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Ventricular septal defect (VSD)

A ventricular septal defect (VSD), a hole in the heart, is a common heart defect that's present at birth (congenital). The hole occurs in the wall that separates the heart's lower chambers (septum) and allows blood to pass from the left to the right side of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to work harder.

A small ventricular septal defect may cause no problems, and many small VSDs close on their own. Larger VSDs need surgical repair early in life to prevent complications.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child's life.

Ventricular septal defect symptoms in a baby may include:

  • Poor eating, failure to thrive
  • Fast breathing or breathlessness
  • Easy tiring

You and your doctor may not notice signs of a ventricular septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if at all. Signs and symptoms vary depending on the size of the hole and other associated heart defects.

Your doctor may first suspect a heart defect during a regular checkup if he or she hears a murmur while listening to your baby's heart with a stethoscope. Sometimes VSDs can be detected by ultrasound before the baby is born.

Sometimes a VSD isn't detected until a person reaches adulthood. Signs and symptoms can include a heart murmur and shortness of breath your doctor hears when listening to your heart with a stethoscope.

When to see a doctor

Call your doctor if your baby or child:

  • Tires easily when eating or playing
  • Is not gaining weight
  • Becomes breathless when eating or crying
  • Breathes rapidly or is short of breath

Call your doctor if you develop:

  • Shortness of breath when you exert yourself or when you lie down
  • Rapid or irregular heartbeat
  • Fatigue or weakness

Congenital heart defects arise from problems early in the heart's development, but there's often no clear cause. Genetics and environmental factors probably play a role. VSDs can occur alone or with other congenital heart defects.

During fetal development, a ventricular septal defect occurs when the muscular wall separating the heart into left and right sides (septum) fails to form fully between the lower chambers of the heart (ventricles).

Normally, the right side of the heart pumps blood to the lungs to get oxygen; the left side pumps the oxygen-rich blood to the rest of the body. A VSD allows oxygenated blood to mix with deoxygenated blood, causing the heart to work harder to provide enough oxygen to the body's tissues.

It's also possible to acquire a VSD later in life, usually after a heart attack.

Ventricular septal defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you already have a child with a heart defect, a genetic counselor can discuss the risk of your next child having one.

A small ventricular septal defect may never cause any problems. Medium or large defects can cause a range of disabilities — from mild to life-threatening. Treatment can prevent many complications.

  • Pulmonary hypertension. Increased blood flow to the lungs due to the VSD causes high blood pressure in the lung arteries (pulmonary hypertension), which can permanently damage them.This complication can cause reversal of blood flow through the hole (Eisenmenger syndrome).
  • Endocarditis. This heart infection is an uncommon complication.
  • Other heart problems. These include abnormal heart rhythms and valve problems.

Ventricular septal defect and pregnancy

Having a repaired VSD without complications or having a small defect doesn't pose an additional pregnancy risk. However, having an unrepaired, larger defect; heart failure; pulmonary hypertension; or other heart defects poses a high risk to both mother and fetus. Doctors strongly advise women with Eisenmenger syndrome not to become pregnant because of the high risk of complications.

Any woman with a congenital heart defect, repaired or not, who is considering pregnancy should talk with a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist). This is especially important if you're taking medications. It's also important to see both an obstetrician and a cardiologist during pregnancy.

In most cases, you can't do anything to prevent having a baby with a ventricular septal defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics:

  • Get early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you're taking.
  • Eat a balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.
  • Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.
  • Avoid risks. These include harmful substances such as alcohol, cigarettes and illegal drugs. Also, avoid X-rays, hot tubs and saunas.
  • Avoid infections. Be sure you're up to date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.
  • Keep diabetes under control. If you have diabetes, work with your doctor to be sure it's well-controlled before getting pregnant.

If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor before getting pregnant.

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