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Children’s heart conditions can’t be prevented, but a lot can be done to improve and often completely repair their hearts at any age. Thanks to advanced technology and the pediatric heart experts at the Nemours Cardiac Center (based at Nemours/Alfred I. duPont Hospital for Children), most children born with a heart problem — even newborns only hours or days old — can be quickly diagnosed and treated right when it matters the most. At the Cardiac Center, we specialize in early detection and repair of congenital heart defects (also often called, “congenital heart disease”).
If your child’s been diagnosed with a ventricular septal defect (or “VSD,” for short), the most common congenital heart defect, we’re here to ease your concerns, answer your questions, and give your child the best possible chance for a healthy future.
A ventricular septal defect (VSD) is a hole in the wall (the ventricular septum) between the right and left ventricles. This hole results in blood moving from the left ventricle (which pumps blood out to the body) into the right ventricle (where it’s pumped to the lungs).
This causes too much blood flow to the lungs and two main problems:
- The excess blood has to be pumped again by the heart to make it out to the body, which forces the heart to work harder than it should.
- The blood vessels in the lungs respond to the excess blood flow by tightening, which — if left untreated — may cause high blood pressure in the lungs (this is called “pulmonary hypertension”). The amount of blood moving from the left ventricle to the right ventricle and then to the lungs is determined by the position and size of the ventricular septal defect. A larger VSD usually allows more blood flow and will cause symptoms sooner.
Types of Ventricular Septal Defects
There are multiple types of ventricular septal defects:
Conoventricular VSD (also called a “perimembranous VSD”) is the typical, simple ventricular septal defect. It isn’t typically associated with other forms of congenital heart disease. These VSDs are located underneath the tricuspid valve (the valve connecting the right atrium, where blood returns from the body) and the right ventricular (where the blood is pumped out to the lungs). Although the size of a conoventricular VSD is primarily what determines how much blood flows across it, parts of the tricuspid valve may partially block the hole and make it behave as if it were smaller than it actually is. These parts of the tricuspid valve are important because they may also contribute to the VSD closing on its own as the child grows.
The smaller the ventricular septal defect (VSD), the more likely it may close on its own. But the likelihood of closure decreases as children get older. Of the VSDs seen in 1-month-olds, 80 percent will close. But 1 year old, only 25 percent of them will close.
Muscular VSD is a hole located in the muscular portion of the septum, relatively distant from the valves leading into and out of the heart. As with conoventricular ventricular septal defects, the amount of blood flow moving across the VSD and, therefore, the severity of symptoms, is related primarily to the size of the hole. This type of VSD has the highest chance of spontaneous closure (closing on its own) so it requires less surgery.
Conoseptal VSD is a hole located in the conoseptal portion of the ventricular septum, close to the aortic valve. This type of VSD has almost no chance for spontaneous closure, so children usually need surgery to repair it.
Atrioventricular canal type VSD is a hole located in the upper portion of the ventricular septum. Often, this type of VSD is associated with a large ASD as well as deformed atrioventricular valves in a complex type of congenital heart disease known as “complete common atrioventricular canal defect”. This type of VSD has no chance of closing on its own, so children will need surgery using patch closure (closing the hole with a patch).
Malalignment VSD is caused by the malalignment (incorrect alignment) of the conoseptal portion of the ventricular septum (the part of the septum which connects to the underside of the valves, results in a malalignment VSD. This type of VSD causes one of the most common forms of congenital heart disease known as “tetralogy of Fallot”. Malalignment in the other direction occurs in cases of interrupted aortic arch. This type of VSD doesn’t close on its own, so children will need surgery.
How Does the Heart Normally Work?
When your child has a congenital heart defect, there’s usually something wrong with the structure of the heart. In order to understand your child’s condition, it can help to know how the heart should work normally.
Learn More About Normal Cardiac Anatomy »
Nemours’ experts at KidsHealth.org also offer these helpful resources to help both you and your child understand how the heart works:
A ventricular septal defect (VSD) may be diagnosed at any age, but are usually diagnosed in the first few years of life.
Newborns with large VSDs may develop heart failure symptoms including:
- rapid breathing
- rapid heart rate
- difficulty feeding and poor weight gain (also known as “failure to thrive”)
Later diagnosis usually happens when a caregiver hears a heart murmur during a physical exam. We can usually diagnose VSDs using an echocardiogram (or “echo”). An echo is a completely safe and painless test that uses ultrasound (sound waves) to build a series of pictures of the heart.
Children usually don’t need any other tests, unless they’re diagnosed in the school age years or older. Older children may need a cardiac catheterization to assess the amount of excess blood flow to the lungs and whether the lungs have developed high blood pressure (“pulmonary hypertension”). Catheterization involves inserting a thin plastic, flexible tube (called a “catheter”) into an artery and vein that lead to the heart. Cardiac catheterization is done under sedation with local anesthesia or under general anesthesia, depending on your child’s age and condition.
If left alone, ventricular septal defects may cause multiple problems, including:
- heart failure (due to too much blood being pumped by the heart)
- high blood pressure in the lungs (“pulmonary hypertension”) because of too much blood flow in the lungs
- risk of infections in the heart (called “endocarditis”) as a result of abnormal blood flow through the hole
Although some ventricular septal defects may close spontaneously (on their own) not all children can wait long enough for them to close.
The timing of surgery depends on the size of the hole and the severity of the symptoms. Large holes that cause symptoms in newborns may need to be closed soon after birth (in the first few months). Large holes that aren’t causing symptoms are usually closed within the first year in order to prevent complications. With smaller holes (especially in the muscular position), it may be possible to wait longer for possible closure.
Our Nemours Cardiac Center heart surgeons close most ventricular septal defects using open-heart surgery and a patch.
The patch may be of multiple materials, including:
- from the patient’s own tissue (usually the sac around the heart, called the “pericardium”)
- tissue from the sac around the heart of a cow (called the “bovine pericardium”)
- human tissue (called a “homograft”)
- artificial tissue such as polytetrafluoroethylene (“PTFE” or Gore-Tex)
- woven tissue (Dacron)
All of these options are safe and work well. Your child’s heart surgeon will determine, usually in the operating room, the patch that will work best for your child.
Some ventricular septal defects (especially muscular VSDs), may be closed using a cardiac catheterization procedure. The catheter technique involves closure of the ventricular septal defect (VSD) with a synthetic device that plugs the hole. The device is introduced through a heart catheter, which is passed through a vein in the leg that leads up to the heart. Initially, the device is held in place by the natural pressures created within the ventricles. Over time, the device acts as a framework over which normal tissue grows.
Children who have their ventricular septal defect (VSD) repaired early in life shouldn’t need any further surgeries. They should also be able to exercise and function, day-to-day, like any other child over in the long term.
If your child has a ventricular septal defect, know that at the Nemours Cardiac Center we’re here to give your child the very best, most comprehensive and compassionate care. Our goal is to guide your family, from start to finish, through your child’s heart defect journey — and to help your child live the healthiest, most fulfilling life possible.
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Information for Patients
Outpatient Services and Inpatient Units: (302) 651-6660
After 5 p.m. and Weekends:
Cardiac Intensive Care Unit: (302) 651-6644
General Inpatient Unit, 2B: (302) 651-6690