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A Hole in the Heart: What Parents Should Know About VSD

Hearing your child has a congenital heart defect (CHD) can bring a whole mix of emotions, ranging from sadness to guilt to anger. CHDs are the most common type of birth defect, but thanks to advancements in care, children with a CHD are living longer, healthier lives than ever before.

One of the most common forms of CHD to know about is a ventricular septal defect, or VSD. Sometimes called a “hole in the heart,” VSD is a congenital defect because a child is born with it. Sometimes it is diagnosed in utero but most often it is found after birth.

If you have a family history of CHD or your child recently received a diagnosis of VSD, you understandably have lots of questions and concerns. To better understand what a VSD is, how it is treated and what it means to you as a parent, we spoke with Andrew Hoyer, MD, a pediatric cardiologist at Banner – University Medical Group in Arizona.

What is a ventricular septal defect?

A VSD is formed when the septum (the wall) between the heart’s left ventricle and right ventricle (or lower two chambers of the heart) doesn’t completely close during heart development. This hole causes a change in the way blood flows through the heart.

“When the heart beats, some of the blood from the left ventricle (which receives red blood from the lungs) flows through the hole in the septum to the right ventricle causing oxygen-rich blood to mix with oxygen poor blood,” Dr. Hoyer said. “This then gets directed through the pulmonary artery into the lungs. When the lungs get too much blood, they can get wet and the heart has to pump harder.”

Over time, if it’s not repaired, a large VSD can increase the risk for other complications, including heart failure, pulmonary hypertension, heart arrhythmia or stroke.

A child with VSD may have one or more holes of varying sizes that may occur in different locations of the septum. “Some VSDs are so small they go away on their own as a child grows, while larger ones will need surgery,” Dr. Hoyer said.

Are there any signs or symptoms to look out for?

While some VSDs can be detected in utero, most often it’s detected in the first few months of life by a doctor during a routine child well-check.

Symptoms of VSD include:

  • Your child’s doctor hears a heart murmur.
  • Your baby has difficulty breathing or rapid breathing, is sweaty while eating and has trouble gaining weight.

“For infants, eating is exercise,” Dr. Hoyer said. “If they aren’t able to eat without getting winded and sweaty and if you notice they are losing weight, you’ll want to get them evaluated by their doctor.”

When is a VSD typically diagnosed?

Most VSDs are found by your child’s pediatrician during a well-check in the nursery or at an office visit. If a doctor hears an abnormal murmur, they will request consultation from a pediatric cardiologist. Common tests include an echocardiogram, electrocardiogram or chest X-ray. The pediatric cardiologist will then carefully evaluate, monitor and track your child’s condition.

How are VSDs treated?

The size and location of the VSD along with symptoms will determine your child’s treatment. Some of the treatment options may include the following:

Medical management

Most babies born with VSD won’t require surgery to close the hole, but your child’s pediatric cardiologist will want to monitor them until it closes on its own. If your child’s heart is working extra hard, they may require medications to manage symptoms.

“For an infant or baby who is having trouble gaining weight or breathing but we’re optimistic their hole will close on its own, we can put them on Lasix and increase their calorie intake,” Dr. Hoyer said. “The idea with Lasix is to have them pee out the extra fluid from their lungs and help them breathe easier. Babies can still breastfeed, but by supplementing with high-calorie formulas, we can help them gain weight.”

Surgical intervention

Babies and children with large VSDs will often need a surgical repair in the first few months of life. In this case, a VSD is usually repaired by a pediatric cardiac surgeon with open heart surgery. The surgeon will repair the heart using a patch or stitches to close the hole.

“Once your baby goes home and the heart isn’t working overtime, your baby should start to get back to being a normal, healthy baby,” Dr. Hoyer said.

After the repair, your child’s cardiologist will schedule a follow-up visit to make sure your child is recovering as expected.

There are certain cases where a VSD can be repaired during a cardiac catheterization procedure, but that is rare for this type of heart problem.

What is the outlook for a patient with a VSD?

“I often tell parents small muscular VSDs are so common, they’re almost considered normal,” Dr. Hoyer said. “The outlook is really good. If the VSD is small or it’s been closed with surgery, most children will not need any additional care. They can go on to do normal sports and activities like their friends.”

Talk to your doctor

If you’re concerned your child may have a congenital heart defect like a VSD, speak with your child’s doctor or specialist. The experts at Banner Health are here to help you with your concerns whether they’re related to heart care, pregnancy or other medical needs.

For additional information on congenital birth defects, read “Diagnosis And Treatment Of Congenital Heart Defects.”

Salud del corazón Salud del niño

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