Ventricular Septal Defect

Overview

A ventricular septal defect (VSD) is a hole in the wall (septum) that separates the lower chambers of the heart. It is often referred to as “a hole in your heart.” The hole allows blood to pass from the left side of the heart to the right side, causing oxygen-rich (red) blood to get pumped back to the lungs instead of out to the body, which makes your heart work harder.

According to the American Heart Association, congenital heart defects (present at birth) are the most common type of birth defect. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects.  

VSDs are among the most common, accounting for 20% to 30% of all congenital heart defects. The US Centers for Disease Control and Prevention (CDC) estimates that 42 out of every 10,000 babies born have a VSD.

Illustration of heart with VSD
This illustration shows a heart with a ventricular septal defect. Illustration by Steven P. Goldberg, MD
Causes of VSD

Causes of VSD

Congenital heart defects, such as VSDs, are the result of problems that occurred early in the heart's development. Although there is no direct cause for the defect, it is thought that genetics and environmental factors during the mother’s pregnancy may play a role, including drinking alcohol and using certain anti-seizure medicines. 

Though VSDs are most often present at birth, it is possible to acquire one later in life, usually after a heart attack.

The defect can occur in many different locations and can vary in size. The location and size of the hole will impact the treatment options available to your child and the decision to proceed with surgical correction.

Two images of doubly committed juxtaarterial ventricular septal defects Two images of doubly committed juxtaarterial ventricular septal defects 

VSDs also can occur in combination with other congenital heart abnormalities and is one of the four congenital heart abnormalities that make up Tetralogy of Fallot.

The hole caused by a VSD does not get bigger and sometimes will get smaller or close completely on its own without any treatment. For this reason, most doctors will not recommend immediate surgery, but will watch your baby closely and try to treat the symptoms with medication.

Symptoms of VSD

Symptoms of VSD

If your child has a VSD, he or she also will likely have a heart murmur. A smaller hole sometimes makes a louder noise than a large hole, so the murmur may get louder as the VSD closes. 

Other symptoms include:

  • Poor feeding
  • Failure to gain weight and grow properly
  • Fast breathing or breathlessness
  • Easily tired

Moderate and large VSDs may cause noticeable symptoms in your baby, including faster breathing, sweating or crying while feeding, getting too tired during attempts to feed, and gaining weight at a slower rate. These signs generally indicate that the VSD will not close by itself, and heart surgery may be needed. Medication may be prescribed to reduce your baby’s symptoms before surgery.

Unrepaired VSDs with significant mixing of blood can lead to additional heart and lung problems, including potentially life-threatening lung infections.

As your child grows older, the pressure inside the lung arteries increase. If left untreated, this can result in very low oxygen levels in the blood, which can cause your baby’s skin to have a bluish-purple color (cyanosis). This complication is usually irreversible and surgical repair cannot be performed safely in these children. 

Diagnosis and Treatment Options

Diagnosis and Treatment Options

As a first step, your child likely will undergo a chest x-ray, which may show enlargement of the heart and increased blood flow to the lungs. Your child’s doctor also may use an electrocardiogram (EKG) to diagnose a VSD. For more information on these tests, visit our common diagnostic tests page.

Computed tomographic scan of the chest revealing the ventricular septal defect (white arrow)Computed tomographic scan of the chest revealing the ventricular septal defect (white arrow)

Treatment options will depend on your child’s overall health, the size of the VSD, and to some degree, the location of the hole.

Many times, observation is the only treatment needed with regular checkups. Visits to the doctor or a heart specialist may be as infrequent as every 2 to 3 years in older children with small VSDs, to as often as weekly in babies with large VSDs.

If your baby grows well in the first few months, the VSD can be safely followed and your baby may not need early surgery. If your child will need surgery, your doctor can refer you to a cardiothoracic surgeon

Be sure to speak with your doctor about what treatment is right for your child. You can print these sample questions to use as a basis for discussion with your doctor.

Medication

If your baby has symptoms of congestive heart failure, he or she usually will be given medication. The goal is to control the symptoms of heart failure to allow the baby time to grow. In babies who aren’t gaining weight, a high-calorie formula or fortified breast milk will be added to help them grow. Sometimes babies get so worn out with feeding that a feeding tube that delivers high-calorie food into the stomach is temporarily necessary.

In the meantime, the VSD may get smaller and cause fewer problems, in which case the child will not require surgery. When the symptoms of a VSD are hard to control with medicines, or if your baby is unable to grow, surgical closure of the defect is often recommended.

Surgery

Surgical repair involves open heart surgery under general anesthesia, requiring an incision on the chest. During the operation, the cardiothoracic surgeon will use a patch to cover the hole in the septum. This patch stops oxygen-rich (red) and oxygen-poor (blue) blood from mixing together.

Very rarely, a device may be used to close a VSD in an appropriate location. This device can be placed during the open heart surgery or separately using a thin tube guided into the heart from a blood vessel in the groin. 

  • Illustration of a repaired VSD
  • Congenital patient in ICU following surgery
Recovery

Recovery

A typical stay in the hospital after surgical closure is 4 to 5 days, if there are no problems. After repair, most children go on to live healthy, productive lives.

Congenital Patient Recovering in Hospital
Reviewed by: Lauren Kane, MD and Ram Kumar Subramanyan, MD, PhD
April 2015