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Ventricular Septal Defect - An Overview!

MBBS, MD - Paediatrics, FNB Pediatric Cardiology
Pediatric Cardiologist, Delhi
Ventricular Septal Defect - An Overview!

VSD (a hole in the heart) refers to a congenital heart disease where a hole is formed in the ventricle septum i.e. wall between two lower chambers of the heart. As a result of this, blood from the left portion of the heart (left ventricle) crosses this hole and goes to right-sided heart that results in blood overflow to lungs.
VSD is one of the commonest child heart diseases that is seen at birth, but adults too may suffer from it following an acute heart attack.

What are the causes for Ventricular Septal Defect?
Congenital VSD occurs during heart development of the fetus. The heart develops from a huge tube, dividing into sections that, in turn, will become the chambers, walls and vessels of the heart. If something goes wrong during this process, a hole can develop in the ventricular septum.
Sometimes, VSD may be caused due to genetic and environmental factors. For instance, if you have a family history of genetic conditions like Down syndrome or congenital heart diseases, then your child may be at risk of developing a Ventricular Septal Defect.

Symptoms Indicating VSD-
The signs and symptoms of Ventricular Septal Defect vary depending on the size of the VSD. If the hole is small, child may be asymptotic. Children or young adults with small VSD only show signs of a heart murmur that is detected by their family physician.
A medium or large sized hole is likely to exhibit the following noticeable symptoms in children –

  • Rapid breathing/Breathlessness
  • Poor weight gain/ Failure to thrive
  • Poor feeding
  • Tiredness and fatigue
  • Excessive sweating
  • Inability to engage in physical activities
  • An enlarged heart
  • A tint of blue on the lips, fingernails, and skin in late stages of large VSD

These symptoms indicate that the VSD will most likely not close by itself, and therefore, require urgent intervention. If left untreated, Ventricular Septal Defect may lead to further complications such as pulmonary hypertension, endocarditis, or Eisenmenger like situation.

How is VSD diagnosed?
Usually, VSD is detected within the first few weeks after the birth of the child during a routine check-up. The doctor can tell if your child has a hole in the heart by hearing a heart murmur, as oxygen-rich blood passes between the two ventricles.

Suspecting VSD, your doctor may refer you to a paediatric cardiologist, who will then perform a physical examination on your child, taking his/her medical history in consideration. The following tools are used to confirm the diagnosis –

  • An X-ray of the chest
  • An electrocardiogram or ECG
  • Most importantly by doing a pediatric echocardiogram (ECHO): this is done from the child's chest, a non-invasive modality with no pain to the child

What is the treatment?
Treatment of VSD depends on the size of the hole, and the age and weight of the child.

A small VSD with no significant symptoms mostly will require only follow-up. The child can do his/her activities without much fear.

Moderately sized VSD children are having poor weight gain and show signs of heart failure but less as compared to large VSD. These VSD needs to be followed up to 9-12 months of age and needs to close. The method of closure of moderate sized VSD depends on its location and size of VSD. Majority of moderate sized VSD can be closed by using a device in cath lab angiographically (VSD device closure non-surgically) or else by doing open heart surgery.

In a case of large VSD: Child shows signs of heart failure or in respiratory distress then first medical therapy in the form of diuretics are prescribed for decreasing the signs of heart failure. Then VSD surgical closure is advised preferably between 3-6 months of age.

Heart Surgery – This involves making an incision in the chest wall and maintaining circulation with the help of a lung-heart machine while closing the hole. The surgeon may either seam the hole or stitch a patch of material over it. The heart tissue will eventually heal over the stitches or patches. In about six months, the tissue will cover the hole completely.
Another treatment option is cardiac catheterization.

Cardiac Catheterization (Non-surgical closure of VSD)– The cardiologist inserts a catheter into the blood vessel in child legs that reach up to the heart. He/she then guides the tube to make measurements of blood pressure, blood flow, and level of oxygen in the chambers of the heart. A special implant known as a device is placed into the septal hole (VSD). The device flattens against the septum on both the sides to permanently heal and close the VSD.

Having your child diagnosed with a heart defect can be scary. However, consulting a paediatric cardiologist at the earliest can be helpful, as he will be familiar with Ventricular Septal Defect, and can tell you the best way to manage the condition.

3293 people found this helpful

All About Atrial Septal Defect!

MBBS, MD - Paediatrics, FNB Pediatric Cardiology
Pediatric Cardiologist, Delhi
All About Atrial Septal Defect!

An Atrial Septal Defect is present at birth (congenital heart disease). The condition refers to a hole in the septum or walls (atrial septum) that separate the heart’s upper chambers – atria.
The heart of the fetus develops during pregnancy. Normally, there are several openings in the septum dividing the atria, which close during pregnancy or soon after birth. However, a hole is formed if one of the openings does not close, leading to atrial septal defect.
Due to a hole in the heart, blood flows from left atrium to the right atrium and extra blood goes to the lungs.

When should you see a doctor?
Majority of atrial septal defect affected children are asymptomatic i.e. not having any symptoms. Only a few babies, especially in the first year of life, can show signs of heart failure if associated with other heart diseases.
It is possible that ASD will remain undetected until adulthood. The most common way to diagnose the condition is to have your doctor listen for a heart murmur while checking up with a stethoscope.
However, if ASD is not treated on time and progresses into adulthood then these problems can occur with time:

Diagnosis and Treatment-
If your doctor suspects your child of having Atrial Septal Defect, he/she will likely perform an X-ray or an ECG.
But for confirming the diagnosis, Pediatric Echocardiogram needs to be done from the chest of the child. This is a non-invasive test.
In bigger children or adolescents, sometimes echocardiogram from the chest is not possible as image quality is not good, in these cases; echocardiogram needs to be done from food pipe (esophagus) known as a transesophageal echocardiogram (TEE).

Treatment for ASD depends on  – age of the child, size and location of the hole
There is no role of medications in ASD.

Paediatric cardiologist may recommend the following options –
1. Catheter Closure – Commonly known as ASD device closure (non-surgical closure of ASD by cardiac catheterization). This process involves positioning special devices called a septal occlude into the hole. The device prevents the flow of blood through the abnormal hole in the heart.
Only ostium secundum variety of ASD (OS-ASD) can be closed by this technique if ASD is having good margins around it.
Ideal time for closing the ASD is between 2-4 years of age.

2. Surgery – The surgeon may perform surgery to correct the defect if the hole has not closed by itself. The procedure is done under general anaesthesia. The surgeon sews the abnormal hole directly with a special patch or stitches. This needs to be done from the chest by open heart surgery. Other types of ASD like primum defect, sinus venosus defect closed by surgery.
Ideally, sinus venosus defects should be closed by 5 years of age.
Ostium primum defect if not associated with significant mitral regurgitation then should be closed by 2-4 years of age or else by 1-2 years of age.

All children diagnosed with an Atrial Septal Defect need special care under the guidance of a paediatric cardiologist.

3037 people found this helpful

I wanted know about Ventricular Septal Defect. Is it genetic or acquired? How it affect on day to day life & it's future consequence on pregnancy. Thanks.

Dr. Neelam Nath 92% (8917 ratings)
Diploma in Obstetrics & Gynaecology, MBBS
General Physician, Delhi
I wanted know about Ventricular Septal Defect. Is it genetic or acquired? How it affect on day to day life & it's fut...
Vsd is by birth, a congenital anomaly, not genetic or aquired. When there is a hole between 2 chambers of lower heart which pump the blood to entire body & to lungs for purification with fresh oxygen, the pumping action of heart will be affected for sure. Luckily the defect can be corrected but not during pregnancy. Depends upon symptoms. Avoid extra load on heart by rest, avoid swelling on body by reducing salt, eat more proteins to help baby grow faster & do operation to deliver the baby according to symptoms shown by mother about her heart being affected or not, she can carry the baby to full term at 36 weeks or an early delivery needs to be planned. But vsd is not inherited. Be sure to have a normal baby.
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My 1 year 8 months baby is suffering from Ventricular septal defect with perimembranous extension. Gradient of 30 mmhg. Doctor has advised for open heart surgery. I want to know that open heart surgery is must in this case or not and if yes then how many days are needed in the hospital for the treatment of heart surgery?

Dr. Neelam Nath 92% (8917 ratings)
Diploma in Obstetrics & Gynaecology, MBBS
General Physician, Delhi
My 1 year 8 months baby is suffering from Ventricular septal defect with perimembranous extension. Gradient of 30 mmh...
Yes it is a must surgery , post operative time depends upon the recovery , and your treating doctor knows best as to when to send less than 2 years old baby home
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Good day. I am 24 years old, female. I have congenital heart disease, ventricular septal defect perimembranous type with the left to right shunt. Based on my 2d echo last 2018 my qp/qs is 1.7:1. But this 2019 it becomes 1.6:1. I just want to ask, what does it mean? It is good or bad result.

Dr. Prakhar Singh 95% (2720 ratings)
MBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)
General Physician, Delhi
Good day. I am 24 years old, female. I have congenital heart disease, ventricular septal defect perimembranous type w...
Congenital heart defect is a problem with the structure of the heart. It is present at birth. Congenital heart defects are the most common type of birth defect. The defects can involve the walls of the heart, the valves of the heart, and the arteries and veins near the heart. Let's have a detailed discussion to Ensure proper treatment.
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My Son (D.O.B.- 05th Oct 2017) is suffered from Ventricular septal defect (06 mm) & Atrial Septal Defect (04 mm. His Surgery is recommended by AIIMS-Delhi, & surgery is expected in coming months. My question is about using DTaP-Pentaxim (Pain-Less) or DPT-Pentavac (Pain-Full). Baby weight is also seems not utpo the mark & feels little lower from standard charts. Since starting we are injecting DTaP-Pentaxim (Pain-Less). Please suggest do I need to move for Pain-Full? Because i've read over google that pain-less is not so effective. Also suggest if anything else you wish to. Thank you in advance.

Dr. Bhagyesh Patel 94% (8331 ratings)
MS - General Surgery, FMAS.Laparoscopy
General Surgeon, Gandhinagar
My Son (D.O.B.- 05th Oct 2017) is suffered from Ventricular septal defect (06 mm) & Atrial Septal Defect (04 mm. His ...
Hello dear lybrate-user, hi Warm welcome to I have evaluated your query for your son thoroughly.* Practically there are no major advantages of Pentavac over Pentaxim, so I do not recommend switching over it and increase pain to the baby. Hope this clears your query. Wishing him fine recovery. Welcome for any further assistance. Regards take care.
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Hello Doctor, we had to terminate our pregnancy in the 24th week due to congenial heart defects (VSD, Truncus arteriosus) in the fetus. I was told that the reasons for the CHD could be a.) getting married in the same blood relation, b.) the effects of some medicines on the pregnancy at the time of conception, c.) because of some defect in chromosomes and/or d.) it was just random or an accident. My wife and I are not married in the same blood relations and my wife was on antibiotics one month prior to conception. Could you please tell me what exactly could be main reason for this defects and what are the chances that these defects will not be there in subsequent pregnancies and what precautions shall we take to mitigate these risks in the future.

Dr. Surbhi Agrawal 92% (19969 ratings)
General Physician, Nashik
Hello Doctor, we had to terminate our pregnancy in the 24th week due to congenial heart defects (VSD, Truncus arterio...
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.
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Im suffering from asd Atrial septal defect. It is 2.27 to 2.58 cms .it will be cure with device closure or not?

Dr. G.R. Agrawal 97% (26699 ratings)
DHMS (Hons.)
Homeopath, Patna
Im suffering from asd Atrial septal defect. It is 2.27 to 2.58 cms .it will be cure with device closure or not?
hello, liberate user, it depend upon the severity of individual case, some times surgical intervention might be needed to repair atrial septal defect. the care.
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My daughter age 8 months old with congenital heart defect, recently echocardiogram report says ostium secundum atrial septal defect sizes of 0.8mm diameter, left to right shunt. No feeding problem. Is it necessary for open heart surgery to close the hole now at these age?

Dr. Pradeep Kumar Jain 89% (142 ratings)
MD - Paediatrics, Fellowship in pediatric cardiology, Post Graduate Program in Pediatric Nutrition (PGPN)
Pediatrician, Varanasi
Hello thanks for the query first of all I would like to know the exact size of atrial septal defect (asd. I think it should be 0.8 cm not 0.8 mm (as 0.8 mm asd will not cause any significant problem). The management depends on the following parameters 1) growth of the baby, 2) how frequent she is getting symptomatic 3) how severe are the symptoms 4) what is the exact hemodynamic finding in the echo (including pulmonary pressure) 8 mm asd considered to be large and chances of spontaneous closure is less. The weight and height you have mentioned is appropriate for age. Also I would like to know the margin of the defects. As on the basis of rims of the defect we can decide whether device closure can be done to avoid the open heart surgery. I request you to give detail history and to attach the echo report so that I better able to help you out. Regards.
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