Ventricular Septal Defect

A ventricular septal defect is a birth defect characterized by a hole in the wall separating the two lower chambers of the heart. This is the most common congenital (meaning present at birth) heart defect, and it frequently occurs in conjunction with other types of heart problems or defects. Typically, a minor ventricular septal defect has few or no symptoms. Nonetheless, a larger hole may require repair to prevent permanent damage and complications.

Ventricular septal defects occurs in approximately one-third of one percent of newborns. However, a VSD diagnosis in adults is much less likely because, in 90% of cases, the defect closes on its own during childhood.

Ventricular Septal Defect Types

There are four primary types of ventricular septal defects that vary in location and hole structure (or holes):

Membranous: This type of VSD accounts for approximately 80% of all cases. These VSDs occur in the upper ventricle wall.
Muscular: Muscular VSDs account for approximately 20% of all VSDs in infants, and frequently involve more than one hole.
Inlet: Just below the tricuspid valve in the right ventricle and the mitral valve in the left ventricle is an opening called the inlet. Thus, when blood enters the ventricles, it must pass through a VSD connecting the two chambers.
Outlet (conoventricular): This type of VSD creates a hole between the right and left ventricles, just before the pulmonary and aortic valves. This means that blood must pass through the VSD on its way through both valves.

Ventricular Septal Defect Symptoms

In infants, moderate to large VSD causes heart failure-like symptoms. These consist of:

Breathing difficulties, such as rapid or labored breathing.
Perspiration or fatigue while feeding.
Slow weight gain
Frequent upper respiratory tract infections

VSD in adolescents and adults can result in the following:

Experiencing fatigue or shortness of breath when exercising.
Slightly increased risk of infection-induced heart inflammation.
After the onset of Eisenmenger syndrome, very pale skin or a bluish tint to the skin and lips (a condition known as cyanosis) may occur.

Ventricular Septal Defect Causes

VSD that is present at birth has no known causes at this time. However, it can occasionally occur in conjunction with other heart defects, heart conditions, and genetic disorders. Taking certain anticonvulsant medications (sodium valproate and phenytoin) or consuming alcohol during pregnancy may also increase your child’s risk of developing a VSD. However, additional research is required to confirm whether these are definitive causes.

VSD occurs only as a rare complication of a heart attack, which is the only known cause.

Ventricular Septal Defect Complications

In endocarditis, a mass of irregular, germ- and cell-based growths forms within the heart. These are referred to as vegetations. They are capable of escaping and traveling to the brain, lungs, kidneys, and other organs. Additionally, they can travel to the limbs.

Endocarditis may cause the following complications:

Heart failure
Valve damage
Pockets of pus that form in the heart, brain, lungs, and other organs.
Blood clot in a lung artery (pulmonary embolism)
Kidney disease
Spleen enlargement
Stroke

Ventricular Septal Defect Diagnostics

The following imaging tests assist in the diagnosis of ventricular septal defect:

Echocardiogram. This test transmits ultra-high-frequency sound waves through your body using a device placed against the chest skin. These sound waves produce an image of the heart’s interior and exterior. Depending on the size and location of the VSD, it may or may not be detectable on an echocardiogram. This examination is also painless and takes only a few minutes to finish.
Electrocardiogram (ECG or EKG). This examination detects the electrical activity of the heart by attaching multiple sensors to the chest skin. This activity is displayed as a wave on a printout or digital display for a healthcare professional to interpret. A VSD can cause structural alterations to the heart over time. When the structure is altered, the electrical pattern is altered as well. However, this test is typically normal if the VSD is not large enough or if the heart has not yet begun to change shape.
Chest or cardiac X-ray. When a VSD is sufficiently large, it will alter the structure of the heart. On specific types of chest or heart X-rays, this change is discernible. In some instances, it also entails injecting a substance into the blood that is easily visible on X-rays, allowing medical professionals to detect any abnormal blood circulation that may indicate a VSD or other problem.
Computed tomography (CT) examination. This test converts X-ray images into a three-dimensional image of the heart’s interior using a computer. Similar to a chest or heart X-ray, an injectable substance that is highly visible on a CT scan could be beneficial.
Catheterization of the heart. This procedure employs a catheter to perform an internal examination of the heart. A specialist inserts the device into a major blood vessel, typically one near the upper thigh, and then advances it to the heart. Once within the heart, it can help pinpoint the size and location of any problems, such as a VSD. When a healthcare professional suspects lung blood vessel damage is when this test is most likely to be performed.

Ventricular Septal Defect Treatment

The majority of VSDs are too small to cause any problems and will likely close on their own by the age of 6. In such situations, a healthcare provider is likely to advise against surgery, recommend monitoring for symptoms, and observe whether the defect closes on its own. When VSDs are moderate or larger in size, your doctor will likely recommend closing the hole to repair the VSD.

The two primary methods of VSD repair are:

Surgery. Patching a VSD surgically is the most reliable method for closing it. A cardiac (heart) surgeon will perform surgery to patch or close the hole. Depending on the size and location of the hole, it may be sufficient to simply stitch it shut. In other instances, the treatment may involve a synthetic patch or a graft of your own tissue.
Transcatheter techniques. These procedures, like cardiac catheterization, utilize a transcatheter (catheter-based) approach to access the heart through a major artery. Once the catheter device reaches the defect, it can insert a specialized device known as an occluder to seal the hole. Typically, these devices consist of a mesh framework covered by a synthetic material.
In either of the aforementioned instances, heart tissue will grow over and around the patch or occluder. Eventually, the patch or device should become a permanent component of the interventricle wall.