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 showing 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.
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)
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.
Expected outcomes: The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database shows an expected outcome of <1% mortality for isolated ventricular septal defect. Outcomes will vary across different programs. It is appropriate to inquire about the outcomes of a surgical group or surgeon during your consultation.
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.
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.