What is a ventricular septal defect?
A ventricular septal defect (VSD) is a hole in the wall (septum) that separates the heart’s two lower chambers (ventricles). Ventricular septal defects usually occur by themselves, without other birth defects of any kind. Experts estimate that VSDs account for about 30 percent of all congenital heart defects, occurring in 1 out of every 500 babies.
What are the symptoms of VSD?
The symptoms and treatment for VSD depend on the size of the hole and where it is located. The size of the defect determines its effects on the heart’s function. When the opening between the ventricles is large, oxygen-containing blood flows backwards into the right ventricle instead of out into the body. From the right ventricle, this oxygen-containing blood gets pumped back to the lungs, displacing blood in the lung circulation that needs oxygen. This inefficient blood flow causes the heart to pump harder, trying to compensate.
As a result, the heart may enlarge and high blood pressure may develop in the arteries of the lungs (pulmonary hypertension). A person with a large VSD may experience shortness of breath, fatigue and weakness.
If the defect is small, the only symptom abnormality is usually is a loud murmur, caused by the blood flowing backwards into the right ventricle.
How is VSD diagnosed?
Ventricular septal defects frequently are diagnosed at birth or within a few days from birth because the doctor can hear the distinctive murmur. Older children or adults with an undetected VSD may experience shortness of breath with exercise or heart rhythm problems that send them to a doctor. Diagnosis may include:
- Chest x-ray
- Electrocardiogram to evaluate the heart’s electrical system
- Transthoracic Echocardiogram with Doppler imaging: Ultrasound images are obtained to show the size and function of the heart’s chambers, assess the condition of the heart valves and measure the velocity of blood flow across the VSD
- Coronary angiography in patients at risk of coronary artery disease or in patients over age 40 if a surgical repair is planned.
- MRI to detect other associated cardiac abnormalities
Does VSD always require treatment?
Approximately 75 percent of small VSDs close on their own within the first year of life or by age 10 and do not require any treatment other than careful monitoring. For medium to large VSDs, the spontaneous closure rate is about 5 to 10 percent. If a VSD has not closed by age 10, spontaneous closure probably will generally not occur; it is rare for a VSD in an adult to close on its own.
An adult who has a VSD without any symptoms probably does not require intervention but should have regular checkups by a physician who specializes in adult congenital heart disease. Although the VSD may not be causing heart or lung problems or symptoms, adults with unrepaired VSDs still have a higher than normal risk for heart valve problems and endocarditis, a potentially life-threatening infection of the heart.
When should an adult with a VSD seek treatment?
An adult with a VSD who develops symptoms should consult a specialist in adult congenital heart disease. Usually treatment is recommended to prevent heart and lung problems.
The treatment for VSD is an operation to patch the hole between the ventricles. It usually is performed as an open-heart procedure with a chest incision and should be performed by a surgeon who specializes in adult congenital heart defects. The surgeon will close the hole with stitches (a primary repair) or by using a mesh fabric patch (a secondary repair). Eventually, heart tissue grows around and over the patch, absorbing incorporating it into the muscle.
Pregnancy and VSD
Women with repaired VSDs and normal heart function, or those with small, asymptomatic VSDs can have children without a higher than normal risk for problems during pregnancy. Women who have an unrepaired VSD or a closed VSD with heart and/or lung complications who desire to become pregnant should seek the advice of an adult congenital heart disease specialist and a specialist in high-risk pregnancy. With proper prenatal care and monitoring, these women usually can have successful pregnancies also.
Pregnancy is not recommended for women with large VSDs and pulmonary hypertension because of high maternal mortality rates.
When either the man or women has a congenital heart defect of any kind, their infant has a higher than normal risk of also having a congenital heart defect.
About 10 percent of people with VSD develop Eisenmenger Syndrome, a complex array of problems caused by the difference in pressure between the left and right ventricles.
Early on, blood flows backwards through the large opening in the septum and into the right ventricle and floods the pulmonary arteries. Over time, changes occur in the thickness and elasticity of the pulmonary artery walls and high blood pressure (pulmonary hypertension) occurs in those vessels. As the blood vessels lose their elasticity, the heart pumps harder, causing it to weaken and results in right-sided heart failure. Flow then reverses across the VSD, resulting in low oxygen blood flowing into the systemic circulation. This can result in cyanosis (low blood oxygen, often seen as blue lips and extremities) and several other complications.
These individuals also may develop atrial fibrillation (a rhythm disturbance of the upper heart chambers), aneurysms in the pulmonary arteries and other complications. The average life expectancy of people with Eisenmenger Syndrome is less than 40 years. Newer medical therapies and close medical attention may significantly improve outcomes in these patients.
Are there any non-surgical options available?
Some major heart centers, including Cleveland Clinic are using a catheter-based technique to repair some VSDs. In this non-surgical, investigational procedure, a long, thin tube (a catheter) is inserted into a blood vessel in the groin and guided to the area of the heart defect. Working through the catheter, the interventionalist closes the defect using a closure device. After the device is in place, the catheter is withdrawn.
Does the heart function normally following surgical repair of a VSD?
In individuals with a VSD and no other heart or lung problems, repair of the defect restores the heart’s normal function. Generally these people can engage in physical activity without restrictions. This is also true for adults with small, unrepaired VSDs.
Individuals who have complications related to a VSD, such as abnormal heart rhythms (arrhythmias) or heart valve problems, may have some activity restrictions. Cleveland Clinic adult congenital heart disease specialists recommend that anyone with a known heart defect – repaired or unrepaired – consult a cardiologist before undertaking any program of regular physical activity, sports or exercise.
What is the success rate for VSD surgery?
Surgical closure of VSDs did not become a widespread procedure until the 1960s, so long-term data on outcomes and life expectancy is only now being collected and analyzed. Available data indicate that adults with closed VSDs and without other heart or lung complications can expect to live a normal lifespan. In the 40 years that the operation has been widely used, about 6 percent of patients have required a re-operation to close small leaks that developed around the patch.
Are there any long term problems or complications after surgery?
Within the first six months after surgical repair of a VSD, the person still has a risk of endocarditis while the heart heals. Your cardiologist can advise you on how to protect yourself from this life-threatening condition.
People with repaired VSDs may develop cardiac arrhythmias later in life, caused by scar tissue that develops ion the heart from the VSD surgery. Several effective treatments are available for arrhythmias; your cardiologist can advise whether your arrhythmia requires treatment. The risk of arrhythmias and sudden cardiac death is higher in patients who have undergone VSD repair late in life.
What type of ongoing follow up is required after surgery?
People with repaired VSDs who do not have other heart problems and those with small, unrepaired, asymptomatic VSDs should have a regular examination by a cardiologist, but usually do not need to see an adult congenital heart disease specialist on a regular basis. Those who have other congenital abnormalities or experience cardiac complications after VSD repair, such as valve disease, coarctation of the aorta, or aortic regurgitation, or lung problems should continue to see a specialist in adult congenital heart disease.
How to find a doctor if you have adult congenital heart disease
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, read more about our Sydell and Arnold Miller Family Heart & Vascular Institute outcomes.
The Center for Adult Congenital Heart Disease in the Sydell and Arnold Miller Family Heart & Vascular Institute is a specialized center involving a multi-disciplinary group of specialists, including cardiologists, cardiac surgeons and nurses from Cardiovascular Medicine, Pediatric Cardiology, Pediatric and Congenital Heart Surgery, Cardiothoracic Surgery, Diagnostic Radiology, Pulmonary, Allergy and Critical Care Medicine, and Transplantation Center, who provide a comprehensive approach to diagnosing and treating adult congenital heart disease.
You may also use our MyConsult second opinion consultation using the Internet.
For younger patients with congenital heart disease:
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
Congenital heart disease is diagnosed by a murmur on a physical exam and several diagnostic tests:
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Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.
- Darst JR, Collins KK, Miyamoto SDCardiovascular Diseases. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013.
- American Heart Association. About Congenital Heart Defects Accessed 3/12/2015.
- Centers for Disease Control and Prevention. Facts about Congenital Heart Defects Accessed 3/12/2015.
- National Heart, Lung, and Blood Institute. What are Congenital Heart Defects? Accessed 3/12/2015.
- Hirsh JC, Devaney EJ, Ohye RG, Bove EL. Chapter 19B. The Heart: II. Congenital Heart Disease. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e. New York, NY: McGraw-Hill; 2010.
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