Ventricular Septal Defect

A ventricular septal defect (VSD) is a hole in the heart. This hole is located in the wall (septum) between the bottom chambers of your heart (ventricles). This is something you are born with. It is often found during the first couple months of life during a routine exam. The size and location of the hole will determine whether an individual experiences symptoms of VSD. Most teens with VSD probably do not remember having a VSD. It either goes away on its own or is discovered so early in childhood that there is no memory of any surgery or recovery.

Your heart is made up of four chambers: the right and left top chambers of the heart(atria) and the right and left ventricles. Your heart and all of your blood vessels are called the circulatory system.

Blood from the body is returned to the right atrium. This acts like a holding tank and pumps blood into the right ventricle. The right ventricle then pumps blood through the lungs. In the lungs, the blood picks up oxygen from the air in your lungs and leaves behind carbon dioxide. This blood from the lungs then empties into the left atrium. This is also like a holding tank. Blood is then pumped into the left ventricle. The large, muscular left ventricle then pumps blood to the rest of the body.

With a VSD, the normal circulation is altered. Some blood low in oxygen from the right ventricle is mixed with oxygenated blood in the left ventricle. If the VSD is large enough, you can get the symptoms described below.

SYMPTOMS

Small VSDs often do not cause problems. The only symptom may be the murmur heard when a caregiver listens to the heart. Regular follow up with a caregiver however is needed.

Moderate and large VSDs may cause some symptoms. These may include:

  • Shortness of breath.

  • Poor appetite.

  • A feeling of tiredness or weakness that is greater during exercise.

  • Trouble gaining weight.

Improvements in medication allow most individuals to be treated long before the VSD ever causes physical symptoms.

DIAGNOSIS

Your caregiver may perform tests to determine what is wrong. Tests may include:

  • A chest X-ray. This produces a picture of the heart and surrounding area.

  • An electrocardiogram (EKG). This test records the electrical activity of the heart.

  • An echocardiogram (echo). This uses sound waves to create a picture of the heart.

  • A cardiac catheterization. This procedure provides information about the heart structures as well as blood pressure and oxygen levels within the heart chambers.

TREATMENT

Once an individual is diagnosed with a VSD, treatment will depend on:

  • Age.

  • The size of the hole.

  • Where the hole is located .

VSDs do not enlarge with time. They may close by themselves without treatment or stay the same. The following are some treatments or suggestions:

  • A child or teen with a small defect that causes no symptoms may simply need to be regularly examined by a heart doctor specializing in children (pediatric cardiologist). This is to make sure that there are no problems.

  • Usually there are no activity limitations for individuals with a small VSD.

  • For individuals with medium to large VSDs, surgery may be necessary to close the defect. In most cases, this surgery takes place in young children within the first 2 years of life.

  • Sometimes surgery for a ventricular septal defect is done during adolescence. Until VSDs are corrected, some individuals with larger VSDs may need to take medication to help the heart pump more efficiently or to help the body get rid of extra fluids. VSD surgery involves making a cut in the chest so a surgeon can stitch the hole closed or sew a patch of surgical material over the defect. The tissue of the heart eventually heals over the patch or stitches. By 6 months after the surgery, the hole will be completely covered with tissue.

  • Instead of surgery, some individuals with VSDs may have a non-open surgery repair of the VSD (percutaneous repair). A thin, flexible tube (catheter) with a closure device is inserted into a blood vessel. A surgeon then guides the catheter into the heart and inserts the device to close off the VSD permanently.

  • After healing from surgical or percutaneous closure, teens with VSDs are considered cured. They should have no further symptoms or problems.

  • Individuals who have their VSDs corrected may need to take antibiotics for 6 months to protect against infective endocarditis. This is an infection of the inner surface of the heart. Talk to your surgeon to see if this applies to you. Six months to 1 year after surgery, most VSD patients are considered cured and usually no longer need to worry about infective endocarditis.

HOME CARE INSTRUCTIONS

  • Some individuals with VSDs or repaired VSDs need to take antibiotics before having dental work or other surgical procedures. This is called prophylactic antibiotic treatment. These drugs help to prevent infective endocarditis. Antibiotics are only recommended for individuals with the highest risk for developing infective endocarditis. Let your dentist and your caregiver know if you have a history of any of the following so that the necessary precautions can be taken :

  • A VSD.

  • A repaired VSD.

  • Endocarditis in the past.

  • An artificial (prosthetic) heart valve.

  • Avoid body piercings. This increases the possibility that bacteria can get into the body and infect the heart. Body piercing puts individuals with VSDs at risk of developing infective endocarditis. If you are considering a piercing and you have a heart defect, talk to your caregiver before you do it.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You are eating poorly.

  • You have shortness of breath.

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

  • You have feelings of depression or unease (malaise).

  • You have poor or sudden weight gain.