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Ventricular Septal Defect

Ventricular Septal Defect

Ventricular septal defect is a hole in the wall between the right and left ventricles of the heart. This abnormality usually develops before birth and is found most often in infants.

  • The ventricles are the 2 lower chambers of the heart. The wall between them is called the septum. A hole in the septum is called a septal defect.
  • If the hole is located between the upper chambers or atria, it is called an atrial septal defect.
  • Infants may be born with either or both types of defects. These conditions are commonly known as «holes in the heart.»

Normally, deoxygenated blood from the body returns to the upper chamber of the right side of the heart called the right atrium. It passes through the tricuspid valve into the right ventricle, which pumps the blood to the lungs to absorb oxygen. After leaving the lungs, the oxygenated blood returns to the left side of the heart, to the left atrium. It then passes through the mitral valve into the left ventricle, where it is pumped out to provide oxygen to all the tissues of the body.

  • A ventricular septal defect can allow newly oxygenated blood to flow from the left ventricle, where the pressures are higher, to the right ventricle, where the pressures are lower, and mix with deoxygenated blood. The mixed blood in the right ventricle flows back or recirculates into the lungs. This means that the right and left ventricles are working harder, pumping a greater volume of blood than they normally would.
  • Eventually, the left ventricle can work so hard that it starts to fail. It can no longer pump blood as well as it did previously. Blood returning to the left side of the heart may back up into the lungs, causing pulmonary congestion, and blood returning the right side of the heart may further back up into the body, causing weight gain and fluid retention. Overall, this is called congestive heart failure.
  • If the VSD is large and surgically uncorrected, pressure can build excessively in the lungs, called pulmonary hypertension. The higher the lung or pulmonary pressure, the greater the chance of blood flowing from the right ventricle through the VSD to the left ventricle, causing deoxygenated blood to be pumped out to the body by the left ventricle, causing cyanosis (blue skin).
  • The risk for these problems depends on the size of the hole in the septum and how well the infant’s lungs function.

The ventricular septal defect may not be heard with a stethoscope until several days after birth. This is because a newborn’s circulatory system changes during the first week, with a drop in the lung or pulmonary pressure creating the greater pressure differential between the 2 ventricles, which may increase the left-to-right shunt and produce an audible murmur.

Ventricular septal defects are the most common congenital heart defects in infants

  • The condition occurs in about 25% of all infants born with a heart defect.
  • These defects are more common in premature infants.

Ventricular Septal Defect Causes

No one knows what causes ventricular septal defects, but they probably come from a malformation of the heart that occurs while the infant is developing in the womb.

  • There may be just one hole or several holes in the septum.
  • The septum itself is divided into multiple areas, including the membranous part, the muscular part, and other areas called the inlet and outlet. Any or all of these parts can have a hole.
  • The location of the hole depends on where the malformation takes place during fetal development.

The most common type of ventricular septal defect is the membranous variant. In this type, the hole is located below the aortic valve, which controls flow of blood from the left ventricle into the main artery of the body, the aorta.

Ventricular Septal Defect Symptoms

Small holes in the ventricular septum usually produce no symptoms but are often recognized by the child’s health care provider when a loud heart murmur along the left side of the lower breast bone or sternum is heard. Large holes typically produce symptoms 1-6 months after an infant’s birth. The left ventricle begins to fail, producing the following symptoms:

  • Fast breathing
  • Sweating
  • Pallor
  • Very fast heartbeatsDecreased feeding
  • Poor weight gain

When a ventricular septal defect is not detected early in life, it can cause more severe problems and more severe symptoms as time goes on. The biggest concern is development of high pressure in the lungs (pulmonary hypertension). If the ventricular septal defect is not surgically closed, irreversible pulmonary hypertension can develop, and the child may no longer benefit from surgery. The following are typical symptoms of pulmonary hypertension:

  • Fainting
  • Shortness of breath
  • Chest pain
  • Bluish discoloration of the skin (cyanosis)

The skin turns faintly bluish when the tissues are not receiving quite enough oxygen. This condition is often termed «hypoxemia» or «hypoxia.»

When to Seek Medical Care

Any of the following should be reported to your child’s health care provider:

  • Poor weight gain or slowing of weight gain in the first months of life
  • Unusual behavior
  • Any of the other symptoms noted in the previous section

An immediate visit to the nearest hospital emergency department is warranted if you notice any of the following in your infant:

  • Shortness of breath, breathing difficulty of any type, or worsening of an existing breathing problem
  • Bluish color of the skin, lips, or under the nails
  • Unusual or unexplained sweating
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Exams and Tests

If a ventricular septal defect is noted before your baby leaves the hospital, several tests may be ordered before discharge.

  • An echocardiogram (an ultrasound picture of the heart), a chest X-ray, and blood tests may be taken.
  • You will be asked to follow up with your child’s primary care provider, and you will have to watch closely for signs and symptoms that suggest congestive heart failure or hypoxia.

A ventricular septal defect is detected on physical examination by a systolic murmur audible with a stethoscope along the lower left sternal or breast bone border. It is related to the oxygenated blood “swishing” through the hole or VSD into the right ventricle.

The presence of a hole in the heart can be confirmed by echocardiogram. This painless test uses ultrasound waves to construct a moving picture of the heart. It can quantitate the size of the left-to-right shunt by enlargement of the left ventricle, pressure in the lungs, and actually estimate the degree of shunting by an empirical formula.

Chest X-ray is useful to see if the overall heart size is enlarged, and may demonstrate evidence of fluid in the lungs or pulmonary congestion. An electrocardiogram is helpful to evaluate the sizes of the left and right ventricle. If right ventricular hypertrophy is indicated, this may suggest pulmonary hypertension.

Cardiac catheterization may be performed in certain circumstances.

  • In this procedure, a very thin plastic tube called a catheter is inserted into the skin in the groin, arm, or neck (under local anesthesia with minimal pain) and advanced to the heart under X-ray observation by the cardiologist.
  • Pressures are measured inside the heart, especially if any concern was previously raised over the degree of pulmonary hypertension and therefore operability. If the lung pressures are very high and won’t drop with oxygen and additional vasodilating drugs, the patient may not be operable.
  • If additional abnormalities are possible, a dye study may be performed to visualize the anatomy of inside the heart. But the echocardiogram may accomplish this goal in the majority of patients.

Ventricular Septal Defect Treatment

In some children with ventricular septal defect, the defect will close on its own as the child grows.

Medical Treatment

If a larger ventricular septal defect is causing symptoms, your child’s health care provider may prescribe medication.

  • Which medication is prescribed depends on the severity of symptoms.
  • The goal of therapy is to reduce the symptoms of congestive heart failure, such as poor growth and development, weight loss and/or poor weight gain, excessive sweating, and fast breathing. An older patient typically develops fluid in the lungs, liver, and legs.
  • Routine antibiotic use is warranted for dental surgery and any invasive procedure if any VSD is still present after closure.

Medications

  • Vasodilators: Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers are used to decrease the work load on the left ventricle. (Lanoxin) increases the strength of the heart muscle to deal with the greater blood volume.
  • Diuretics such as Lasix(furosemide) or spironolactone help remove excess fluid from the body so the heart doesn’t have to work as hard and the patient feels much better.

Surgery

Larger ventricular septal defects do not close as the child grows. If it does not close, closing the heart surgically is necessary.

  • Surgical closure is typically done before the child begins preschool.
  • Surgery is indicated if medications do not work in the first few months or years of life, especially if the child is not growing adequately even with medications.
  • Surgery is more urgent if evidence of pulmonary hypertension has developed.
  • The most used operation involves placing a Gore-Tex patch over the hole. This prevents shunting (the movement of oxygenated blood from the left to the right ventricle).

Surgery is not usually performed in newborns because small defects will close spontaneously in 20%-25% of cases. The surgery also is more risky in the first few months of life; the risk of death from the operation is higher in the first 6 months of life.

Researchers are testing devices that cover the defect, performed in the cardiac catheterization laboratory, not by open heart surgery.

Next Steps — Follow-Up

  • Regular office visits and echocardiograms are required to continually reassess the ventricular septal defect.
  • The child’s weight and length/height will be checked often. Feeding and activity levels should be assessed routinely.
  • Routine antibiotic use is warranted for dental surgery and any invasive procedure.

Prevention

Women can do nothing during pregnancy to prevent their babies from developing a ventricular septal defect.

Outlook

During the growth of a child, the defect may become smaller and close on its own.

  • Twenty to 25% of all ventricular septal defects close by age 3 without medical intervention.
  • Children who show no symptoms and are being monitored by a primary care provider do not have to restrict their activities. Children with mild-to-moderate shunting of blood may have to reduce their levels of activity.
  • Once a defect is repaired, there are no restrictions on activity.

Several other conditions may result from ventricular septal defects.

  • Aortic regurgitation: Blood flowing backward from the aorta into the left ventricle.
  • Endocarditis: An infection of the heart valves due to abnormal blood flow. Because endocarditis is always possible, medical professionals may recommend that children with certain types of ventricular septal defects receive antibiotics before undergoing dental procedures or surgery.
  • Pulmonary hypertension: An increase in pressure in the right side of the heart and in the arteries of the lungs. This is caused by the shunting of blood from the left to the right ventricle, which increases the pressure in the right ventricle.
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For More Information

American Heart Association
National Center
7272 Greenville Avenue
Dallas, TX 75231

Web Links

Synonyms and Keywords

Sources

Authors and Editors

Author: Mark Merlin, DO, FACEP, Faculty/EMS Fellowship Director, Clinical Instructor, Department of Emergency Medicine, Morristown Memorial Hospital/Atlantic Health System.

Coauthor(s): Kathryn L Hale, MS, PA-C, Medical Writer, eMedicine.com, Inc.

Editors: Alan D Forker, MD, Program Director of Cardiovascular Fellowship, Professor of Medicine, Department of Internal Medicine, University of Missouri at Kansas City School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Jonathan Adler, MD, Instructor, Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital.

Facts about Ventricular Septal Defect

Ventricular septal defect

A ventricular septal defect (pronounced ven·tric·u·lar sep·tal de·fect) (VSD) is a birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers (ventricles) of the heart. This wall also is called the ventricular septum.

What is a Ventricular Septal Defect

A ventricular septal defect happens during pregnancy if the wall that forms between the two ventricles does not fully develop, leaving a hole. A ventricular septal defect is one type of congenital heart defect. Congenital means present at birth.

In a baby without a congenital heart defect, the right side of the heart pumps oxygen-poor blood from the heart to the lungs, and the left side of the heart pumps oxygen-rich blood to the rest of the body.

In babies with a ventricular septal defect, blood often flows from the left ventricle through the ventricular septal defect to the right ventricle and into the lungs. This extra blood being pumped into the lungs forces the heart and lungs to work harder. Over time, if not repaired, this defect can increase the risk for other complications, including heart failure, high blood pressure in the lungs (called pulmonary hypertension), irregular heart rhythms (called arrhythmia), or stroke.

Types of Ventricular Septal Defects

Ventricular septal defect

An infant with a ventricular septal defect can have one or more holes in different places of the septum. There are several names for these holes. Some common locations and names are (see figure):

  1. Conoventricular Ventricular Septal Defect
    In general, this is a hole where portions of the ventricular septum should meet just below the pulmonary and aortic valves.
  2. Perimembranous Ventricular Septal Defect
    This is a hole in the upper section of the ventricular septum.
  3. Inlet Ventricular Septal Defect
    This is a hole in the septum near to where the blood enters the ventricles through the tricuspid and mitral valves. This type of ventricular septal defect also might be part of another heart defect called an atrioventricular septal defect (AVSD).
  4. Muscular Ventricular Septal Defect
    This is a hole in the lower, muscular part of the ventricular septum and is the most common type of ventricular septal defect.

Occurrence

In a study in Atlanta, the Centers for Disease Control and Prevention (CDC) estimated that 42 of every 10,000 babies born had a ventricular septal defect. 1 This means about 16,800 babies are born each year in the United States with a ventricular septal defect. In other words, about 1 in every 240 babies born in the United States each year are born with a ventricular septal defect.

Causes and Risk Factors

The causes of heart defects (such as a ventricular septal defect) among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes. Heart defects also are thought to be caused by a combination of genes and other risk factors, such as the things the mother comes in contact with in the environment or what the mother eats or drinks or the medicines the mother uses.

Diagnosis

A ventricular septal defect usually is diagnosed after a baby is born.

The size of the ventricular septal defect will influence what symptoms, if any, are present, and whether a doctor hears a heart murmur during a physical examination. Signs of a ventricular septal defect might be present at birth or might not appear until well after birth. If the hole is small, it usually will close on its own and the baby might not show any signs of the defect. However, if the hole is large, the baby might have symptoms, including:

  • Shortness of breath,
  • Fast or heavy breathing,
  • Sweating,
  • Tiredness while feeding, or
  • Poor weight gain.

During a physical examination the doctor might hear a distinct whooshing sound, called a heart murmur. If the doctor hears a heart murmur or other signs are present, the doctor can request one or more tests to confirm the diagnosis. The most common test is an echocardiogram, which is an ultrasound of the heart that can show problems with the structure of the heart, show how large the hole is, and show how much blood is flowing through the hole.

Treatments

Treatments for a ventricular septal defect depend on the size of the hole and the problems it might cause. Many ventricular septal defects are small and close on their own; if the hole is small and not causing any symptoms, the doctor will check the infant regularly to ensure there are no signs of heart failure and that the hole closes on its own. If the hole does not close on its own or if it is large, further actions might need to be taken.

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Depending on the size of the hole, symptoms, and general health of the child, the doctor might recommend either cardiac catheterization or open-heart surgery to close the hole and restore normal blood flow. After surgery, the doctor will set up regular follow-up visits to make sure that the ventricular septal defect remains closed. Most children who have a ventricular septal defect that closes (either on its own or with surgery) live healthy lives.

Medicines

Some children will need medicines to help strengthen the heart muscle, lower their blood pressure, and help the body get rid of extra fluid.

Nutrition

Some babies with a ventricular septal defect become tired while feeding and do not eat enough to gain weight. To make sure babies have a healthy weight gain, a special high-calorie formula might be prescribed. Some babies become extremely tired while feeding and might need to be fed through a feeding tube.

References

  1. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of Congenital Heart Defects in Metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153:807-13.
Ventricular Septal Defect (VSD)

Ventricular Septal Defect

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

Ventricular Septal Defect (VSD)

Ventricular Septal Defect

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

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.

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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.

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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.

When Your Child Has a Ventricular Septal Defect (VSD)

Front view cross section of heart showing atria on top and ventricles on bottom. Ventricular septum is between right ventricle and left ventricle.

The heart has 4 chambers. A ventricular septal defect (VSD) is a hole in the dividing wall (ventricular septum) between the 2 lower chambers (ventricles) of the heart. A VSD can occur anywhere in the ventricular septum. Left untreated, this defect can lead to certain heart problems over time. But the problem can be treated.

What causes a ventricular septal defect?

A VSD is a congenital heart defect. This means it’s a problem with the heart’s structure that your child was born with. It can be the only defect. Or it can be part of a more complex set of defects. The exact cause is unknown. But most cases seem to occur by chance. Having a family history of heart defects can be a risk factor.

Why is a ventricular septal defect a problem?

Blood normally flows from chamber to chamber in 1 direction through the left and right sides of the heart. With a VSD, blood flows through the defect from the left ventricle to the right ventricle. This is called a left-to-right shunt. It causes more blood than normal to pass through the right side of the heart and lungs. It causes the left side of the heart to become enlarged (dilated). More blood than normal has to be pumped to the lungs. With a large VSD, the lungs can become filled with extra blood and fluid. When this happens, your child develops a condition called congestive heart failure (CHF). In the case of a large VSD, the extra blood flow can increase the pressure in the pulmonary arteries. These are the blood vessels leading from the heart to the lungs. Over time, this can cause more lung problems.

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What are the symptoms of a ventricular septal defect?

A child with a small or medium-sized VSD may have no symptoms. A child with a large VSD can develop CHF and will have symptoms. These can include:

Trouble breathing or rapid breathing

Trouble feeding (in babies)

Poor weight gain and growth (in babies)

Fast heart rate

Pale skin color

How is a ventricular septal defect diagnosed?

Front view cross section of heart showing ventricular septal defect (VSD) allowing blood to flow from left ventricle to right ventricle.

During a physical exam, the doctor checks your child for signs of a heart problem such as a heart murmur. This is an extra noise caused when blood doesn’t flow smoothly through the heart. If a heart problem is suspected, your child will be referred to a pediatric cardiologist. This is a doctor who diagnoses and treats heart problems in children. To check for a VSD, these tests may be done:

Chest X-ray. X-rays are used to take a picture of the heart and lungs.

Electrocardiogram (ECG). The electrical activity of the heart is recorded.

Echocardiogram (echo). Sound waves (ultrasound) are used to create a picture of the heart and look for structural defects.

How is a ventricular septal defect treated?

If your child has CHF symptoms, medicines will be prescribed, most often a diuretic or «water pill.» They can help reduce the amount of extra fluid in the lungs and ease the work of the heart.

Some VSDs may close on their own. So the cardiologist may check your child’s heart regularly and wait to see if a VSD closes.

If a VSD is large, causes severe symptoms, or doesn’t close on its own, closure is needed. VSD closure is usually done with heart surgery.

Your child’s experience: heart surgery

Heart surgery to close a VSD is done by a pediatric heart surgeon. The surgery lasts about 2 to 4 hours. It takes place in an operating room in a hospital. You’ll stay in the waiting room during your child’s surgery.

Before surgery. You’ll be told to keep your child from eating or drinking anything for a certain amount of time before surgery. Follow these instructions carefully.

During surgery. Your child is given medicines (sedative and anesthesia) to sleep and not feel pain during surgery. A breathing tube is placed in your child’s trachea (windpipe) during this time. Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. Your child is also placed on a heart-lung bypass machine. This allows blood to continue flowing to the body while the heart is stopped so that it can be operated on. An incision is made in the chest through the sternum (breastbone) to access the heart. The VSD is closed with stitches or a patch, or both. Then your child is taken off the bypass machine and the chest is closed.

After surgery. Your child is taken to a critical care unit to be cared for and monitored. Several catheters, tubes, or wires may be attached to your child. These are in place to assist the medical team in caring for your child. You can stay with your child during much of this time. He or she may remain in the hospital for 3 to 7 days. When your child is ready to leave the hospital, you’ll be given instructions for home care and follow-up.

Risks and possible complications of heart surgery

Risks and possible complications may include:

Reaction to sedative or anesthesia

Incomplete closure of the VSD, requiring more treatment

Arrhythmia (abnormal heart rhythm)

Nervous system problems, such as seizure or stroke

Abnormal buildup of fluid around the heart and lungs

When to call the healthcare provider

After heart surgery, call the healthcare provider right away if your child has:

Pain, swelling, redness, bleeding, or fluid leaking at the incision site that gets worse

A fever (ask the healthcare team what temperatures to be concerned about)

Nausea or vomiting that doesn’t go away

A cough that won’t go away

An irregular heartbeat

What are the long-term concerns?

A VSD that’s left untreated can lead to more health problems later in life. Your child is more likely to have growth problems, frequent respiratory infections, and develop disease of the blood vessels in the lungs after a year of age. Your child’s development will be watched closely.

After treatment, most children with a VSD can be active like other children.

Your child will need regular follow-up visits with the cardiologist. Your child will need less of these visits as he or she grows older.

Your child may need to take antibiotics before having any surgery or dental work for 6 months or longer after surgery. This is to prevent infection of the inside lining of the heart and valves. This infection is called infective endocarditis. Ask your child’s cardiologist about this.

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