A ventricular septal defect (VSD) is a hole in the wall between the heart's two lower chambers. It can change the way blood flows in the heart and make the heart work harder. This can make the right side of the heart larger and cause problems in the lungs.
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A VSD happens as the baby grows in the uterus. A specific area of the heart does not develop as it should. It is not always known why this happens. Factors that may play a role include:
- Changes in certain genes—may occur on their own or be passed down from parent
- Illness or exposure during the mother’s pregnancy
Some VSDs can occur after a heart attack or trauma. This is rare.
A baby’s chances of a VSD may be higher if they have:
- A family history of septal defects
- Genetic disorders such as Down syndrome, DiGeorge syndrome or Turner syndrome
Factors that increase risk based on the mother include:
A small VSD may not cause symptoms. Larger VSD may cause:
- Difficulty feeding or sweating while feeding
- Poor growth
- Fast breathing
- Breathing problems during activity
The doctor will ask about your baby’s symptoms and past health. A heart murmur may be heard during the physical exam. The doctor may suspect a heart issue based on symptoms and the murmur.
Tests may include:
- Echocardiogram —to confirm diagnosis
- Cardiac catheterization —to look at the heart and blood supply (not used for everyone)
- MR angiography —to look for the VSD
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Treatment depends on the size of the hole and the problems it's causing. Smaller holes may not need to be treated. They may shrink or close on their own.
Larger holes put an extra workload on the heart. It also causes higher blood pressure in the arteries of the lungs. These problems can lead to heart failure and lung damage. If your baby has these problems, they will need to be treated. A larger hole can be closed with surgery.
A VSD is treated with one or more of these:
Medicines can delay the need for surgery for severe VSD. They can ease symptoms of heart failure. It may be used until the child is ready for surgery.
If your baby has symptoms of heart failure, medicines will:
- Relax the blood vessels
- Help the heart pump more effectively
- Lessen the work load on the heart
- Remove excess fluid from the body
- Lower blood pressure
In cases of VSD in which a child fails to gain weight, extra nutrition may be needed. This consists of high-calorie formulas, breast milk supplements, and tube feedings.
Surgery is often advised to fix large VSDs that cause problems or that haven’t closed by 1 year of age. Having surgery also lowers the risk of other heart-related problems in the future. The hole is fixed with a patch. Over time, the heart lining will grow over it. Options include:
- Open—The chest is opened to gain access to the heart. Once the hole is found it's covered with a patch. This is the most common method. It takes longer to get better with an open procedure.
- Percutaneous—A tube is threaded through a blood vessel in the thigh. It's passed up to the heart. Once there, a patch is passed, then placed. The patch will seal the hole. This method uses a small incision to get to the blood vessel.
Most VSDs will close on their own. If there are no signs of heart failure, the best treatment may be to wait. Regular check-ups will make sure complications do not arise.
Some children with severe VSD may need to limit certain activity.
Long Term Care
VSD will need to be watched throughout life. How often depends on the size of the hole, if it was fixed, or if there are any lasting problems. This may involve:
- An exam with a heart specialist—every 1 to 5 years
- Regular heart testing
- Changes to their treatment plan
There is no way to prevent VSDs since the cause is unknown.
American Heart Association
Family Doctor—American Association of Family Physicians
Canadian Adult Congenital Heart Network
Heart and Stroke Foundation
Facts about ventricular septal defect. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html. Updated May 30, 2018. Accessed July 25, 2018.
Ventricular septal defect. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T116076/Ventricular-septal-defect. Updated June 16, 2017. Accessed July 25, 2018.
Ventricular septal defect (VSD). American Heart Association website. Available at: https://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Ventricular-Septal-Defect-VSD_UCM_307041_Article.jsp. Updated March 20, 2018. Accessed July 25, 2018.
Ventricular septal defect (VSD). Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/ventricular-septal-defect-vsd. Updated November 2016. Accessed July 25, 2018.
Ventricular septal defect (VSD). UCSF Pediatric Cardiothoracic Surgery website. Available at: https://pediatricct.surgery.ucsf.edu/conditions--procedures/ventricular-septal-defect.aspx. Accessed July 25, 2018.
Last reviewed May 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 7/25/2018