What is a Ventricular Septal Defect (VSD)?
What is a Ventricular Septal Defect (VSD)?A ventricular septal defect (VSD) is a congenital disability (present at birth) that causes someone to have one or many openings in the wall separating the heart’s lower chambers. These defects can be small or severe, including a hole or several holes in the heart’s wall. The defects allow blood to leak between the two chambers, meaning that some oxygen-rich blood flows back into the lungs rather than out to the body, forcing the heart and lungs to work harder.
The heart has two lower chambers (the ventricles) which are separated by a solid wall (septum). The right ventricle pumps blood to the lungs, while the left pumps blood to the rest of the body. A ventricular septal defect (VSD) affects the septum, causing the wall to allow blood from the left ventricle into the right. This reduces the efficiency of the left ventricle since the blood meant to reach the muscles and other organs is lost to the heart’s right side.
Types of Ventricular Septal Defects
TypesThere are a few different types of ventricular septal defects, each named for the location of the hole in the heart wall.
- Perimembranous VSD (also called membranous VSD). The defects are in the upper part of the heart wall, between the tricuspid and aortic valves. It is the most common type of VSD, making up 80% of cases.
- Muscular VSD. This type is also very common but with a higher recovery rate than most. Patients with this type of VSD have defects in the lower muscular part of the wall. Most often, these defects close spontaneously on their own as the heart muscle grows.
- Inlet VSD (also called AV canal VSD or endocardial cushion VSD). This type is much less common but is often associated with children who have Down syndrome. It is also linked to other heart defects, such as holes in the wall between the top heart chambers and abnormalities of the mitral valve. With Inlet VSD, the defects are located in the back of the heart wall between the mitral and tricuspid valves.
- Outlet VSD (also called conoventricular VSD or malalignment VSD). Defects are found at the top of the heart wall. The defects cause portions of the heart wall not to align properly, leaving a hole in the path blood travels through in both valves.
- Subpulmonic VSD (also called supracristal or doubly committed VSD). This type of VSD is most commonly found in people of Asian descent. This defect occurs in the heart wall just below the pulmonary valve, in the pathway to the lungs. It is frequently associated with progressive leakage and damage to the aortic valve.
Signs & Symptoms of Ventricular Septal Defects
SymptomsSymptoms associated with VSD depend primarily on the amount and size of the defects, which determine how much blood can escape from the left ventricle. Symptoms typically appear within days or weeks of a child’s birth.
Most often, VSD is discovered when a pediatrician detects a heart murmur while examining the baby. If the VSD is small, the baby may have no symptoms at all, but if the defect is larger, babies will develop symptoms including:
- Rapid breathing
- Difficulty feeding due to shortness of breath
- Failure to thrive (poor weight gain)
- Sweating during feedings
- Frequent infections
Complications
ComplicationsWhile most VSDs don’t cause symptoms and may close on their own, there are complications that can occur in more severe cases.
- Congestive heart failure. A hole in the ventricular septum causes the heart to work harder while pumping blood, and can consequently lead to heart failure.
- Pulmonary hypertension. Another complication caused by the increased blood flow to the lungs. Pulmonary hypertension occurs due to the increased pressure in the lung’s arteries .
- Endocarditis. This condition is a life-threatening inflammation of the inner lining of the heart's chambers and valves, typically caused by an infection. Increased blood flow due to a VSD can increase the chances of bacteria from other parts of the body moving into the heart and causing an infection.
- Heart valve leakage. Depending on the location of the VSD, it may cause instability and heart valve leakage.
What Causes Ventricular Septal Defects?
CausesGenerally, doctors don’t know for sure what causes a ventricular septal defect. VSD occurs early in the heart’s development and defects are already present at birth. Sometimes, a VSD can be detected during pregnancy, allowing doctors to determine treatment options for the child before birth. If a VSD was detected during your latest pregnancy screening, the pediatric cardiology team at NewYork-Presbyterian is here to discuss treatment plans with you and help to plan for your infant’s care ahead of time.
Risk Factors for Ventricular Septal Defects
Risk FactorsWhile the cause of VSD is not fully understood, some factors may put an infant at a higher risk of developing a ventricular septal defect. These include:
- Genetics. VSDs may run in families or occur alongside other genetic conditions like Down syndrome. If you have a family history of genetic disorders or heart defects, you should consider discussing these risks with a genetic counselor.
- Drinking alcohol during pregnancy
- Taking anti-seizure medication during pregnancy. Certain medications like sodium valproate and phenytoin can increase the risk of your infant developing a VSD.
- Smoking during pregnancy
Ventricular Septal Defect Prevention
PreventionWhile there is no way to prevent ventricular septal defects, taking steps to stay healthy during pregnancy can help you avoid any unnecessary risks. The following actions can help keep both you and your infant healthy:
- Getting regular prenatal checkups
- Avoiding alcohol and drugs during pregnancy
- Eating a balanced diet
Trust NewYork-Presbyterian for Ventricular Septal Defect Care
The pediatric cardiac care team at NewYork-Presbyterian provides world-class care to infants with ventricular septal defects and many other congenital heart defects. Our doctors are well versed in recognizing the signs of VSD and getting your child the care they need as early as possible.