Ventricular Septal Defect (VSD)

What is Ventricular Septal Defect (VSD)?

The normal heart has four chambers - the two upper chambers are called atria and the two lower compartments are called ventricles. The left and right atria are separated by the interatrial septum while the ventricles are separated by a wall called the interventricular or ventricular septum. The ventricular septum usually bulges into the right ventricle due to higher pressure in the left ventricle. It is made up of two parts, a larger muscular part, and a small upper membranous part.

Ventricular septal defect or VSD is a common developmental problem where there is a small opening in the ventricular septum. It may occur alone or may accompany other cardiac developmental malformations. In a heart with a VSD, there is an open communication between the left and right ventricles. There may be just a single defect or several defects in the septum. Symptoms usually depend on the size of the defect, which may be small, medium or large in size. Though large VSDs are usually detected in childhood, smaller defects may not produce any symptoms and may be detected only once the child becomes an adult.

What are the Causes of Ventricular Septal Defect (VSD)?

A VSD occurs due to a problem during the development of the fetus within the uterus. Genetic factors are often considered as responsible for the faulty development. In addition, maternal factors could also influence the development of a congenital heart disease. These include illnesses like diabetes or obesity in the mother, or habits like smoking or excessive alcohol intake during pregnancy.

Some cases of congenital VSD may be detected only in adulthood. In addition, VSD may develop for the first time in adulthood due to an injury affecting the heart, or a heart attack that damages the muscle of the interventricular septum.

What are the Symptoms of Ventricular Septal Defect (VSD)?

The age at which symptoms of a VSD appear depends on the severity of the condition. A large VSD is usually diagnosed a few weeks after birth or in childhood since it causes symptoms early. Symptoms of a small-to-medium sized VSD may appear later in life, sometimes even in adulthood.

Symptoms of VSD in a baby include:

• Sweating
• Poor weight gain
• Appearing tired while feeding
• Frequent respiratory tract infections
• Breathlessness

What are the Complications Associated with a Ventricular Septal Defect (VSD)?

Complications of a VSD include the following:

• Heart failure, where the patient may suffer from symptoms like breathlessness, increase in heart rate, and enlargement of the liver and heart
• Eisenmenger syndrome, where the shunting of blood through the defect occurs from the right to the left side of the heart.
• Aortic regurgitation, where there is backflow of blood from the aorta to the left ventricle
• Infective endocarditis, which is infection of the heart
• Arrhythmias or irregular heartbeat
• Death

How do you Diagnose Ventricular Septal Defect (VSD)?

Diagnosis may be made at birth through a routine physical examination, or when the baby develops symptoms. The doctor may hear an abnormal sound with the stethoscope which indicates the presence of a heart problem.

An echocardiography commonly helps to diagnose a VSD and also to detect any associated heart abnormality if present. Other tests that may also be used include ECG and chest X-ray. Cardiac catheterisation, where a catheter is passed into the heart, may be required to get an exact estimation of the severity of the condition.

How do you Treat Ventricular Septal Defect (VSD)?

A small VSD may close on its own by the time the child is around 2 years old and the child may only need regular monitoring.

Treatment of VSD includes the following:

• Medications may be required to treat symptoms of VSD. These may include:
• Diuretics to reduce fluids overload
• ACE inhibitors to reduce blood pressure
• Digoxin to improve the contractions of the heart
• Adequate nutrition should be provided to maintain growth of the baby
• Surgery - An open heart surgery may be performed to repair a VSD. A patch may be used to close the gap. A procedure called banding of the pulmonary trunk may be done as an initial step to reduce blood flow to the lungs in more serious cases. The surgeon should take care to prevent damage to the conduction tissue of the heart, which runs through its muscles.

How do you Prevent Ventricular Septal Defect (VSD)?

Since ventricular septal defect may have a genetic basis, genetic counseling may help to prevent VSD in some babies. Also, treatment of illnesses affecting the mother like diabetes and hypertension, and advising the mother to avoid smoking or alcohol intake during pregnancy may help to prevent VSD to some extent.

References:

1. Facts about Ventricular Septal Defect - (http://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html)
2. Spicer DE, Hsu HH, Co-Vu J, Anderson RH, Fricker FJ. Ventricular septal defect
3. Orphanet Journal of Rare Diseases (2014) 9:144 DOI 10.1186/s13023-014
   -0144-2 Nishith B, Chirantan M, Sanjula V, Harpreet S and Deepak S. (2014) Ventricular Septal Defect after Blunt Trauma in a Case of Preexisting Prosthetic Mitral Valve. World Journal of Cardiovascular Surgery, 4, 227-231. doi: 10.4236/wjcs.2014.412033
4. Harrison's Principles of Internal Medicine 19^th edition

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