Ventricular Septal Defect

A ventricular septal defect (VSD) is a congenital heart defect in which there is a hole in the wall or septum that separates the lower chambers (ventricles) of the heart. This wall is also called the ventricular septum. VSD is the most common congenital heart defect in newborn babies. It is more likely to happen in premature babies or those with certain genetic conditions.

In cases with VSD, blood flows from the left ventricle through the hole to the right ventricle and into the lung arteries. If left uncorrected, this can lead to complications such as heart failure, failure to thrive, growth retardation, pulmonary hypertension, arrhythmia, or stroke.

Types of VSD

A VSD is one of four types based on the location and structure of the hole or holes. These include:

• Membranous VSD: Membranous VSD is the most common type of VSD, accounting for approximately 80% of cases.It happens in the upper section of the wall between the ventricles.
• Muscular VSD: In muscular VSD, there is a hole in the membranous part of the ventricular septum. There may be two or more holes that are part of the defect. This accounts for approximately 20% of VSDs in infants.
• Inlet VSD:This type of VSD includes a hole in the septum where the blood enters the ventricles through the tricuspid and mitral valves, i.e. inlet part of the ventricular septum.
• Outlet VSD: In outlet VSD, a hole is present before the pulmonary valve in the right ventricle and the aortic valve in the left ventricle, i.e., the outlet or infundibular part of the ventricular septum.

Symptoms of VSD

The symptoms of VSD in infants include shortness of breath, fast breathing, sweating, or fatigue during feeding, slow weight gain, frequent respiratory infections, etc. Older children and adults can experience symptoms such as feeling tired and breathless while exercising, heart inflammation, pale skin, etc.

Treatment of VSD

Small VSDs are likely to close on their own in infants before the age of 6 years. In cases where the VSDs are larger or malaligned or in the inlet and outlet parts of the ventricular septum, they will most likely need surgical repair.

Surgery is the most reliable way to close a VSD. VSDs are patched surgically by the cardiac surgeon and the hole is closed using a patch made of synthetic material or a graft of the patient’s tissue. Transcatheter procedures involve accessing the heart via a major artery. The catheter device places a specialised device called an occluder and closes the hole. Transcatheter device closure is available only in selected cases.

In both surgery and the transcatheter approach, the heart tissue will grow over and around the patch and occluder device, respectively.

Most children with a closed VSD lead healthy lives. Some children may require medicines for a short period of time to strengthen the heart muscle, lower blood pressure, and help the body get rid of extra fluid.