Ventricular septal defect (VSD)

Some ventricular septal defects (VSDs) are diagnosed soon after a child is born. However, ventricular septal defects (VSDs) may not be diagnosed until later in life. Sometimes a ventricular septal defect (VSD) can be detected by a pregnancy ultrasound before the baby is born.

If ventricular septal defect is present, the health care provider may hear a whooshing sound (heart murmur) when listening to the heart with a stethoscope.

Tests that are done to help diagnose ventricular septal defect include:

• Echocardiogram. This is the most commonly used test to diagnose a ventricular septal defect. Sound waves are used to create pictures of the heart in motion. An echocardiogram can show how well blood is moving through the heart and heart valves.
• Electrocardiogram (ECG). This quick and painless test records the electrical activity of the heart. It can show how fast or how slowly the heart is beating.
• Chest X-ray. A chest X-ray shows the condition of the heart and lungs. It can tell if the heart is enlarged and if the lungs have extra fluid.
• Pulse oximetry. A sensor placed on the fingertip records the amount of oxygen in the blood. Too little oxygen may be a sign of a heart or lung problem.
• Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or arm and guided through the blood vessels into the heart. Through cardiac catheterization, doctors can diagnose congenital heart defects and determine the function of the heart valves and chambers.
• Cardiac magnetic resonance imaging (MRI) scan. Magnetic fields and radio waves are used to create detailed images of the heart. A health care provider might request this test if more information is needed after an echocardiogram.
• Computerized tomography (CT) scan. A series of X-rays create detailed images of the heart. It may be done if an echocardiogram didn't provide as much information as needed.

Ventricular septal defect treatment may include regular health checkups, medications and surgery. Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. Some small VSDs close on their own.

If the VSD is small, regular health checkups may be all that's needed. Medication may be prescribed to treat any symptoms.

Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow. Some babies may require medication to help treat heart failure symptoms.

Medications

Medications won't repair a ventricular septal defect, but they may be given to treat symptoms or complications. The specific medications used depend on the symptoms and their cause. Water pills (diuretics) are used to decrease the amount of fluid in the body and reduce the strain on the heart.

Oxygen may be given.

Surgeries or other procedures

Surgery may be done if the VSD is medium or large or if it's causing severe symptoms. Babies who need surgery to repair the hole often have the procedure in their first year.

A surgeon may close small ventricular septal defects if their location in the heart could cause damage to nearby structures, such as the heart valves.

Surgeries and procedures to repair a ventricular septal defect include:

• Open-heart surgery. This is the preferred procedure for repairing most ventricular septal defects. A surgeon uses a patch or stitches to close the hole between the lower heart chambers. This type of VSD surgery requires a heart-lung machine and an incision in the chest.
• Catheter procedure. Some ventricular septal defects can be repaired using thin, flexible tubes (catheters) without the need for open-heart surgery. The health care provider inserts a catheter into a blood vessel, usually in the groin, and guides it to the heart. A small device is inserted through the catheter to close the hole.

After ventricular septal defect surgery, regular checkups are needed for life, ideally by a heart doctor (cardiologist). Checkups often include imaging tests to determine how well surgery is working.

Lifestyle changes may be recommended to keep the heart healthy and prevent complications.

• Prevent heart infections. Sometimes heart problems can increase the risk of infection in the lining of the heart or heart valves (endocarditis). Antibiotics may be recommended before dental procedures if you have low oxygen due to a large VSD. The medicines may also be recommended if you have a surgically repaired VSD with a patch that still has some blood flow across it. Antibiotics may also be recommended if you recently had catheter-based VSD repair.

  For most people with a ventricular septal defect, good oral hygiene and regular dental checkups can prevent endocarditis.

• Ask about exercise restrictions. Many people with a ventricular septal defect can lead healthy, active lives without restrictions. But some may need to limit exercise and sports activities. Ask your health care provider which sports and types of exercise are safe for you or your child. People with Eisenmenger syndrome should avoid strenuous physical activity.

• Talk to your provider before getting pregnant. If you have a ventricular septal defect and are pregnant or hoping to be, talk to your health care provider about the possible risks and complications. Together you can discuss and plan for any special care needed during pregnancy.

  A small VSD or a repaired one without complications doesn't pose a large additional pregnancy risk. However, a large, unrepaired VSD, irregular heart rhythms, heart failure or pulmonary hypertension increase the risk for pregnancy complications.

  Pregnancy is considered very high risk for those with Eisenmenger syndrome and is not recommended.

You may find that talking with others who've experienced similar events or situations can be helpful. Support groups offer parents, families and caregivers a place to share concerns and find encouragement. Ask your health care provider if there are any support groups in your area.

If a baby has a large ventricular septal defect, it will likely be diagnosed soon after birth. Sometimes it's diagnosed before birth during a pregnancy ultrasound.

If you think your child has a VSD that wasn't recognized at birth, make an appointment with your child's health care provider. You may be referred to a heart doctor (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

Write down the following and bring the notes with you to the appointment:

• Any symptoms, including any that may seem unrelated to heart problems.
• When the symptoms started and how often they occur.
• Important medical information, including a family history of heart problems present at birth.
• All medications, including those bought without a prescription. Include dosages.
• Questions to ask the health care provider.

Ask a family member or friend to come with you to the appointment, if possible. Someone who goes with you can help remember what the care provider says.

Preparing a list of questions can help you and your health care provider make the most of your time together. Questions to ask the provider at the first appointment include:

• What is likely causing these symptoms?
• Are there other possible causes?
• What tests are needed? Is any special preparation needed?
• Should a specialist be consulted?
• Are there any brochures or other printed material I can take home with me? What websites do you recommend?

Questions to ask if you are referred to a heart doctor (cardiologist) include:

• How large is the hole in the heart?
• What is the risk of complications from this condition?
• How can we monitor for complications?
• What treatment do you recommend?
• How often should we schedule follow-up exams and tests?
• What is the long-term outlook for this condition?
• Are there any activity restrictions?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask many questions, including:

If you are the person affected:

• What are the symptoms?
• When did the symptoms begin?
• Have the symptoms gotten worse over time?
• Are you aware of heart problems in your family?
• Are you being treated, or have you recently been treated, for other health conditions?
• Are you planning to become pregnant?

If your baby or child is affected:

• Does your child tire easily while eating or playing?
• Is your child gaining weight?
• Does your child breathe rapidly or run out of breath when eating or crying?
• Has your child been diagnosed with other medical conditions?