Ventricular Septal Defect

Overview

A ventricular septal defect (VSD) is an abnormal communication in the wall between the lower pumping chambers of the heart (right and left ventricles). This congenital heart defect occurs when the wall (ventricular septum) doesn’t form properly during fetal development, leaving an opening or “hole in the heart.”

This hole allows blood from one side of the heart to cross into the other. Typically the blood flows from the left side to the right side, resulting in increased blood flow to the baby’s lungs after birth.

The severity of the condition depends on the size and location of the hole. In cases where the hole is moderate to large, the additional blood flowing into the lungs can lead to heart failure and in some cases damage to the arteries in the lungs resulting in elevated lung artery pressures a condition called pulmonary hypertension (if left untreated).

A ventricular septal defect can be found in isolation or may be present with congenital heart disease involving multiple heart lesions, such as tetralogy of Fallot, double outlet right ventricle (DORV) , tricuspid atresia, truncus arteriosus or transposition of the great arteries.

How will a ventricular septal defect affect my baby?

In a normal heart, the right ventricle pumps oxygen-poor blood to the lungs to receive oxygen. This blood returns to the left side of the heart. The left ventricle pumps oxygen-rich blood out to the body. The two lower pumping chambers (ventricles) are separated by a wall of muscle called the ventricular septum. This septum keeps the oxygen-poor (blue blood) on the right side of the heart from mixing with the oxygen-rich (red blood) from the left side of the heart.

In a baby with a VSD, oxygen-rich blood from the left ventricle flows through the opening in the ventricular septum and into the right ventricle, where it gets pumped back to the lungs instead of out to the body.

If the VSD is small, there may be very little blood passing from the left to the right ventricle, with little to no impact on the heart and lungs. In more severe cases involving excessive blood flow to the lungs, complications can include:

• Heart failure, as the left heart dilates over time with excessive blood flow to the lungs resulting in congestion (edema) in the lungs
• High pressure in the blood vessels in the lungs (pulmonary hypertension) and exposure to increased pressure from the VSD which can cause permanent damage over time
• Poor growth and development, if the baby experiences breathing difficulties and fatigue that can lead to feeding problems and ultimately a condition called failure to thrive

Cause

A ventricular septal defect is a congenital heart defect, meaning it is present at birth. The condition occurs in the first eight weeks of pregnancy when the fetal heart fails to form properly.

The cause is typically unknown.

Diagnosis

Ventricular septal defects may be detected during a routine prenatal ultrasound. A fetal echocardiogram (ultrasound of the fetal heart) is typically needed to confirm the diagnosis and learn more about the defect. Fetuses with an isolated VSD are not symptomatic and are rarely at risk as a fetus from the VSD.

A diagnosis during pregnancy enables your family and your healthcare team to plan ahead for the specialized treatment and cardiac expertise your baby will need at birth, optimizing outcomes.

In cases where the VSD is small, it may not be detected until after the baby is born. Following birth, your doctor may detect a heart murmur (abnormal sound heard with the doctor’s stethoscope) and diagnose this condition.  Infants with moderate to large VSDs may experience difficulty feeding, irregular heartbeat (arrhythmia), rapid breathing, fatigue, pale skin, and poor weight gain or weight loss. The larger the hole, the more severe the symptoms and the earlier they may appear. Symptoms may not develop until 4 to 6 weeks after birth which is typically when the pressures in the lungs decrease resulting in more flow across the hole to the lungs.

Specialized Prenatal Evaluation and Care

If a ventricular septal defect is diagnosed during pregnancy, referral to a fetal cardiac center is important for further evaluation and to ensure proper treatment planning.

At Texas Children’s Fetal Center, we arrange for you to visit as quickly as possible for a comprehensive assessment by a team of specialists experienced in diagnosing and treating congenital heart defects. Your healthcare team will include maternal-fetal medicine physicians (OB/GYNs specializing in high-risk pregnancies), fetal and pediatric cardiologists, fetal imaging experts, genetic counselors, congenital heart surgeons and neonatologists.

Additional testing may include:

• High-resolution anatomy ultrasound to confirm the diagnosis, evaluate the condition and look for other abnormalities
• Ultra-fast MRI for a more detailed view of fetal anatomy
• Fetal echocardiogram to assess fetal heart structure and function
• Doppler ultrasound to examine blood flow patterns 
• Amniocentesis and chromosomal analysis to screen for genetic abnormalities

Our specialists will then meet with you about the results, provide treatment recommendations, and answer any questions your family has, to help you make the most informed decisions regarding your baby’s care and treatment.

During pregnancy, mother and baby will be closely monitored for early detection of complications, including fetal non-immune hydrops (fluid accumulation in multiple areas of the baby’s body) and fetal heart failure, requiring early delivery.

Delivery

For the best possible outcomes, delivery should take place at a center with the highest quality congenital heart program, ensuring the expertise and resources required at birth to treat ventricular septal defects, including an advanced neonatal intensive care unit (NICU).

Delivery and postnatal care should be carefully planned and coordinated. Our Fetal Center team works closely with Texas Children’s Heart Center, seamlessly transitioning your baby’s care at delivery to this national leader in pediatric cardiology and heart surgery. Here, the heart specialists treating your newborn have been an integral part of their care team since before birth.

Following delivery at Texas Children’s Pavilion for Women, your baby will be transferred to Texas Children’s level IV NICU, the highest level of care available for premature and critically ill newborns, or Texas Children’s specialized cardiac intensive care unit (CICU). 

Treatment After Birth

Treatment after birth depends on the severity of the condition, the child’s symptoms, age, and overall health, and the presence of any other defects.

Babies with small VSDs with no symptoms rarely require treatment or surgery. Often a small hole will close on its own for the fetus or following birth within the first few years of life.  

In cases involving larger VSDs, treatment strategies include:

• Medications – to help with symptoms, such as feeding and breathing difficulties
• Nutritional supplements and supplemental tube feedings – to improve weight gain
• Heart surgery – to close the hole in the septum. For moderate to large holes, surgery is often performed within the first 3 to 6 months of life or sooner if growth is poor or symptoms are severe

Postnatal Care Team

Depending on the severity of your baby’s condition, their postnatal care team may include:

• Neonatologist
• Pediatric cardiologist
• Congenital heart surgeon
• Cardiovascular anesthesiologist

Babies born with a ventricular septal defect require lifelong monitoring by a cardiologist experienced in congenital heart defects.

At Texas Children’s Heart Center, our pediatric cardiologists follow your child through adolescence, seamlessly transitioning their care at adulthood to a cardiologist who specializes in the treatment of adults with congenital heart defects. 

Why Texas Children’s Fetal Center?

• A single location for expert maternal, fetal and pediatric care. Texas Children’s Hospital offers mothers and babies the specialized care required for the diagnosis and treatment of congenital heart conditions all in one location, for highly coordinated care and treatment planning.
• A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, fetal imaging experts, fetal and pediatric cardiologists, congenital heart surgeons, neonatologists and others who work in concert to care for you and your baby every step of the way, using proven protocols we’ve developed over the years. With their combined expertise and unified approach, this team offers the best possible care for babies with ventricular septal defects.
• We care for your child’s cardiac needs at every stage of life, from fetus to adulthood. Our comprehensive approach starts with your first prenatal visit and continues through delivery, postnatal care, childhood and adulthood, thanks to one of the nation’s leading teams of fetal, pediatric and adult congenital heart specialists.

Texas Children’s – #1 in the Nation for Pediatric Cardiology and Heart Surgery

Our Fetal Cardiology Program is a collaboration between Texas Children’s Fetal Center and Texas Children’s Heart Center, ranked #1 in the nation for pediatric cardiology and heart surgery by U.S. News & World Report for the third consecutive year, with outcomes among the best in the nation.

Volumes and Outcomes

• Volumes and outcomes for patients treated by the Fetal Cardiology program
• Texas Children’s Heart Center Outcomes
• Texas Children’s Heart Center ventricular septal defect surgical volumes and outcomes

In the News

• Best hospitals for children with severe congenital heart disease
• 10 ways to get your child the best heart surgeon

Videos

• Critical congenital heart disease screening now required for all newborns in Texas
• Texas Children's Fetal Center: Our care began before he was born

Research and Clinical Trials

Texas Children’s, together with our partner institution Baylor College of Medicine, constantly strives to seek new and better treatments for babies with congenital heart defects.

Learn more about our fetal cardiology research.

For additional information, please contact the Cardiovascular Clinical Research Core at 832-826-2064 or email sandrea@texaschildrens.org.