Ventricular septal defect (VSD) is a common heart defect were a hole develops in the heart during fetal development. The hole separates the lower chambers (septum) of the heart allowing blood flow to pass from the left side to the right side. This defect allows oxygenated blood to be pumped backward into the child's lungs instead of normally out to the body. The defect causes the heart to work significantly harder, producing its own serious side effects.
Many ventricular septal defects cause no significant problems and some will eventually heal themselves. However, larger ventricular septal defects require surgical procedure repairs within the first few months or years of the child's life to ensure that complications are prevented.
- What Causes Ventricular Septal Defect?
- Common Symptoms
- Diagnosing the Condition
- Treating Ventricular Septal Defect
What Causes Ventricular Septal Defect?
Ventricular septal defect is a congenital heart condition that arises in the early stages of a developing heart of the fetus. Doctors and scientists have yet to determine a clear cause of the defect. However, environmental and genetic factors are likely two causes. Some children are born with both the ventricular septal defect and other congenital heart defects.
A ventricular septal defect can occur during the developing phases of fetal growth when the muscular wall separates inside the heart to form both the left and right septum chambers. It is usually at this stage of development that a failure occurs when the lower chambers of the heart (ventricles) do not fully form.
Typically, the heart's right side will pump blood into the lungs to receive oxygen. While that occurs, the left side then pumps the oxygen-rich blood out to arteries that wind through the entire body. The defect causes both oxygenated and deoxygenated blood to mix together. This causes the heart to work significantly harder to ensure that all body tissue and organs receive sufficient oxygen.
Some adults develop ventricular septal defects after suffering a heart attack. Both children and adults can suffer serious complications caused by ventricular septal defect including:
- Heart failure
- Growth failure
- Irregular heartbeats (arrhythmias)
- High blood pressure
- High blood volume
The doctor can usually detect a ventricular septal defect by its characteristic murmur that might or might not be heard at birth. The murmur can become much stronger when pressure changes blood flow moving across the hole defect between the heart pumping chambers. Small holes tend to make much louder sounds than a large hole defect that can even increase in volume when the defect closes. The most common ventricle septal defect symptoms involve:
- Challenged breathing that causes rapid breathing
- Chronic respiratory infections
- Pale skin color
- Bluish tint to the skin, especially around the fingernails and lips
- Abnormal weight gain
- Failure to thrive due to poor eating
- Profuse perspiration while the baby is feeding
- Excessive tiredness
Many of the symptoms associated with a small ventricular septal defect never produce any problems. However, large or medium defects often result in a variety of disabilities that in some cases can be life-threatening. Failing to provide adequate treatment can induce serious complications that include:
- Pulmonary Hypertension – A ventricular septal defect in cost blood flow to increase into the lungs and produce high blood pressure resulting in pulmonary hypertension. Without treatment, pulmonary hypertension can cause permanent damage to the lungs, Eisenmenger syndrome or blood flows in reverse through the whole.
- Endocarditis – The condition can cause the development of a heart infection that results in serious damage to the heart muscle.
- Another Heart Issue –The condition can cause abnormal valve problems and heart rhythms.
Women who are diagnosed with a ventricular septal defect may not be at risk of serious complications when pregnant. However, larger, unrepaired defects along with pulmonary hypertension, heart failure or other heart condition could increase the potential risk of complications in both the fetus and mother.
Women of childbearing age are often strongly advised to avoid becoming pregnant if they suffer from Eisenmenger syndrome. Additional complications can arise if the pregnant woman, or a woman hoping to become pregnant, is taking medications. That is why doctors recommend pregnant mothers to seek out medical attention from cardiologists in obstetricians.
Diagnosing the Condition
Early detection of a ventricular septal defect often occurs when the pediatrician using a stethoscope hears a characteristic murmur when listening to the sound of the heart. However, further testing to verify the condition might involve:
- Chest X-Ray – The image produced by an X-ray can assist the doctor in looking at the integral structures of the lungs and heart.
- ECG (Electrocardiogram) – Test results can help identify rhythm problems and diagnose heart defects by recording the heart's electrical activity.
- Echocardiogram – Video images of the heart can be produced by sound waves that can assist the doctor in determining if a ventricular septal defect is present. The sound wave-generated imaging can provide verification of how the heart is pumping. Fetal echocardiography is also available to provide information on a fetal heart.
- Cardiac Catheterization – The doctor can insert a flexible, thin catheter tube into the child's blood vessel at the arm or groin and guided to through the body's blood vessels until it reaches the heart. This process provides information on accurately diagnosing congenital heart defects and determine how the chambers and valves of the heart function.
- Pulse Oximetry – This machine with a small clip attached to the child's fingertip can register the amount of oxygen in the bloodstream.
Treating Ventricular Septal Defect
Some small ventricular septal defects cause no symptoms or complications and require no treatment because the defect will close without surgical intervention. Doctors may still choose to surgically repair small ventricular septal defects because of their location, which might be causing damage to the valves of the heart. Children who do require a ventricular septal defect repair on their heart typically undergo the procedure prior to their first birthday.
The most common ventricular septal defect treatments include:
- Medications that increase the strength of contractions in the heart
- Drugs that decrease the levels of fluid and blood flow circulation throughout the body and in the lungs.
- Medicine to maintain a regular heartbeat.
- Surgical repair procedures that closed the hole in the heart.
- Catheter procedures to repair the defect without the need to open the chest.
- Hybrid procedures that involve catheter techniques and surgical repairs that are often performed without the need to stop the heart or use a heart-lung machine.
- Preventative antibiotics for children at the highest risk of developing severe complications caused by infective endocarditis.
- Antibiotic use to treat complications associated with artificial valves and heart conditions.
Children born with ventricular septal defects often require support from parents and groups of individuals who face similar challenges to assist the caregivers in finding answers they need to improve the child's quality of life.
As a part of an effective treatment plan, the doctor will recommend or advise the types of activities that are safe for a child suffering from this condition. Many activities can be dangerous. The child will always need regular healthcare and may need additional procedures and surgeries as they grow into adulthood. However, additional surgeries are rarely needed in young adults and teenagers whose ventricular septal defect have been repaired or closed.