Ventricular Septal Defect

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, and in most cases they're 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 located in different places on the septum and can vary in size.

What Causes a Ventricular Septal Defect?

Ventricular septal defects happen during fetal heart development and are present at 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 in the heart determines what kind of symptoms it causes.

VSDs are usually found in the first few months of life by a doctor 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 causes 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.

The best way to protect the heart from endocarditis is to reduce oral bacteria by brushing and flossing daily, and visiting the dentist regularly. In general, it's not recommended that patients with simple VSDs take antibiotics before dental visits, except for the first 6 months after 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 notices a heart murmur that was not noticed earlier, you may be referred to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.

The cardiologist will do a physical 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're taking, 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. This is often the primary tool used to diagnose 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 kid or teen with a small defect that causes no symptoms might simply need to visit a pediatric 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 likely will take prescription medicines to aid circulation and help the heart work more efficiently. Medicines alone won't close the VSD, and in the rare cases when surgery wasn't done in childhood, the cardiologist will recommend fixing the hole now, either with cardiac catheterization or heart surgery.

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, and by 6 months after the surgery, the hole will be completely covered with tissue.

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

Certain types of VSDs may be closed by cardiac catheterization. A thin, flexible tube (a catheter) is inserted into a blood vessel in the leg that leads to the heart. The cardiologist guides 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.

After healing from an operation to repair the defect, a teen should have no further symptoms or problems.

What Else Should I Know?

In most cases, 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
• fever, swollen glands, or both
• increasing pain or tenderness
• pus or blood oozing from the incision
• swelling and an expanding area of redness (or red streaks) around the wound

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.

These days, having a VSD is usually nothing to worry about. Your pediatric cardiologist is very familiar with this common heart problem and understands how best to take care of it. Most people who have had a VSD can enjoy the same activities as their friends, and go on to live healthy, active lives.