Ventricular Septal Defect
Maybe your mom or dad told you about the surgery you had as a little kid. Or maybe you found out when you asked about the scar on your chest. Or perhaps you're wondering why you have to visit the doctor so often. Lots of people who have, or have had, a ventricular septal defect may find themselves wondering: What is it and what does it mean for me?
Ventricular septal defect (pronounced: ven-TRIK-yu-lar SEP-tul DEE-fekt), or VSD for short, is a heart condition that can affect teens — although most people with VSDs have had the problem diagnosed long before they reach their teenage years.
What Is a Ventricular Septal Defect?
To understand this defect, it first helps to review some basics about the way a healthy heart typically works.
The heart has four chambers: The two lower pumping chambers of the heart are called the ventricles, and the two upper filling chambers are the atria. In normal circulation, blood that returns from the body to the right-side filling chamber (right atrium) is low in oxygen. This blood passes to the right-side pumping chamber (right ventricle), and then travels to the lungs to receive oxygen. The oxygen-enriched blood returns to the left-side filling chamber (left atrium), then moves to the left-sided pumping chamber (left ventricle).
The blood is then pumped out to the body through the aorta, a large blood vessel that carries blood to the smaller blood vessels in the body to deliver oxygen. The right and left-sided pumping chambers (ventricles) are separated by shared wall, called the ventricular septum.
In a person with a VSD, there is an opening in the wall (called the septum) between the right ventricle and the left ventricle. You might hear this type of problem also referred to as a "hole in the heart." As a result, when the heart beats, some of the blood in the left ventricle (which has received oxygen from the lungs already) is able to flow through the hole in the septum into the right ventricle.
In the right ventricle, this oxygen-rich blood mixes with the oxygen-poor blood and is directed via the pulmonary artery back to the lungs. The blood flowing through the hole creates an extra noise during the listening exam of the heart, known as a heart murmur. The character of the heart murmur, along with other specific heart sounds that can be detected a cardiologist, may be clues that a person has a VSD.
There are different types of VSDs, based on the exact location within the ventricular septum. They also can vary in size. The symptoms and medical treatment of the VSD will depend on these features. Sometimes, VSDs can also be present as part of more complex types of congenital heart disease.
Most teens with VSD had it — as in, past tense. Although ventricular septal defects are quite common, it's pretty rare for a VSD to go unnoticed until the teenage years. This means that the chances are good a VSD is no longer causing problems for a teen.
In about 40% of kids born with VSDs, the hole is small and it closes on its own after birth. If a VSD is large and needs surgery, it was most probably fixed during early childhood. In the remaining cases (kids who have VSDs that have not been corrected by surgery and have not closed on their own), the hole is too small to cause health problems.
What Causes a VSD?
Ventricular septal defects occur during fetal heart development and are present at birth. During the first weeks after conception, the heart develops from a large tube, dividing into sections that will eventually become the walls and chambers. If a problem occurs during this process, a hole in the ventricular septum may result.
In some cases, the tendency to develop a VSD may have a genetic basis. Some genetic syndromes can cause extra or missing pieces of chromosomes that can be associated with VSD. For the vast majority of children with a defect, however, there's no clear reason why a VSD develops.
Signs and Symptoms
VSDs are usually found in the first few months of life by a doctor during a routine checkup. The size of the hole and its location in the heart will determine whether someone experiences symptoms of VSD. Most teens with VSD probably don't remember having it because it either goes away on its own or is diagnosed so early in childhood that there's no memory of any surgery or recovery.
Teens who have small VSDs that haven't closed yet usually don't notice any physical signs other than the heart murmur that doctors hear. They may need to see a doctor regularly to check on the heart defect and make sure there aren't any problems.
The very small number of teens with moderate and large VSDs that haven't been treated in childhood may notice some symptoms, however. These include shortness of breath, a feeling of tiredness or weakness (especially during exercise), poor appetite, and trouble gaining weight.
Most kids with moderate to large VSDs are treated long before the VSD ever causes problems.
Diagnosing a VSD
If your doctor notices a heart murmur that was not noticed earlier, you may be referred to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.
In addition to doing a physical exam, the pediatric cardiologist will take your medical history by asking about any concerns, past health, family health, any medications you are taking, any allergies you may have, and other issues. If a VSD is suspected, the cardiologist may order one or more of these tests:
- a chest X-ray, which produces a picture of the heart and surrounding organs
- an electrocardiogram (EKG), which records the electrical activity of the heart
- an echocardiogram (echo), which uses sound waves to produce a picture of the heart and to visualize blood flow through the heart chambers. This is often the primary tool used to diagnose VSD.
- a cardiac catheterization, which provides information about the heart structures as well as blood pressure and blood oxygen levels within the heart chambers. This test is not typically performed for VSD unless additional information is needed that cannot be obtained with other testing.
If a doctor diagnoses someone with a VSD, treatment will depend on the patient's age, the size of the hole, and where it's located in the heart. There's no concern that a VSD will get any bigger, though: VSDs may become smaller or close completely without treatment, or they may not change. But they don't get any larger.
A kid or teen with a small defect that causes no symptoms might simply need to visit a pediatric cardiologist regularly to make sure there are no problems. In most kids and teens, a small defect will close on its own without surgery. And there's more good news — if you have a small VSD, you probably won't have to restrict your sports or extracurricular activities in any way.
If there is a medium to large VSD, surgery may be necessary to close it. In most cases, this surgery takes place in young children — usually in the first year of life. A few people have surgery during adolescence. Until their VSDs are corrected, some people with larger VSDs may need to take medication to help the heart pump more efficiently or help the body get rid of extra fluids.
VSD surgery involves making a cut in the chest so a surgeon can stitch the hole closed or sew a patch of manmade surgical material (such as Dacron or Gore-Tex) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, and by 6 months after the surgery, the hole will be completely covered with tissue.
Certain types of VSDs may be closed by a non-surgical technique during a procedure known as cardiac catheterization. A thin, flexible tube (a catheter) is inserted into a blood vessel in the leg that leads to the heart. A cardiologist guides the tube into the heart to make measurements of blood flow, pressure, and oxygen levels in the heart chambers.
Doctors might put a special implant into the hole in the septum. The implant is made of flexible wire mesh shaped into two disks. It's designed to flatten against the septum on both sides to close and permanently seal the VSD. Doctors only use this technique to treat certain types of VSD.
After healing from surgery or having catheterization, people shouldn't have any more problems from the VSD.
People with some types of heart defects, including VSD, are at more risk of having infective endocarditis in their lifetime. It's caused by bacteria in the bloodstream. The best way to protect the heart is to reduce the bacteria count in the mouth, teeth, and gums. You can do this by brushing and flossing every day, and getting dental cleanings every few months.
Doctors often recommend that people who have had heart surgery take antibiotics before a dental visit for the first 6 months or so after surgery. After that, most doctors don't think there's a need for kids and teens to take antibiotics before dental visits. Every case is different, though, so ask your doctor what's best for you.
Teens who have a heart defect should avoid getting body piercings. Piercing increases the possibility that bacteria can get into the bloodstream, infect the heart, and damage heart valves. If you're considering a piercing and you have a heart defect, talk to your doctor first.
Taking Care of Yourself
Teens who have surgery for larger VSDs usually leave the hospital 4 to 5 days after surgery if there are no problems.
The first few days at home after VSD surgery, your doctor will probably tell you to get lots of sleep or hang out in bed or on the couch doing quiet activities like watching TV or reading. In 2 to 3 weeks, you might feel better, but it's still important to take it easy until about 6 weeks after the surgery. Everyone heals differently. Your doctor will let you know when it's best to go back to school and return to normal activities.
After surgery, the incision (the place where the surgeon cut into the chest) may be tender and sore. A doctor may tell you to take a pain reliever if you feel a lot of pain. It takes about 6 weeks for a chest incision to heal. Sometimes there can be numbness, itchiness, tightness, and burning around the incision. These are normal parts of healing, but let your doctor know if you have any of the problems listed below.
In most cases, teens who have had VSD surgery recover quickly. But some things can be signs of a problem. Tell a parent or another adult so you can get medical treatment right away if you have:
- trouble breathing
- fever, swollen glands, or both
- increasing pain or tenderness
- pus or blood oozing from the incision
- swelling and an expanding area of redness (or red streaks) around the wound
You'll also want to let your parents and doctors know if you don't feel like eating or you've lost weight, as these can be signs of a problem.
A chest incision leaves a scar in the middle of the chest. How it ends up looking depends on skin type. Everyone heals differently. It's natural to feel a little self-conscious about a scar. If the way your scar looks bothers you a lot, talk to your doctor or a dermatologist about what can be done.
These days, having a VSD is usually nothing to worry about. Your pediatric cardiologist is very familiar with this common heart problem and understands how to best take care of it. Most people who have had a VSD can enjoy the same activities as their friends, and live long, healthy, active lives.