Ventricular Septal Defect (VSD)

What Is a Ventricular Septal Defect?

A ventricular septal defect (VSD) — sometimes referred to as a hole in the heart — is a type of heart defect. In a VSD, there is an abnormal opening in the wall between the main pumping chambers of the heart (the ventricles).

Ventricular septal defects (pronounced: ven-TRIK-yu-lar SEP-tul DEE-fekts) are the most common congenital heart defect. Most are diagnosed and treated successfully with few or no complications.

It's pretty rare for a VSD to go unnoticed until the teenage years. This means that the chances are good a VSD is no longer causing problems for a teen.

What Happens in a Ventricular Septal Defect?

The right and left ventricles of the heart are separated by shared wall, called the ventricular septum. People with a VSD have an opening in this wall. As a result:

• When the heart beats, some of the blood in the left ventricle (which has been enriched by oxygen from the lungs) flows through the hole in the septum into the right ventricle.
• In the right ventricle, this oxygen-rich blood mixes with the oxygen-poor blood and goes back to the lungs.

The blood flowing through the hole creates an extra noise, which is known as a heart murmur. The heart murmur can be heard when a doctor listens to the heart with a stethoscope.

VSDs can be in different places on the septum and can vary in size.

What Causes a Ventricular Septal Defect?

VSDs happen as a baby's heart develops before birth. The heart develops from a large tube, dividing into sections that will eventually become the walls and chambers. If there's a problem during this process, a hole can form in the ventricular septum.

In some cases, the tendency to develop a VSD may be due to genetic syndromes that cause extra or missing pieces of chromosomes. Most VSDs, though, have no clear cause.

What Are the Signs & Symptoms of a Ventricular Septal Defect?

The size of a VSD and its location determines what kind of symptoms it causes.

Doctors usually find a VSD in a baby's first few weeks of life during a routine checkup. Most teens born with a VSD probably don't remember having it because it either goes away on its own or it was found so early in childhood that there's no memory of any surgery or recovery.

Teens who have small VSDs that haven't closed yet usually don't notice any physical signs other than the heart murmur that doctors hear. They may need to see a doctor regularly to check on the heart defect and make sure there aren't any problems.

The very small number of teens with moderate and large VSDs that haven't been treated in childhood may notice some symptoms, however. These include shortness of breath, a feeling of tiredness or weakness (especially during exercise), poor appetite, and trouble gaining weight.

Most moderate to large VSDs are treated long before they ever cause problems.

What Problems Can Happen?

Teens with a VSD are at greater risk for developing endocarditis, an infection of the inner surface of the heart caused by bacteria in the bloodstream. Bacteria are always in our mouths, and small amounts get into the bloodstream when we chew and brush our teeth.

Good dental hygiene to reduce oral bacteria is the best way to protect the heart from endocarditis. Teens with a VSD should brush and floss daily, and see their dentist regularly. In general, they don't need to take antibiotics before dental visits, except for the first 6 months after VSD surgery.

Teens who have a heart defect should avoid getting body piercings. Piercing increases the possibility that bacteria can get into the bloodstream, infect the heart, and damage heart valves. If you're considering a piercing and you have a heart defect, talk to your doctor first.

How Are Ventricular Septal Defects Diagnosed?

If your doctor hears a heart murmur that was not noticed earlier, you may go see a pediatric cardiologist (a doctor who diagnoses and treats heart problems in kids and teens).

The cardiologist will do an exam and take a medical history, asking you about any concerns and symptoms you have, your past health, your family's health, any medicines you take, and other issues relating to the heart.

If a VSD is suspected, the cardiologist may order one or more of these tests:

• a chest X-ray, which produces a picture of the heart and surrounding organs
• an electrocardiogram(EKG), which records the electrical activity of the heart
• an echocardiogram(echo), which uses sound waves to produce a picture of the heart. Often, this is the main way doctors diagnose a VSD.
• a cardiac catheterization, which provides information about the heart structures as well as blood pressure and blood oxygen levels within the heart chambers.

How Are Ventricular Septal Defects Treated?

Treatment for a VSD will depend on a patient's age, and the size of the hole and its location. There's no concern that a VSD will get any bigger, though: VSDs may get smaller or close completely without treatment, but they won't get any bigger.

A teen with a small defect that causes no symptoms might simply need to see the cardiologist regularly to make sure there are no problems. Most small defects close without surgery. And there's more good news — if you have a small VSD, you probably won't have to restrict your sports or other activities in any way.

Teens with medium to large VSDs might need prescription medicines to aid circulation and help the heart work better. Medicines alone won't close the VSD, though. In rare cases when surgery wasn't done in childhood, the cardiologist will recommend surgery now to fix the hole. Rarely, a VSD might be closed by cardiac catheterization instead.

Heart Surgery

The surgeon makes an incision in the chest wall and a heart-lung machine will maintain circulation while the surgeon closes the hole. The surgeon can stitch the hole closed directly or, more commonly, will sew a patch of manmade surgical material over it. Eventually, the tissue of the heart heals over the patch or stitches. By 6 months after the surgery, tissue will completely cover the hole.

Patients usually leave the hospital within 4 to 5 days after surgery if there are no problems.

The first few days at home after VSD surgery, your doctor will probably tell you to get lots of sleep or hang out in bed or on the couch doing quiet activities like watching TV or reading. Everyone heals differently. Your doctor will let you know when it's OK to go back to school and return to normal activities.

Cardiac Catheterization

Rarely, cardiologists may close some types of VSDs with cardiac catheterization. They insert a thin, flexible tube (a catheter) into a blood vessel in the patient's leg that leads to the heart. They guide the tube into the heart to make measurements of blood flow, pressure, and oxygen levels in the heart chambers. A special implant, shaped into two disks formed of flexible wire mesh, is positioned into the hole in the septum. The device is designed to flatten against the septum on both sides to close and permanently seal the VSD.

What Else Should I Know?

Most teens who have had VSD surgery recover quickly. But some things can be signs of a problem. Tell a parent or another adult so you can get medical treatment right away if you have:

• trouble breathing
• a long-lasting or unexplained fever
  
• increasing pain, tenderness, or pus oozing from the surgery site

You'll also want to let your parents and doctors know if you don't feel like eating or you've lost weight, as these can be signs of a problem.

Having a small VSD usually is nothing to worry about. Your cardiologist is very familiar with this common heart problem and understands how best to take care of it. After surgery, most people who had a larger VSD can enjoy the same activities as their friends, and go on to live healthy, active lives.