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Quick reference medical handouts used by Pediatric offices

A Hole in the Heart

A ventricular septal defect (VSD) is a congenital malformation of the heart in which there is a defect or hole in the wall that separates the two main pumping chambers, the right and left ventricles. The hole allows some blood to flow from the left ventricle to the right ventricle instead of entering the aorta for distribution throughout the body It is the most common congenital heart defect and accounts for 20-30% of children seen by a pediatric cardiologist. A ventricular septal defect may be small, medium-sized or large, and may be single or multiple. It may occur in different parts of the ventricular wall, and may sometimes be found along with other heart defects.

Congenital heart defects, such as a VSD, are errors in the development of the heart and occur early in the life of the fetus. There is no known cause.

The wall between ventricles is meant to separate low oxygen blood returning from the body with rich oxygen blood going to the arteries. The right ventricle pumps blood to the lungs and the left ventricle pumps blood throughout the body. When a "hole" is present between the ventricles, some blood from the left side of the heart is forced through the defect to the right side every time the heart beats. This is because pressure in the left ventricle is much higher than the right, and fluids always flow from places of high to lower pressure. This blood recycles through the lungs before returning to the left ventricle. Cardiologists call this a "left to right shunt" because the blood flows from the left to right ventricle across the VSD.

Blood squirting through the hole causes turbulent blood flow producing a heart murmur, which is often the first clue that a child has a VSD. In many children, the murmur is heard right after birth but it may not be appreciated until the child is six to eight weeks of age. Only those children with moderate to large VSD's get into trouble during the first months of life. When the VSD is large, in a very small child, lung blood flow may be so enormous that the tiny ventricles cannot pump such a volume. This causes heart failure and is manifested by shallow breathing, excessive sweating, inability to feed well, irritability, constant crying, and a failure to grow normally. A baby with a large VSD tires quickly after not eating very much, falls asleep, wakes us in a short while quite hungry, tries to eat again, tires easily, and the cycle is repeated.

In general, small defects cause no symptoms and do not affect the child's growth or development. They often close spontaneously, often in the first year of life, and rarely require surgical or medical treatment. If otherwise healthy, children with small ventricular defects can participate fully in physical activities including vigorous and competitive athletics (exercise recommendations are best made by the child's primary care doctor or cardiologist). Usually, the only significance of a small ventricular septal defect is a slightly increased risk for subacute bacterial endocarditis (SBE). This is an infection of the heart caused by bacteria in the blood stream. It most commonly occurs after a dental or other medical procedure and can usually be prevented by a dose of antibiotic prior to the procedure.

Most children suspected of having a ventricular septal defect are usually referred to a pediatric cardiologist for confirmation of the diagnosis and follow up care. Certain medical tests may be performed, including an electrocardiogram (EKG), an oxygen saturation test, a chest x-ray, and an echocardiogram.

If the child with a large ventricular septal defect develops congestive heart failure, treatment involves the use of medications to decrease the work of the heart and increase the strength of the heart beat. Medications often control the symptoms until the child gets bigger and the defect gets smaller or closes all together. If the child's symptoms cannot be controlled by medications, surgical repair will be considered. Even if the symptoms are minimal, surgical closure is recommended for any defect that is big enough in the first year or two of life to allow excessive pulmonary blood flow and pressure. This is to prevent a very serious long term complication called pulmonary vascular obstructive disease.

Holes that persist and are causing problems in growth and development are corrected by open heart surgery, usually before one year of age. Surgical repair of a ventricular septal defect involves the placement of a prosthetic patch, sutured in placed, that covers the defect. The heart tissue grows over the patch so the heart never "outgrows" it. VSD closure is one of the most commonly performed congenital heart operations, and is a safe and effective operation.. Following repair, the youngster should have virtually normal growth, development, and life expectancy.

Diagram courtesy of Heartpoint


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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