In other words, about 1 in every babies born in the United States each year are born with a ventricular septal defect. The causes of heart defects such as a ventricular septal defect among most babies are unknown.
Some babies have heart defects because of changes in their genes or chromosomes. Heart defects also are thought to be caused by a combination of genes and other risk factors, such as the things the mother comes in contact with in the environment or what the mother eats or drinks or the medicines the mother uses. The size of the ventricular septal defect will influence what symptoms, if any, are present, and whether a doctor hears a heart murmur during a physical examination.
Signs of a ventricular septal defect might be present at birth or might not appear until well after birth. If the hole is small, it usually will close on its own and the baby might not show any signs of the defect.
However, if the hole is large, the baby might have symptoms, including:. During a physical examination the doctor might hear a distinct whooshing sound, called a heart murmur.
If the doctor hears a heart murmur or other signs are present, the doctor can request one or more tests to confirm the diagnosis. The most common test is an echocardiogram , which is an ultrasound of the heart that can show problems with the structure of the heart, show how large the hole is, and show how much blood is flowing through the hole.
Treatments for a ventricular septal defect depend on the size of the hole and the problems it might cause. Many ventricular septal defects are small and close on their own; if the hole is small and not causing any symptoms, the doctor will check the infant regularly to ensure there are no signs of heart failure and that the hole closes on its own.
If the hole does not close on its own or if it is large, further actions might need to be taken. Depending on the size of the hole, symptoms, and general health of the child, the doctor might recommend either cardiac catheterization or open-heart surgery to close the hole and restore normal blood flow.
After surgery, the doctor will set up regular follow-up visits to make sure that the ventricular septal defect remains closed. It is normal for all infants to be born with a small hole between the two atria which usually closes within the first few weeks of life. Normally there is no hole between the two ventricles, but some infants are born with these holes called ventricular septal defects.
Ventricular septal defects are among the most common congenital heart defects, occurring in 0. Ventricular septal defects are probably one of the most common reasons for infants to see a cardiologist. Ventricular septal defects occur in many locations and sizes.
The ventricular septum is made up of different types of tissue, with one part composed of mainly muscle and another part made of thinner, fibrous tissue. The location and size of the hole within the septum will determine in part the consequences of the ventricular septal defect. Small ventricular septal defects rarely cause problems. A physician usually discovers these holes by noticing an extra heart sound called a murmur , on a routine physical exam. This murmur is often not present in the first few days of life.
Most of these holes will close on their own, particularly if they are in the muscular portion of the septum. Even if these holes do not close, they will rarely cause any health problems. Rarely, these holes can be associated with the development of other heart issues that with time can become important. Therefore, if the small ventricular septal defect does not close, the child should continue to be seen by a cardiologist for occasional checkups. Large ventricular septal defects can cause problems, often developing gradually in the first few months of life.
Before birth, the pressure on the right side of the heart is equal to pressure on the left side of the heart. As soon as the baby takes its first breath, the pressure in the lungs and the right side of the heart starts to decrease. This process is slow and usually takes about weeks for the pressure in the lungs to reach normal level. In the first 1 to 2 weeks of life, babies with large ventricular septal defects may do very well.
But as the pressure in the right side of the heart decreases, blood will start to flow to the path of least resistance i.
This will gradually lead to symptoms of congestive heart failure and must be treated. Medium or moderate ventricular septal defects are more challenging to predict. Sometimes babies born with moderate ventricular septal defects will have problems with congestive heart failure like babies with large ventricular septal defects.
Others will have no problems at all and just need to be watched. Ventricular septal defects never get bigger and sometimes get smaller or close completely. This is why when a baby is diagnosed with a ventricular septal defect, most cardiologists will not recommend immediate surgery but will closely observe the baby and try to treat symptoms of congestive heart failure with medication to allow time to determine if the defect will close on its own.
Ventricular septal defects have a very characteristic murmur, to the point where a cardiologist may be able to pinpoint the location and estimate the size of a ventricular septal defect just by how it sounds. However, a murmur is often not heard at birth. It is only with time and pressure changes that flow across the hole between the pumping chambers can be heard as a murmur. A smaller hole may actually make a louder noise than a large hole, and the murmur may get louder as the ventricular septal defect closes.
Think of a garden hose. If the water flows freely, it makes a soft sound. If you make the outlet of the hose smaller with your finger, the noise will get louder. Unfortunately, this causes the heart to pump more blood. The heart, especially the left atrium and left ventricle, will begin to enlarge from the added work.
High blood pressure may occur in the lungs' blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls. When the defect is small, not much blood crosses the defect from the left to the right and there's little effect on the heart and lungs.
In childhood a large opening may have caused breathing difficulties and therefore, most of these children had surgery to close the defect. Therefore, large VSDs in adults are uncommon, but when they are present, can cause shortness of breath. Most adults have small VSDs that don't usually cause symptoms because the heart and lungs don't have to work harder. On physical examination, small VSDs produce a loud murmur.
Even small VSDs may occasionally be a source of infection called endocarditis. Many children who had a VSD did not need surgery or other treatments, and many of these defects closed on their own. Adults who were told they "had a hole in their heart" that closed on its own usually have no murmur and a normal EKG. If an echocardiogram is performed, it may show an outpouching called a ventricular septal aneurysm in the area where the VSD was located.
If the aneurysm isn't recognized as an expected finding after a VSD has closed, it can lead to unnecessary concern and testing. If the opening was large, it's likely that open-heart surgery was performed. VSD closure is usually performed by sewing a patch of fabric or pericardium the normal lining around the outside of the heart over the VSD to close it completely. The normal heart lining tissue eventually grows to cover this patch and it becomes a permanent part of the heart.
It's now possible to close some types of VSDs in the catheterization laboratory using a special device that can "plug" the hole and some younger adults may have had this procedure.
Patients with repaired VSDs and normal pulmonary artery pressures have normal lifespans. Late problems are uncommon, but a small number of patients may have problems with the heart valves aortic or tricuspid or extra muscle inside the right side of the heart.
Anyone who had surgery for a VSD requires a regular check up with a cardiologist who is experienced with adults with congenital heart defects. Medications are rarely needed. In a patient with a large unrepaired VSD, pulmonary hypertension can occur. Usually closure is recommended for small VSDs only if there's been an episode of endocarditis which is a heart infection that may be due to the VSD, or if the location of the VSD affects the function of one of the heart valves.
If the VSD is large, the pressure in the lungs determines whether it can be closed in an adult patient. Those with low lung pressures will benefit from surgery; those with high pressures may or may not. Patients with small VSDs that stay open have a small risk of a heart infection called endocarditis. The aortic valve may develop leakage and should be monitored. Patients whose VSD has been repaired early in life are unlikely to have any significant long-term problems.
If the ventricular septal defect is completely closed without a leak in the patch, the risk of late infection, endocarditis, is minimal. Rarely, abnormal heart rhythms can occur.
In some people, the heart muscle may be less able to contract following a VSD repair. If heart failure develops as a result of the heart muscle weakness, diuretics to control fluid accumulation, agents to help the heart pump better and drugs to control blood pressure are often given. In the uncommon patients with a VSD and pulmonary hypertension , medical therapy may be needed. A cardiologist should examine you regularly. If your VSD is small or was closed as a child and no other problems are detected, visits every 3—5 years are probably sufficient.
Medications may be required only if you have heart failure which is very uncommon or if you have pulmonary hypertension. Your cardiologist can monitor you with noninvasive tests if needed. These include electrocardiograms, Holter monitors, exercise stress tests and echocardiograms.
They will help show if more procedures, such as a cardiac catheterization, are needed. Most patients won't need to limit their activity. However, if you have pulmonary hypertension or your heart doesn't pump as well as it used to, you may need to limit your activity to your endurance. Your cardiologist will help determine if you need to limit your activity.
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