Ventricular Septal Defect (VSD)

Signs and symptoms of significant VSD often appear during the first weeks or months of a child's life.

Symptoms in a baby may include:

• Poor eating, failure to thrive
• Fast breathing or breathlessness
• Easy tiring

If the defect is small, symptoms may not appear until later in childhood — if at all. Signs and symptoms may vary depending on the size of the hole and other associated heart defects.

Your doctor may suspect a heart defect during a regular heart examination and hearing a murmur while listening to your baby's chest. Sometimes a small VSD is diagnosed in adulthood.

During foetal the heart develop from early on,  a VSD occurs when the muscular wall separating the heart into left and right ventricles fails to form fully.

A VSD allows oxygenated blood to be pumped back to the lungs, making the lungs congested which receive too much blood, but also depriving the body from the full flow causing shortnes of breath and fatigue.

VSDs may be various sizes, and they can be present in several locations in the wall between the ventricles. There may be one or more VSD.

A small ventricular septal defect may never cause any problems, whereas larger defects can cause a range of complications.

• Heart failure. Heart failure may develop a few weeks after birth, and is usually treated with anti-failure medications like diuretics and or Ace Inhibitors.
• Pulmonary hypertension. Increased pulmonary blood flow due to the VSD can cause high blood pressure in the lung arteries (pulmonary hypertension), in particular if there are delays in the diagnosis and treatment. Most of the time it is a transient complication which tend to resolve once the VSD is closed. In longstanding, untreated VSD, pulmonary hypertension can be a debilitating complication leading to reversal of blood flow through the hole (Eisenmenger syndrome).
• Endocarditis. This heart infection is an uncommon complication in children and more frequent in adults with undiagnosed VSD.
• Other heart problems. These include abnormal heart rhythms and valve problems.

If there is a suspected VSD, or if your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may order several tests including:

• Echocardiogram. In this test, sound waves produce a video image of the heart. Doctors may use this test to diagnose a ventricular septal defect and determine its size, location and severity. It may also be used to see if there are any other heart problems. Echocardiography can be used on a foetus (foetal echocardiography).
• Electrocardiogram (ECG). This test records the electrical activity of the heart through electrodes attached to the skin and helps diagnose heart defects or rhythm problems.
• Chest X-ray. An X-ray image helps the doctor view the heart and lungs. This can help doctors see if the heart is enlarged and if the lungs have extra fluid.
• 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.
• Pulse oximetry. A small clip on the fingertip measures the amount of oxygen in the blood.

Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. After birth, your doctor may want to observe your baby and treat symptoms while waiting to see if the defect closes on its own.

Babies who need surgical repair often have the procedure in their first year. Children and adults who have a medium or large ventricular septal defect or one that's causing significant symptoms may need surgery to close the defect.

Some smaller ventricular septal defects are closed surgically to prevent complications related to their locations, such as damage to heart valves. Many people with small VSDs have productive lives with few related problems.

Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow. Some babies may require tube feeding.

Medications

Medications for ventricular septal defect may include those to:

• Decrease the amount of fluid in circulation and in the lungs. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).
• Keep the heartbeat regular. Examples include beta blockers, such as metoprolol (Lopressor), propranolol (Inderal LA) and others, and digoxin (Lanoxin, Lanoxin Paediatric).

Procedures

Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles. If you or your child is having surgery to repair a ventricular defect, consider having surgery performed by surgeons and cardiologists with training and expertise in conducting these procedures. Procedures may include:

• Surgical repair. This procedure of choice in most cases usually involves open-heart surgery under general anaesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses a patch or stitches to close the hole.
• Catheter procedure. Closing a ventricular septal defect during catheterization doesn't require opening the chest. Rather, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart. The doctor then uses a specially sized mesh device to close the hole.
• Hybrid procedure. A hybrid procedure uses surgical and catheter-based techniques. Access to the heart is usually through a small incision, and the procedure may be performed without stopping the heart and using the heart-lung machine. A device closes the ventricular septal defect via a catheter placed through the incision.

After repair, your doctor will schedule regular medical follow-up to ensure that the ventricular septal defect remains closed and to look for signs of complications. Depending on the size of the defect and the presence of other problems, your doctor will tell you how frequently you or your child will need to be seen.

After your ventricular septal defect (VSD) is repaired, you or your child will need follow-up care throughout life for doctors to monitor your condition and check for any signs of complications.

Your doctor may suggest that you or your child have regular follow-up appointments with a doctor who specializes in congenital heart disease. In follow-up appointments, your doctor may evaluate you or your child and order imaging tests to monitor your or your child's condition.

Here are a few tips for managing your or your child's condition:

• Consider pregnancy carefully. Before becoming pregnant, talk to a doctor trained in heart conditions (cardiologist) to determine if you can undergo pregnancy safely. This is especially important if you're taking medications. It's also important to see both an obstetrician and a cardiologist during pregnancy.

Having a repaired VSD without complications or having a small defect doesn't pose an additional pregnancy risk. However, having an unrepaired, larger defect; heart failure; pulmonary hypertension; abnormal heart rhythms; or other heart defects poses a high risk to both mother and foetus. Doctors strongly advise women with Eisenmenger syndrome not to become pregnant because of the high risk of complications.

• Prevent endocarditis. You or your child usually won't need to take antibiotics before certain dental procedures to prevent an infection of the heart's inner lining (endocarditis).

However, your doctor may recommend antibiotics if you've had prior endocarditis, a heart valve replacement, if you have had a recent VSD repair with artificial material, if you still have leaks through the VSD, if the repaired VSD is next to a defect that's been repaired with artificial material, or if you have a large ventricular septal defect that's causing low oxygen levels.

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

• Follow exercise recommendations. Your doctor can advise you about which activities are safe for you or your child. If some activities pose special dangers, encourage your child to engage in other, safer activities. Keep in mind that many children with VSDs can lead healthy, fully active, productive lives.

Children with small defects or a repaired hole in the heart will usually have few or no restrictions on activity or exercise. Children whose hearts don't pump as normally will need to follow some limits. A child with irreversible pulmonary hypertension (Eisenmenger syndrome) has the greatest number of restrictions.