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Septal Defect, Ventricular / Ventricular septal defect (VSD)

Definition :
If your baby has a ventricular septal defect (VSD) — an abnormal opening between the heart's lower pumping chambers — you're bound to be concerned. Fortunately, a ventricular septal defect, also called a "hole in the heart," is a common heart defect that's present at birth (congenital). The defect is readily treatable. Smaller ventricular septal defects often close on their own or don't cause problems. Others need surgical repair. Many kids with ventricular septal defects have normal, productive lives with few related problems.

The consequences of a ventricular septal defect depend on the size of the hole. Babies with small defects may have no problems at all and may appear physically normal. In babies with larger defects or associated congenital heart defects, oxygen-poor blood may be pumped out to the body through the ventricular septal defect. Because of this, some babies with larger ventricular septal defects may have a telltale bluish tint to their skin — called cyanosis — often most visible in the lips and fingernails.

When a ventricular septal defect is one of several heart defects, the sequence of treatment and the outcome varies. Typically, doctors tackle one defect at a time — over time — while managing symptoms of others.

Causes:
Although doctors know that congenital heart defects arise from errors early in the heart's development, there is often no clear cause. Genetics and environmental factors probably play a role.

A ventricular septal defect occurs when the septum, the muscular wall separating the ventricles, fails to form fully during fetal development. This opening allows mixing of new (oxygenated) and used (deoxygenated) blood. As a result, blood overfills the lungs and overworks the heart. If not treated, the blood pressure in the lungs goes up (pulmonary hypertension) and the ventricles enlarge and no longer work

efficiently. Ultimately, this can lead to irreversible damage to the lung arteries and to congestive heart failure.


Risk Factor :
Congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you already have a child with a congenital heart defect, a genetic counselor can predict the approximate odds that your next child will have one.

Having the following conditions during pregnancy can increase your risk of having a baby with a heart defect.

  • Rubella infection.Becoming infected with rubella (German measles) while pregnant can increase the risk of fetal heart defects. The rubella virus crosses the placenta and spreads through the fetus' circulatory system damaging blood vessels and organs, including the heart.
  • Poorly controlled diabetes.Uncontrolled diabetes in the mother in turn affects the fetus' blood sugar causing various damaging effects to the developing fetus.
  • Drug or alcohol use or exposure to certain substances.Use of certain medications, alcohol or drugs or exposure to chemicals or radiation during pregnancy can harm the developing fetus.

When to seek medical advice :
Call your doctor if your baby or child :

  • Tires easily when eating or playing
  • Is not gaining weight
  • Becomes breathless when eating or crying
  • Has a bluish tint to his or her skin, especially around the fingernails and lips
  • Breathes rapidly or is short of breath
Symptoms:
Signs and symptoms of serious heart defects usually appear during the first few days, weeks and months of life. Swelling may develop in the legs, abdomen or around the eyes.

Perhaps your baby has shortness of breath during feedings, which leads to poor weight gain. If the defect is large, your baby's skin may lose its healthy color, appearing pale gray or blue. Although other conditions can cause these signs, they may be those of a congenital heart defect.

You and your doctor may not notice signs of a ventricle septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if ever. Signs and symptoms vary depending on the size of the hole. Your doctor may first suspect a heart defect during a regular checkup while listening to your baby's heart through a stethoscope.

Larger ventricular septal defects may cause :

  • A bluish tint to the skin, lips and fingernails
  • Poor eating, failure to thrive
  • Fast breathing or breathlessness
  • Easy tiring
  • Swelling of legs, feet or abdomen
  • Rapid heart rate

Diagnosis:
Your baby's doctor may detect a heart defect by simply listening to your baby's heart. Ventricular septal defects often cause a heart murmur that your doctor can hear through a stethoscope. If your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may request one or more of these tests :

  • Chest X-ray. An X-ray image helps the doctor see the condition of your baby's heart and lungs. An X-ray may identify conditions other than a heart defect that may explain your baby's symptoms.
  • Electrocardiogram (ECG or EKG). This test records the electrical activity of your baby's heart through patches attached to the skin. This test helps diagnose heart defects or rhythm problems.
  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of the heart. This image can help doctors see if your baby's heart is abnormal and determine if it is pumping properly. Echocardiography can also be done while the baby is still in the womb (fetal echocardiography).
  • Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your baby's groin or arm and guided through the blood vessels into the heart. Through catheterization, doctors can diagnose congenital heart defects and test the strength of the baby's ventricles — the heart's pumping chambers — and the function of the heart valves. Doctors are studying this technique for the repair of heart defects.
  • Pulse oximetry. This painless test measures how well oxygen is reaching your baby's tissues. It helps determine whether oxygenated blood is mixing with deoxygenated blood, which can help diagnose the type of heart defect present. A small finger clip on the baby's fingertip measures the amount of oxygen in the blood.

Complication :
A small ventricular septal defect may never cause any problems. Larger defects can cause a wide range of disabilities — from mild to life-threatening. Treatment can prevent many of these complications.

Ultimately, if a large ventricular septal defect goes untreated, increased blood flow to the lungs causes high blood pressure in the lung arteries (pulmonary hypertension). Over time, permanent damage to the lung arteries develops and the pulmonary hypertension can become irreversible. This complication, called Eisenmenger's syndrome, may occur in early childhood, or it can develop progressively over many years. In people with Eisenmengers' syndrome, the majority of the blood flow through the ventricular septal defect goes from the right ventricle to the left and bypasses the lungs. This means deoxygenated blood is pumped to the body and leads to a bluish discoloration of the lips, fingers and toes (cyanosis) and other complications. Once a child has Eisenmenger's syndrome, it's too late to surgically repair the hole because irreversible damage to the lung arteries has already occurred.

Other complications may include :

  • Heart failure. The increased blood flow through the heart due to a ventricular septal defect can also lead to heart failure, a chronic condition in which the heart can't pump effectively.
  • Endocarditis. Children with a ventricular septal defect are at increased a risk of an infection of the heart (endocarditis).
  • Stroke. Children with large defects, especially occurring with Eisenmenger's syndrome, are at risk of a stroke due to a blood clot passing through the hole in the heart and going to the brain.
  • Other heart problems. Ventricular septal defects can also lead to abnormal heart rhythms and valve problems.
Treatment:
Many babies born with ventricular septal defect won't ever need to have it surgically closed. After birth, your doctor may want to observe your baby and treat any symptoms while waiting to see if the defect will close on its own. Depending on the size of the defect, doctors may try to delay surgery until the child is older. All people with aventricular septal defect need to take antibiotics before dental work and certain types of surgical procedures. Be sure to remind the dentist or doctor that your child has a ventricular septal defect and ask if he or she needs antibiotics before any procedure.

Medications
Medications for ventricular septal defect may include those to :

  • Keep the heartbeat regular. Examples include beta-blockers (Lopressor, Inderal) and digoxin (Lanoxin).
  • Increase the strength of the heart's contractions. Examples include digoxin (Lanoxin).
  • Decrease the amount of fluid in circulation. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).

Surgery
Surgery for a ventricular septal defect involves plugging or patching the abnormal opening between the ventricles. This usually involves open-heart surgery, which is done under general anesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses patches or stitches to close the hole.

Another method — cardiac catheterization — also is being used to close some ventricular septal defects. Catheterization, which is in the investigational stage, doesn't require opening the chest. Rather, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the baby's heart. For a ventricular septal defect, the doctor may be able to close the hole by using a small mesh patch or plug during catheterization. The heart tissue grows around the mesh, forming a permanent seal.

Even after repair, your child will need some medical follow-up to ensure that the ventricular septal defect remains closed. Depending on the size of the ventricular septal defect and the presence or absence of any other problems, your doctor will tell you how frequently your child will need to be seen.

Prevention:
In most cases, you can't do anything to prevent having a baby with a ventricular septal defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics :

  • Get early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you are taking.
  • Eat a well-balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.
  • Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.
  • Avoid risks. These include harmful substances such as alcohol, cigarettes and illicit drugs. Also, avoid X-rays, hot tubs and saunas.
  • Avoid infections. Be sure you are up-to-date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.
  • Keep diabetes under control. If you have diabetes, work with your doctor to be sure its well controlled before getting pregnant.

If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor before getting pregnant.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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