What is Ventricular Septal Defect?

Ventricular Septal Defect (VSD) is a hole in the wall (septum) that separates the right and left ventricles (the larger, pumping chambers of the heart). When the left ventricle contracts or pumps, it sends blood out the aorta. (The aorta is the main artery coming from the heart that supplies blood to the rest of the body).

Blood is also sent 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. In turn more blood than normal is returning from the lungs to the left atrium and left ventricle. If the hole is large, 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 well and blood can back up into the lungs.

This may lead to signs of congestive heart failure, such as difficulty breathing, exertional fatigue, and leg edema. Large Ventricular Septal Defects can cause increased blood pressure in the arteries in the lungs (called Pulmonary Hypertension) and may 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. The physician will order an echocardiogram, which will show a clear picture of the defect as well as its size and effect on heart function.

What is the treatment 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 need surgery to close the hole. At what point surgery is done depends on the degree of symptoms.

Oftentimes, symptoms can be improved by giving 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
• Medicines which improve the forward flow of blood from the left ventricle to the aorta

If symptoms are still present, 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.

6/16/2008