What is Ventricular Septal Defects (VSD)?

A ventricular septal defect (VSD) is a hole between the right and left pumping chambers of the heart. VSDs are the most common type of congenital heart disease other than bicuspid aortic valve. They are classified by size, number and location on the ventricular septum and can be associated with other congenital heart diseases and genetic conditions.

Effects and Symptoms

This hole between the lower chambers of the heart allows blood to move between the pumping chambers of the heart. Most commonly, blood moves from the left ventricle through the hole to the right ventricle. This is called a “right to left shunt”.

The effects of a VSD depend on the amount of blood that flows through the defect/s. Small holes may be of no consequence, causing no symptoms and can spontaneously close with time. Large or numerous holes can cause too much blood flow from the left to the right side of the heart and to the lungs. This can cause both short and long term consequences.

Diagnosis

VSDs can be found incidentally in a healthy child during a visit to a doctor when a murmur is heart on the chest. 

Large VSDs can cause symptoms of congestive heart failure such as poor growth, feeding difficulties and trouble breathing. These are typically observed at 6-8 weeks of age when the pressure in the lungs normally decreases allowing for more blood flow to the lungs. In these cases, a chest xray can show an enlarged heart with prominent lung vessels. An echocardiogram can provide details about the location, size and number of VSDs.

Management and Treatment

Depending on its size and location, small VSDs can close spontaneously or get smaller with age. If the defect remains clinically insignificant, there is no need to treat it with medications or surgery. 

Symptoms of congestive heart failure are treated with medications to control fluid retention, support the heart function and high caloric diet for good nutrition prior to surgical treatment.

Clinically significant VSDs are closed surgically. Some muscular VSDs can be closed with a device introduced through cardiac catheterization. 

In the absence of other heart disease, there is no need for exercise restrictions or long term medications for children whose VSDs have spontaneously closed or surgically repaired.

Surgery

Sometimes a patient with a VSD may need a pulmonary artery band at first. Surgically placing a band on the pulmonary artery is a way to restrict blood flow to the lungs until the time comes when the VSD can be repaired. 

VSDs are repaired through open heart surgery using stitches or a patch of material to close the defect.

Adult and Adolescent Management

Older children and adults with unrepaired large VSDs can have long term consequences on the lungs. Pressure in the lungs increases over time due to the chronic excessive blood flow returning to the right side of the heart. Elevated pressures in the lungs cause elevated pressures in the right side of the heart. This can cause oxygen-poor blood or “blue blood” to mix with oxygen-rich or “red blood” on the left side of the heart, decreasing the oxygen delivered to the rest of the body. Decreased oxygen content in blood delivered to the body can be seen as cyanosis or a blue discoloration of the lips and nailbeds. This can be more evident during exercise and activity.