Ventricular septal defect

Definition:

Ventricular septal defect describes one or more holes in the muscular wall that separates the right and left ventricles of the heart -- the most common congenital (present from birth) heart defect.

Alternative Names:

VSD; Interventricular septal defect

Causes, incidence, and risk factors:

Before a baby is born, the right and left ventricles of its heart are not separate. As the fetus grows, a muscular wall forms to separate these lower heart chambers. If the wall does not completely form, a hole remains. This is what is known as a ventricular septal defect, or a VSD.

It is estimated that up to 0.4% of babies are born with this condition. In the vast majority (80-90%) of babies born with this condition, the hole is small. They will have no symptoms, and the hole will close spontaneously as the muscular wall continues to grow after birth.

If the hole is large, then too much blood will be pumped to the lungs, leading to congestive heart failure. These babies are often have symptoms related to the problem and may need medicine or surgery to close the hole.

As with most types of congenital heart disease, no one knows what causes VSDs. This defect often occurs along with other congenital heart malformations.

In adults, interventricular septal defects are a rare, but serious complication of heart attacks. These holes are related to the heart attack and do not result from a birth defect.

Symptoms:

shortness of breath
paleness
breathing fast
breathing hard
failure to gain weight
fast heart rate
pounding heart
sweating while feeding
frequent respiratory infections in children

Signs and tests:

A stethoscope examination (auscultation) of the heart usually reveals a loud, continuous murmur (the sound of the blood rushing across the hole).

Tests include:

a chest X-ray to see if there is a large heart with fluid in the lungs
an ECG shows signs of an enlarged left ventricle
an echocardiogram -- definitive diagnosis
rarely a cardiac catheterization

Treatment:

In mild cases, no treatment is needed, although the baby should be closely followed to ensure that the hole closes properly as the child grows. With congestive heart failure, medications, such as digitalis (digoxin) and diuretics, may be prescribed to control symptoms.

If symptoms persist despite optimal medical management, surgical closure of the defect with a Gore-tex patch is indicated. Treatment of asymptomatic defects is controversial so it should be carefully discussed with your health care provider.

Expectations (prognosis):

Many small defects will close on their own. For those defects that do not spontaneously close, the outcome is good with surgical repair. Complications may result if a large defect is not treated.

Complications:

congestive heart failure
infective endocarditis (bacterial infection of the heart)
aortic insufficiency (leaking of the valve that separates the left ventricle from the aorta)
damage to the electrical conduction system of the heart during surgery (causing arrhythmias)
delayed growth and development (failure to thrive in infancy)
pulmonary hypertension (high blood pressure in the lungs) leading to failure of the right side of the heart

Calling your health care provider:

Most often, this condition is diagnosed during routine examination of an infant. Call your infant's health care provider if the baby seems to be having difficulty breathing, or if the baby seems to have an unusual number of respiratory infections.

Prevention:

Except for the case of heart attack associated VSD, this condition is always present at birth. Maternal alcohol consumption during pregnancy and maternal use of the antiseizure medicines -- valproic acid and phenytoin (depakote and dilantin) -- during pregnancy have been associated with increased incidence of VSDs. Other than avoiding these, there is no known way to prevent a VSD.

Review Date: 5/22/2002
Reviewed By: Satish K. Rajagopal, M.D., Department of Pediatrics, Columbia Presbyterian Medical Center, The Children's Hospital of New York, New York, NY. Review provided by VeriMed Healthcare Network.

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