A ventricular septal defect (VSD) is a hole in the heart that forms an abnormal connection between 2 of the heart's chambers.
There are 4 chambers in the human heart. The 2 lower chambers are called the right and left ventricles, and the upper 2 are called the right and left atria. The wall between the 2 ventricles is called the ventricular septum.
When there is a hole in the ventricular septum, oxygen-rich blood from the left ventricle flows into the right ventricle. Then it is pumped back to the lungs, even though this blood does not need oxygen. This problem makes the heart have to work harder to pump blood.
A VSD is found most often in babies. It happens before birth and is the most common birth defect of the heart. Often it is the only defect, but sometimes there are other heart defects as well. Most of the time the cause of the birth defect is not known. A gene defect or something else may keep this part of the heart from developing properly.
A VSD may be caused in adults by a heart attack. A heart attack can weaken the muscle of the septum. Blood pressure in the left ventricle breaks open the weakened septum, pushing blood into the right ventricle through the new opening.
Rarely, an injury to the heart may cause a VSD.
Septal defects vary in size and in the symptoms they cause. A small VSD usually causes no symptoms. Even if the defect is large, a baby often does not have symptoms until several weeks after birth. Some babies with a large VSD do not grow normally and may become undernourished because they do not feed well. Other symptoms include sweating, increased breathing rate, and frequent lung infections. A large VSD in small children can lead to severe heart failure. This means that the heart cannot do its proper job as a pump.
A VSD resulting from a heart attack is very serious. Symptoms caused by the VSD may include shortness of breath, fluid in the lungs and other body tissues, and low blood pressure. It can cause heart failure and death.
Your healthcare provider will listen for a heart murmur with a stethoscope. A heart murmur is an extra sound heard between heartbeats. The murmur is caused by the blood flowing abnormally through the heart. Sometimes, if the opening is very large, a murmur may not be heard.
You will have a physical exam, and the following tests may be done:
In addition to making pictures of the heart, an echocardiogram can show if there is increased blood pressure in the lungs. Catheterization may be used to confirm the diagnosis and to make sure there are no other heart problems. It can also be used to repair the heart.
A small VSD usually does not cause any problems and seldom needs treatment. Small VSDs may close on their own during the first years of childhood. The smaller the defect, the greater the chance that it will close on its own. People with a small VSD may lead normal lives.
Medium and large ventricular septal defects may need to be fixed with surgery or heart catheterization. The VSD is closed by sewing a patch of a special material (Dacron) over the defect. This treatment helps prevent problems later in life, including heart failure and high blood pressure in the lung arteries.
When a heart attack causes a septal defect, the attack can weaken the septal muscle so much that it cannot hold the stitches that would be used to patch the defect. This makes the surgery quite risky. If other kinds of treatment can control heart failure until about 2 weeks after the heart attack, the septum will recover enough to hold the stitches, and there is a greater chance that the surgery will be successful.
When surgical repair of a VSD is not an emergency, the operation carries very little risk.
Often, if the VSD is small, it will close on its own. If a large VSD is not repaired, a child may have trouble growing. The child may have signs and symptoms of heart failure--for example, breathing problems.
Children whose VSD is repaired before they are 2 years old usually do well. Older children and young adults may still have some problems with how their heart works after the defect is repaired. These problems, which include abnormal heart rhythms and a slightly reduced pumping ability of the heart, are usually not serious and may be treated with medicine.
Without surgery, people who develop a VSD after a heart attack have a high risk of death.
