Resource Center
What is a Ventricular Septal Defect (VSD)?
Topics listed below include:
- Overview
- How common are VSDs?
- What other heart problems can occur with a VSD?
- How do VSDs develop?
- What causes a VSD to develop?
- How are VSDs diagnosed?
- If I have a VSD, can I have children?
- If I have a VSD, do my children have a higher risk of having a heart defect?
- What are the long-term outcomes for adults with unrepaired VSD?
- What health problems are caused by a VSD?
- Do all VSDs cause health problems?
- Are there restrictions on how much those with VSD can exercise?
- When and how was VSD surgery first performed?
- How are VSDs treated now?
- What are the long-term outcomes for adults with repaired VSD?
- What kind of cardiology care is recommended for adults with repaired and unrepaired VSD?
- What other challenges face adults living with VSD?
- CACHnet information on VSD
A ventricular septal defect (VSD) is a hole in the wall of the heart between the bottom two chambers. The septum is the wall that separates the left and right sides of the heart. If there is a hole in the septum between the two ventricles, it is called a ventricular septal defect (VSD).
How common are VSDs?
VSD is the most common heart birth defect. About 1 in 500 babies are born with a VSD. About 30% of all heart defects are VSDs.
What other heart problems can occur with a VSD?
Some people born with VSDs have additional heart problems, such as leaking or narrowing of their heart valves. VSDs can also be a part of other more complex heart defects. If you have a more complex defect in addition to your VSD, the more complex defect is considered to be your primary diagnosis.
How do VSDs develop?
In the womb the heart starts out as a single chamber tube. As this chamber loops, the two ventricles come to lie more side by side and a wall (septum) develops to complete the division of the heart into left and right sides. This allows the two sides to perform different functions. The right side pumps blood to the lungs, and the left side pumps blood to the body. Sometimes this wall does not grow completely and a hole remains.
What causes a VSD to develop?
No one knows exactly why VSDs happen. Research suggests that a combination of genes and environment may be a factor. As we learn more about the human DNA, we may understand more about what causes this heart defect. VSDs are more common in children with other genetic problems, such as Down syndrome. But 95% of those born with a VSD have no other birth defects.
How are VSDs diagnosed?
Most ventricular septal defects are found shortly after birth. By listening to the heart with a stethoscope, a doctor can usually hear the rumble or swish of blood as it goes through the hole. This is called a murmur. Sometimes you can even feel the rumble of the blood going through the hole, just by putting a hand on the chest; this is called a thrill. Sometimes VSDs are not found until later in childhood or adulthood. Patients may be sent to the cardiologist with symptoms such as shortness of breath with exercise and heart rhythm problems. Tests to verify the presence and impact of a VSD may include:
- Chest x-ray to look at the heart and lungs for enlargement or fluid
- Electrocardiogram, which is a tracing of the heart’s electrical system.
- Echocardiogram, which is an ultrasound picture of the heart to look at its structure.
- Cardiac MRI, which is a special scan looking at heart structure.
If I have a VSD, can I have children?
If you have a repaired VSD with normal heart function you have no increased risk compared with women with normal hearts. This is also true for those with small VSDs.
If you have a significant unclosed VSD, and/or have additional heart or lung problems, specialized care by experts in heart defects and pregnancy is advised. Most women with these problems can also have children successfully.
If you have a large VSD and have developed serious pulmonary hypertension, pregnancy is not advised. More than 50% of mothers and children in this situation do not survive.
If I have a VSD, do my children have a higher risk of having a heart defect?
All adults with congenital heart defects have a higher-than-average risk of having a child with a heart defect. These defects may be the same or different than the parent’s defect. Overall for mothers with congenital heart disease, their children will have about a one in 30 risk of having a heart defect. However, as we learn more about the genetics of CHD, we may find that each individual’s risk is higher or lower based on as-yet unknown factors. The general population has about a one in 100 risk of having a baby with a heart defect.
What are the long-term outcomes for adults with unrepaired VSD?
Many small VSDs do not require treatment and cause no harm. But if heart and lung problems occur, closure should occur promptly. VSD closure was not widely available until the late 1960's. This means that many adults with VSDs born before this time had surgery later in life or not at all. Many have developed additional heart, lung, and blood problems in response to the long term effects of their VSD. When this occurs, it is called Eisenmenger's Syndrome. Once permanent lung and heart damage has occurred, VSD closure may no longer be an option.
What health problems are caused by a VSD?
If the hole between the two sides is big enough, blood from the left side of the heart will flow across the hole and back into the right side of the heart. This causes blood to be pumped through the lungs again, making the heart work less efficiently. Over time, the heart and lungs can get overloaded. This can cause too much pressure in the lungs (pulmonary hypertension), which can cause lung damage. The heart may weaken and develop heart failure. Symptoms such as shortness of breath, pale skin, slow growth, and poor appetite may develop.
Do all VSDs cause health problems?
No. Many children are born with small VSDs that close on their own. In addition, many children and adults have small VSDs which do not affect their heart’s pressure or function. Instead of closing these VSDs, doctors may monitor the heart to make sure that intervention does not become necessary. If you have a VSD, it is important that you continue to go to the doctor as recommended to make sure your heart stays healthy.
Are there restrictions on how much those with VSD can exercise?
If you have a repaired VSD with no additional problems, your cardiac function is considered normal. This means you can engage in all athletic activities. This is also true of those with small VSDs.
If you have additional problems, such as shunting, rhythm problems, and/or valve problems, you should consult with your cardiologists about what kind of exercise is most appropriate for you.
We recommend that all those with heart conditions check with their cardiologist before taking on any new athletic activities.
When and how was VSD surgery first performed?
VSDs were one of the first heart defects to be treated. The first VSD closure was done in 1954. Children who underwent these early operations are still alive today. As surgery developed, VSDs were closed using a variety of materials and approaches. Surgeons tried entering the heart in different locations. They also used different patch materials and techniques. The specific way VSD was closed may affect your long-term health.
How are VSDs treated now?
There are now two options for closing VSDs - by catheter, and by open-heart surgery. A catheter is a long thin tube that the doctor guides into the heart. They use it to put a patch across the hole.
Most patients who require VSD closure have open heart surgery. Most adults with previously-repaired VSDs had open heart surgery as an infant or child, since catheter closure only recently became available and is still considered experimental.
What are the long-term outcomes for adults with repaired VSD?
The oldest survivors of VSD closure are now in their forties and fifties—or older if operated on in adulthood. This means that we do not yet know what the life-long impact of VSD closure will be. However, the information we have is very encouraging for patients who had an isolated VSD. If your surgery was done early, before the onset of serious heart and lung problems, your prognosis is excellent. Adults with closed VSDs are expected to have a normal life span. So far only about 6% have needed re-operation. The most common reason was to close small leaks that develop around the original patch.
But remember that if you have a repaired VSD you do not have a "normal" heart. Everyone who had a VSD has a life-long risk of additional heart problems. Problems can occur many years after your original repair. One risk is endocarditis, or heart infection. It is very important that you ask your cardiologist about how to protect yourself from endocarditis. People with repaired VSDs can also develop heart rhythm problems. This is sometimes caused by scars in your heart created by your previous surgery.
What kind of cardiology care is recommended for adults with repaired and unrepaired VSD?
If you had your VSD repaired and have no additional heart problems, you do not need on-going specialized ACHD care. This is also true if you have a small unrepaired VSD which causes no symptoms. However, a periodic general cardiac exam is suggested. You should also continue to protect yourself from heart infection (endocarditis). Some experts also recommend that you be seen once at a specialized ACHD center, to make sure that your diagnosis is accurate. Patients with small unrepaired VSDs continue to be at risk of developing narrowing under the aortic or pulmonary valves, aortic valve insufficiency, or endocarditis.
If you are experiencing additional heart problems, regular care by a specialized adult congenital heart clinic is recommended. These problems include the following: missing valves, aortic regurgitation or insufficiency, coarctation (narrowing) of the aorta, mitral valve disease, right ventricular outflow tract obstruction, straddling tricuspid/mitral valve, and/or subaortic stenosis. This is also true if you show signs of lung problems or heart function problems, such as enlarged ventricles.
If you have an unrepaired or repaired VSD with pulmonary hypertension, you should receive regular care at a specialized ACHD clinic. It is important that you see doctors who know about your special needs and can help keep you feeling your best. New treatments for your symptoms may also be available.
What other challenges face adults living with VSD?
Like all those with congenital heart defects, adults with VSD can face psychosocial issues related to their CHD. For example, teens and young adults may have self-esteem issues related to their scar. Adults with VSDs can also have difficulty obtaining life and health insurance. If you are rejected or asked to pay higher premiums, we suggest that you ask your cardiologists to send additional documentation about your health condition to your insurance company, including data on long-term outcomes in your disease.