Ventricular septal defect

A ventricular septal defect is a hole in the partition, or septum, between the two lower pumping chambers (ventricles) of the heart. This is the most common congenital heart defect. The hole allows blood to cross from the left ventricle, where the pressure is high, into the right ventricle, where the pressure is much lower. The larger the hole, the more blood will cross from the left to the right side.

VSD symptoms
Children with a VSD often will have a loud heart murmur after the first few weeks of life. Early in the newborn period, the pressure in the lungs and the right ventricle are higher than usual. This high pressure in the right ventricle prevents a lot of blood from crossing the VSD in the first days and weeks after the baby is born. The heart murmur at this time may be very soft, or absent, and the baby may not have any symptoms. When the lung and right ventricle pressure begin to fall to normal to low levels, more blood will cross the VSD and the heart murmur will get louder. Additionally, the baby may begin to show the following signs:

  • Poor feeding
  • Fast breathing even when the baby is sleeping
  • Excessive sweating
  • Poor weight gain
  • Congestion and coughing

Treatment for VSD
Initial treatment of VSD often is with medication to help the heart and lungs deal with the increased workload. If treatment with medicine is successful at controlling congestive heart failure, your doctor may advise waiting for the VSD to close by itself.

If the hole is small, no treatment may be needed. Medications may include Digoxin, which helps the heart beat more strongly, and Lasix, which decreases the amount of fluid in the body. Additional medications, such as Captopril, which helps the blood vessels in the body relax to decrease the amount of work the heart must pump against, may also be prescribed. In addition to medication, a child with VSD may be placed on a high-calorie formula. Normally, formula and breast milk contain 20 calories per ounce. To help the baby gain weight, doctors may recommend mixing normal formula with less water or adding powdered formula to breast milk to increase the amount of calories per ounce.

Surgery will be recommended if:

  1. Congestive heart failure persists or the baby does not gain weight well even on maximal medical treatment.
  2. Persistent high pressure in the lungs due to the VSD is likely to cause permanent damage.
  3. Other parts of the heart can potentially be affected by letting the hole remain open.
  4. There is no evidence that the hole is closing by itself.