Ventricular septal defect

A ventricular septal defect (VSD) — sometimes referred to as a hole in the heart — is the most common congenital heart defect.

The hole between the right and left ventricles of the heart allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle, and can cause babies to be cyanotic (blue). In other patients, the connecting hole may cause too much blood flow to the lungs and damage the lung arteries.

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 health care provider listens with a stethoscope.

As the leading providers of pediatric heart care in Louisville and Southern Indiana, our cardiothoracic surgeons are experienced with successfully repairing VSDs with few or no complications. They have the skill and training to know when a VSD needs only regular monitoring and doesn’t require surgery.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute, affiliated with the University of Louisville, have the skill and experience to provide a pinpoint diagnosis and develop a customized treatment plan for you and your child.

Most kids who have had a VSD corrected go on to live healthy, active lives.

Ventricular septal defect symptoms

Whether a VSD causes any symptoms depends on the size and location of the hole. Small VSDs usually don’t cause symptoms, and might close on their own.

Older kids or teens with small VSDs usually have no symptoms other than the heart murmur. They might need to see a doctor regularly to make sure the VSD isn’t causing any problems.

Medium and large VSDs that haven’t been treated in childhood may cause noticeable symptoms. Babies may have faster breathing and get tired while trying to eat. They may start sweating or crying with feeding, and may be slower gaining weight. These signs generally indicate that the hole will not close by itself, and heart surgery may be needed. Surgery usually is done within the first three months of life to prevent other complications. A cardiologist can prescribe medicine to lessen symptoms before surgery.

What causes a hole in the heart?

Ventricular septal defects happen while the heart is developing during pregnancy. The heart develops from a large tube. The tube divides into sections that will eventually become the walls and chambers of the heart. If something goes wrong during this process, a hole can form in the wall (septum) that separates the left ventricle from the right.

In some cases, the tendency to develop a VSD may be inherited. Genetic syndromes can cause extra or missing pieces of chromosomes that can be associated with atrial septal defects (ASDs). Most VSDs, though, have no clear cause.

What complications can a VSD cause?

People born 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 always exist in our mouths, and small amounts get into the bloodstream when we chew food and brush our teeth. Brushing and flossing daily and visiting a dentist regularly can reduce bacteria in the mouth.

Diagnosing a ventricular septal defect

A pediatrician doing a routine checkup will usually find the VSD in the first few weeks of life. The doctor will hear a heart murmur, a sound distinctive for a VSD, as blood passes between the left and right ventricles.

If your child has a heart murmur, your doctor may refer you to a pediatric cardiologist, a doctor who specializes in diagnosing and treating childhood heart conditions.

The cardiologist will do an exam and take your child’s medical history. If a VSD is suspected, the cardiologist may order one or more of these tests:

  • Chest X-ray: An image of the heart and surrounding organs
  • Electrocardiogram (ECG or EKG): A record of the heart’s electrical activity; this test often is the main tool used to diagnose a VSD
  • Cardiac catheterization: Provides information about the heart’s structures, blood pressure and blood oxygen levels in its chambers; cardiac catheterization also can be performed to close certain kinds of VSDs

Repairing a ventricular septal defect

Treatment depends on a child’s age and the size, location and severity of the VSD. A child with a small defect that causes no symptoms may need to visit a cardiologist regularly to make sure that there are no other problems.

In most kids, a small defect will close on its own without surgery. Some might not close, but they won’t get any larger. Kids with small VSDs usually don’t need to restrict their activities.

Kids with medium to large VSDs likely will take prescription medicines to aid circulation and help the heart work more efficiently. Medicines alone, however, will not close the VSD. In these cases, the cardiologist will recommend fixing the hole, either with cardiac catheterization or heart surgery.

What else should I know?

If your child is having trouble breathing, call your doctor or go to the emergency department immediately. Other symptoms that may indicate a problem include:

  • A bluish color around the mouth or on the lips and tongue
  • Poor appetite or difficulty feeding
  • Failure to gain weight or weight loss
  • Listlessness or decreased activity level
  • A long-lasting or unexplained fever
  • Increasing pain, tenderness, or pus oozing from the incision

Call your doctor if you notice any of these signs in your child after closure of the VSD.

Why Norton Children’s Heart Institute?

Norton Children’s Heart Institute, affiliated with the University of Louisville, is a comprehensive pediatric heart surgery, heart failure and heart transplant program serving Kentucky, Southern Indiana and beyond.

The goal of the full-service Norton Children’s Heart Institute is to provide care for the child and the whole family. Our specialists are prepared to repair even the most complex congenital and acquired heart conditions.

Our heart team includes:

  • Pediatric cardiothoracic surgeons
  • Pediatric transplant surgeons
  • Pediatric cardiologists
    • Fetal cardiologists
    • Adult congenital heart cardiologists
    • Heart failure/heart transplant cardiologists
    • Pediatric electrophysiologists
    • Pediatric cardiac catheterization cardiologists
    • Pediatric cardiovascular anesthesiologists
    • Pediatric intensive care physicians
    • Cardiac critical care nurses
    • Critical care pharmacists
    • Family support team
    • Child life specialists
    • Rehabilitation specialists
    • Social workers
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Norton Children’s Heart Institute

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