Ventricular
Septal Defect
What is Ventricular Septal Defect?
 Ventricular
Septal Defect (VSD) is a hole in the wall (called the septum)
that separates the right and left ventricles. When the left
ventricle contracts, in addition to sending blood out the
aorta, it sends oxygenated blood through the defect to the
right ventricle. In the right ventricle, this oxygenated blood
mixes with the normal unoxygenated blood coming back from
the body and then it is all pumped to the lungs. This results
in more blood than normal being pumped to the lungs and in
turn more blood than normal returning from the lungs to the
left atrium and left ventricle. If the hole is more than small,
then this increase in blood returning to the left
atrium and left ventricle causes these chambers to enlarge
and work harder than normal. If the enlargement is significant,
then the left ventricle may not function efficiently and blood
can back up into the lungs. This may lead to signs of congestive
heart failure. In addition, large Ventricular Septal Defects
can lead to increased blood pressure in the arteries in the
lungs (called Pulmonary Hypertension) and may eventually lead
to damage in the small arteries in the lungs.
What are the warning signs and symptoms of Ventricular
Septal Defect?
There are often no obvious signs or symptoms of a Ventricular
Septal Defect in a newborn infant. After several days or
weeks, the following may appear and suggest the presence of
a VSD:
- Abnormal heart murmur
- Labored breathing
- Poor feeding
- Poor growth
How is Ventricular Septal Defect detected?
Often the first sign of a Ventricular Septal Defect is the
presence of an abnormal heart murmur. This often leads to
the performance of an echocardiogram, which generally will
show the precise anatomy of the defect as well as its size
and effect on the heart function.
What are the treatment options for Ventricular Septal
Defect?
Ventricular Septal Defects are small and most of these will
get even smaller or close by themselves. A medium-sized Ventricular
Septal Defect may need to be closed surgically but it is
often possible to wait several years to see if the VSD will
get smaller on its own. Small VSDs often never need
treatment. If the VSD, however, is large enough to cause the left ventricle
to be enlarged and there are no signs that the hole is getting
any smaller, surgery is generally recommended. Large Ventricular Septal Defects will require surgical closure, the timing of
which depends on the degree of symptoms. Symptoms often can
be improved by giving the infant medication such as:
- Diuretics, which decrease the
amount of fluid retention in the body by increasing urine
output
- Digoxin, which helps the heart pump
more efficiently
- After-load reducing medicines, which improve the forward
flow of blood from the left ventricle to the aorta
If, in spite of medication, the infant is still symptomatic,
then surgery will be necessary. If the symptoms are improved
but the hole is large, then a short period of observation
is possible to see if there are any signs that the hole is
getting smaller.
Recently, some Ventricular Septal Defects have been closed
in the Cardiac Catheterization Laboratory with devices that
are undergoing research, but the vast majority still require
surgical closure.
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