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Ventricular Septal Defect (Child)

Ventricular Septal Defect (VSD): What it is, effects of VSD, diagnosis and treatment | KKH

Ventricular Septal Defect (Child) - What it is

 

​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.

Heart with VSD and normal heart - KKH

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.

Blood circulation in a normal heart - VSD - KKH

Figure 3.3

Blood circulation in a normal heart. Note that the red and blue bloods do not mix during circulation through the heart.

The effects of now having "extra" blood flowing across the VSD into the right ventricle and subsequently re-circulated into the lungs are:

  • The left-sided upper heart chamber (left atrium) and left-sided lower heart chamber (left ventricle) can become dilated to accommodate the extra blood volume returning from the lungs.
  • The lungs become more "wet" or even become "flooded" with this extra blood. This can lead to breathlessness.
  • The blood pressure in the lungs increases.

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.

Ventricular Septal Defect (Child) - Symptoms

Ventricular Septal Defect (Child) - How to prevent?

Ventricular Septal Defect (Child) - Causes and Risk Factors

Ventricular Septal Defect (Child) - Diagnosis

​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.

Ventricular septal defect disgnosis at KKH

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.

Ventricular Septal Defect (Child) - Treatments

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:

  • Continued Outpatient Observation - Small VSD with insignificant haemodynamic effect need not be treated. Small defects, especially small muscular defects, do close spontaneously with time. However, they should be followed-up by a cardiologist or your family physician.
  • Medical treatment - drugs such as diuretics may be prescribed by your cardiologist.
  • Surgical closure - This is an open-heart surgery performed under cardiopulmonary bypass. The surgeon can close the VSD with a patch made with the patients own pericardium or with an artificial patch such as Dacron.
  • Transcatheter device closure - Certain VSD can be closed using special devices delivered via cardiac catheters (long, thin tubes). The VSD must be carefully assessed prior to recommending this option as not all VSDs are suitable for transcatheter device closure.

Ventricular Septal Defect (Child) - Preparing for surgery

Ventricular Septal Defect (Child) - Post-surgery care

Ventricular Septal Defect (Child) - Other Information

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