Ventricular Septal Defect
When you learn before birth or soon after birth that your child has a ventricular septal defect, also referred to as a VSD, your concern may overwhelm you. We are here to explain the condition, and describe how we can help to ensure your child’s well-being and how to treat the VSD.
You can rely on Mount Sinai’s pediatric cardiologists and cardiac surgeons. We specialize in the delicate business of treating the smallest heart to heal the VSD and restore your child’s health. And, we can advise you on the best treatment for your child.
About Ventricular Septal Defect
A ventricular septal defect (VSD) is an opening in the wall between the two lower chambers of the heart, the ventricles. Like an atrial septal defect (ASD), a VSD involves a hole, but instead of being located in the wall between the upper atrial chambers of the heart, a VSD occurs in the wall between lower ventricular chambers of the heart. The ventricles are the stronger pumping chambers of the heart. Therefore, the effects of a VSD, the timing of when it is diagnosed, and the urgency of treatment are unique to the VSD.
In normal circulation, the right side of the heart pumps de-oxygenated (blue) blood to the lungs. Then the oxygenated (red blood) returns to the left side of the heart and then gets pumped to the body.
Because there is higher pressure in the left ventricle than the right ventricle, blood flows across the hole from the left to the right side of the heart. The overall effect is that blood flows back to the lungs, where it just came from. The blood going back and forth between the heart and the lungs causes the heart to work harder than it should. The excessive blood flow to the lungs causes the symptoms of a VSD.
Symptoms
A VSD may affect your baby’s health by causing the following symptoms:
- Difficulty feeding or gaining weight
- Fast or difficult breathing
- Heart murmur
- Rapid heartbeat
Diagnosis
If your baby has a VSD, the condition may be diagnosed in utero during a regularly scheduled echocardiogram or ultrasound during your pregnancy. However, it is possible for a VSD to be missed during pregnancy as it can be a tricky diagnosis to make in a fetus. Your child’s VSD may be diagnosed at birth when a heart murmur is heard. This can also happen later in childhood.
If your child’s doctor suspects a heart condition, we may perform the following tests to diagnose a VSD:
- Physical exam—observes the pulse, blood pressure, temperature, and number of breaths your baby takes in a minute, and listens for any changes in how the heart sounds with a stethoscope
- Oxygen saturation monitor—determines how much oxygen is getting into your child’s blood
- Chest X-ray—shows the size and position of the heart
- Electrocardiogram (ECG or EKG)—checks the electrical activity which shows how the heart’s chambers and how your child’s heart is beating
- Echocardiogram—a safe, noninvasive procedure that uses high frequency ultrasound to show the structure of your child’s heart, how blood flows through the heart, and overall how your child’s heart and circulatory system are working
A heart with a ventricular septal defect may have other associated abnormalities, which our doctors will diagnose, explain to you, and treat as needed.
Treatments We Offer
Many small VSDs, and even some medium size VSDs, may get smaller or even close on their own. If that happens, your child may require no treatment.
If the VSD does not close, your child’s treatment will depend on the size of the VSD, and whether it is causing symptoms. To help your baby become big and strong enough for an operation to close the VSD, we may use the following medications:
- Diuretics—which to make your baby urinate more to help get rid of excess fluid
- Digoxin— which makes the heart beat more slowly and stronger
If your baby isn’t growing enough, we may need to supplement feeding with extra calories and nutrients. In this case, we use a feeding tube.
If the VSD is large, you may need to bring your baby to the hospital so we can adjust feeding and medication for the best possible outcome.
With large VSDs, we generally recommend closure during the first year of life, to prevent abnormal changes in the small arteries in the lungs. The more significant your child’s symptoms, the earlier we will want to close the VSD. This is most often done through open heart surgery.
Procedures we use to close your child’s VSD include:
- Surgery—a pediatric cardiac surgeon operates to repair the VSD by either:
- Placing a patch or using stitches to close the hole during open-heart surgery
- Placing a band around the pulmonary artery. We use the band if your baby is very small, if the hole is too large or complex with multiple holes, or if there other significant abnormalities. The pulmonary band restricts the amount of blood flowing to the lungs, which helps control your baby’s symptoms and gives your baby time to grow. In a second procedure, we perform a permanent repair using a patch or stitches.
- Catheterization— in some select cases, catheterization for closure may be an option. A pediatric interventional cardiologist inserts a thin tube (a catheter) through a vein or artery in the leg, and then guides it to the heart to insert a small device that closes the VSD. To guide the device, the cardiologist uses both ultrasound and X-ray.
Once your child’s VSD is repaired successfully, we recommend regularly checking in with one of our cardiologists periodically over the course of your child’s life.
Why Choose Children’s Heart Center?
Our Children’s Heart Center team of compassionate and expert professionals is experienced in diagnosing and treating congenital heart disease, including VSD, in children of all ages in utero and shortly after birth or later in life. We provide the type of personal and sensitive care you need during your pregnancy, and we are dedicated to the care of your newborn after delivery. Our staff makes sure that you understand what is going on during diagnostic tests, as well as before, during, and after any required surgery.
We also treat adults with congenital heart defects, working collaboratively with our expansive team of cardiologists.
We are here to treat your child and support you in focusing on caring for your child and the rest of your family.