptoms occur. Symptoms may not occur until several weeks after birth.
A small VSD will sometimes cause no symptoms at all, or even close on its own. A larger hole means that more blood goes through the opening and makes the right side of the heart work harder, making the condition more serious.
Symptoms vary, but may most commonly include:
- Fatigue and low energy
- Disinterest or tiredness while feeding
- Poor weight gain
- Accelerated heart rate and sweating
- Rapid, heavy or difficult breathing
- Cyanosis: A blue tone to the skin, lips, or nails
- Swelling of the legs, feet or stomach
Your baby's doctor may also suspect a heart defect if he or she hears a heart murmur — an abnormal whooshing noise, heard through a stethoscope exam, which may indicate a problem with blood flow. Most heart murmurs are called "innocent heart murmurs." Children with innocent heart murmurs do not have a heart defect and do not experience heart problems. However, if a heart murmur is present along with other symptoms, your doctor may want to investigate further by ordering other tests.
How is VSD diagnosed?
Smaller VSDs often close spontaneously or don't cause problems. Typically, only the larger ones need surgical repair.
A clear diagnosis is the first step to treatment. A pediatric cardiologist (a children's heart doctor) can use several tests to confirm your child's diagnosis. These tests may include:
- Chest X-ray: A beam of electromagnetic energy creates images on film that show the inside structures of your baby's body. With a VSD, the x-ray may show a larger heart than normal or changes in the lungs due to extra blood flow.
- Cardiac magnetic resonance imaging (MRI): This test produces a three-dimensional image of the heart so you're your child's doctors can examine blood flow and functioning of the heart as it is working.
- Electrocardiogram (ECG or EKG): This test, conducted by attaching patches with wires (electrodes) to your baby's skin, records the heart's electrical activity. It will show if there are abnormal heart rhythms (arrhythmias or dysrhythmias) and/or stress on the heart muscle.
- Echocardiogram (Echo): This test uses sound waves to produce a moving image of the heart on a video screen. It is similar to an ultrasound. An echo can show the pattern of blood flow through the VSD; it can determine the opening's size and how much blood passes through it.
- Cardiac catheterization: During this procedure, your doctor inserts a thin flexible tube (a catheter) into a blood vessel in the groin, then guides it up to the inside of the heart. A dye injected through the catheter makes the heart structures visible on x-ray pictures. The catheter also measures blood pressure and oxygen levels.
How is VSD treated?
Once diagnosed, your child's treatment may vary depending on his or her individual needs. Many babies born with VSD won't need to have it surgically closed. Your doctor may simply want to observe your baby, treat any symptoms, and wait to see if the defect closes naturally.
Your child may be given medications to keep the heartbeat regular, increase the strength of the heart's contractions, and decrease the amount of fluid in circulation.
If your child's condition is severe or the septal defect is large, surgery may be a good idea in order to prevent complications later. Procedures vary, but the options may include:
- Surgical repair: This surgery involves closing the VSD through open-heart surgery.
- Cardiac catheterization: This is similar to the diagnostic test described above, except the doctor may be able to use the catheter to place a mesh patch over the VSD. When heart tissue grows in around the patch, a permanent seal is formed. This is a less invasive procedure that does not require open-heart surgery.
Your baby's doctor may wish to delay surgery until the child is older. If your child has multiple heart defects or a VSD in an unusual location, a separate procedure, called pulmonary banding, may relieve severe symptoms and pressure in the lungs. This narrows the pulmonary artery to reduce blood flow to the lungs. It is a temporary measure that allows the child to grow; when he or she is older, doctors can remove the band and operate to repair the VSD. Generally, surgical repair of a VSD improves blood circulation and pressure.
Many children with VSDs have normal, productive lives with few related problems. After surgery, a child must be examined regularly by a pediatric cardiologist to make sure the VSD remains closed and the heart is working normally. All people with VSD need to take antibiotics before dental work and certain surgical procedures. Be sure to remind the dentist or doctor that your child has a ventricular septal defect and ask if he or she needs antibiotics before any procedure.
About treatment for ventricular septal defect at Children's
Ventricular septal defect is treated through Children's cardiovascular program one of the largest and oldest pediatric cardiovascular programs in the region. Team members consistently achieve treatment results that are among the best in the nation. Each year, care is provided for thousands of the region¹s sickest children with heart conditions, including fetuses, newborns, infants, children, adolescents, and adult, long-term patients with pediatric cardiovascular conditions.
For more information, please call Children's Heart Clinic at 1-800-938-0301.
(From Pritchet & Hull Assoc., Inc.)
Heart with VSD
(From Pritchet & Hull Assoc., Inc.)