Ventricular septal defect (VSD) is a defect or hole in the wall separating the two pumping chambers (the right and left ventricles) of the heart - see figure 3.1.
VSD is one of more common "hole in the heart" seen, and it can occur in isolation or in combination with other congenital heart defects. Not counting those occurring as part of a complex heart disease, VSD accounts for about 15 - 20% of all congenital heart diseases. VSD can be subclassified according to their location on the ventricular septum into perimembranous, subarterial or muscular types.
Figure 3.1 Diagram of a heart with a ventricular septal defect (VSD) on the left, compared to a normal heart on the right. Hover the mouse pointer over the diagram to see the description. LA - Left Atrium, RA - Right Atrium, LV - Left Ventricle, RV - Right Ventricle.
What Are The Effects of VSD?
Figure 3.2 Blood circulation in a heart with an VSD. Note some red blood now crosses the VSD to mix with the blue blood.
The effects of now having "extra" blood flowing across the VSD into the right ventricle and subsequently re-circulated into the lungs are:
The degree at which these effects occur would depend on the size of the VSD and the amount of blood that is re-circulated back to the lungs. This can range from insignificant to severe.
The most common presentation of a VSD is that of a cardiac murmur. Babies with large VSDs can present with symptoms of heart failure such as rapid breathing and poor feeding.
The chest X-ray and electrocardiogram are often non-specific; they can be totally normal in small VSDs. In larger defects, the chest X-ray may show enlargement of the heart and increased blood vessel markings in the lungs.
The investigation of choice when a VSD is suspected is the echocardiogram. This will not only confirm the presence of the VSD (figure 3.4), it will also allow the cardiologist to assess the number and sizes of the VSD(s), as well as it's haemodynamic effects on the heart. The echocardiogram can also demonstrate the presence of any associated cardiac lesions.
Figure 3.4 Echo picture showing the presence of a VSD in the ventricular septum between the right and left ventricles.
In some cases of VSD where complications had raised (e.g. severe pulmonary hypertension) or when there are other associated cardiac defects, cardiac catheter study may need to be performed.
What is the appropriate treatment for a particular child with a VSD will depend on many factors such as the number, size and location of the VSD(s), any associated cardiac defects and the effects of the VSD on the heart. The suitability of the various treatment options will vary from person and person and should be discussed with your cardiologist. These options would include:
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