Ventricular Septal Defect (VSD)

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A ventricular septal defect (VSD) is a type of "hole in the heart." It is a congenital (present at birth) heart problem in which there is an opening in the ventricular septum, the wall of tissue that separates the two lower chambers of the heart. A VSD can allow blood to flow, or shunt, abnormally between the heart's lower two chambers, which impacts its ability to pump effectively.

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Ventricular Septal Defects (VSDs) can vary in size and location on the ventricular septum, which will make a difference in what symptoms a child experiences and what treatment is most effective. VSDs are the most common form of congenital heart defects, occurring in about 20 percent of cases. They usually are treated successfully with few, if any, complications. In rare cases, ventricular septal defects can be related to other congenital heart and vascular defects (including atrioventricular canal, tetralogy of Fallot, and truncus arteriosus) so expert treatment is required. With extensive experience in treating patients with VSDs, the Herma Heart Institute's pediatric cardiologists and heart surgeons offer individualized care and exceptional outcomes, including 100 percent survival for children undergoing surgery. Our program consistently outperforms when it comes to congenital heart surgery outcomes for even the most complex types of heart disease, as evaluated by the Society of Thoracic Surgeons. Learn more about our heart surgery outcomes.

Note: Data is provided from the Society of Thoracic Surgeons (STS). New data is not available beyond June 2019, as STS is in the process of refining their reporting methodologies. Hospitals are also limited in providing updated data due to the demands of the COVID-19 pandemic.

What is Ventricular Septal Defect (VSD)?

When a child's circulation flows normally, oxygen-poor (blue) blood enters the heart's right atrium from the body, flows to the right ventricle, and then is pumped into the lungs to receive oxygen. From the lungs, the oxygen-rich (red) blood flows into the left atrium, passes into the left ventricle, and then is pumped out to the body through the aorta.

With VSDs, there is hole between the hearts' two lower chambers that allows oxygen-rich (red) blood from the left side of the heart to combine with oxygen-poor (blue) blood that is headed from the heart's right side for oxygenation in the lungs. With too much blood leaking to the right side and getting pumped into the lungs, the heart works harder and much less efficiently.

Causes of ventricular septal defects

VSDs form early in pregnancy as the fetus develops and are present at birth. Sometimes s genetic syndrome may increase a fetus's tendency to develop a VSD. For the most part, however, there is no clear cause for ventricular septal defects.

Why is Ventricular Septal Defect (VSD) a concern?

Small ventricular septal defects may not cause noticeable symptoms or health concerns. Large openings, however, can cause your child to breathe quicker and harder than normal. In babies, breathing problems can make feeding difficult and they may not grow at a normal rate. High blood pressure is another concern, often occurring in the blood vessels in the lungs and eventually causing permanent damage. People with ventricular septal defects also are at higher risk throughout their lives of developing endocarditis, an infection of the inner surface of the heart. Endocarditis happens when bacteria in the bloodstream infect the lining of the heart.

Symptoms of ventricular septal defects

Many children with small VSDs show no symptoms and appear healthy. If the VSD is large, however, it can let quite a bit of blood pass through to the right side of the heart and into the lungs, causing both the heart and lungs to overwork. The most common symptoms of VSD include:

• Heart murmur
• Rapid breathing
• Shortness of breath
• Difficulty feeding for babies
• Poor growth
• Fatigue
• Sweating

The symptoms of a ventricular septal defect are common to other medical conditions or heart concerns. Always consult with your child's doctor for a full assessment and diagnosis.

How is a ventricular septal defect diagnosed?

VSDs are usually discovered within a few weeks of birth when your child's physician hears a heart murmur during a routine checkup. A heart murmur is the sound caused when blood flows through the opening from the left side of the heart to the right. Murmurs related to VSDs sound different than those associated with other causes, so your doctor will likely identify it right away.

To confirm the diagnosis, your doctor may refer you and your child to a pediatric cardiologist – a specialist in diagnosing and managing the care of children with congenital heart defects and possible related heart concerns that could develop later. The cardiologist will ask about your family health history, perform a physical examination and listen to your child's heart and lungs. Other tests may also be used to help with the diagnosis, including the following:

• Chest x-ray – to look for areas of enlargement in the heart due to the handling of larger amounts of blood flow than normal and to assess for changes in the lungs, which may be working harder as a result.
• Electrocardiogram (ECG or EKG) - a test that assesses the electrical activity of the heart, shows irregular heart rhythms (arrhythmias or dysrhythmias), and indicates signs of heart muscle stress.
• Echocardiogram (echo) - a test to evaluate the structure and function of the heart, which will help determine how large the opening is and how much blood is passing through it.
• Cardiac catheterization – if the other tests don't provide enough information, a cardiac catheterization is an invasive test that can be conducted to provide specific details about the structures inside the heart. 

Treatment for ventricular septal defects

Small VSDs may ultimately close on their own, so require no treatment other than monitoring through regular checkups. There are no medications or other approaches to speed the closure process, however.

If a VSD is large or causing symptoms that are not going away, heart surgery is usually recommend to prevent complications later in life. When possible, surgery happens within the first three months after birth to minimize the symptoms, but it can be delayed depending on a baby's needs. Medications can be prescribed before surgery to lessen symptoms, if necessary. During surgery, stiches or a special patch are used to close the VSD completely. The procedure may be performed in the operating room or by cardiac catheterization, depending on your child's needs. Recovery from VSD surgery is typically rapid and uneventful.

Medications and prevention practices may be included in treatment to lessen the risk of bacterial endocarditis infection.

Long-term outlook for children with VSD

For most children with a VSD, the condition will have little, if any, long-term effects other than the need for regular checkups with your child's cardiologist to confirm that the heart continues to function well. The cardiologist may prescribe antibiotics to prevent bacterial endocarditis for a time following treatment, but usually no medications or additional surgeries will be required as your child gets older.

Always consult your child's physician for specifics regarding your child's future needs and outlook.