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VSD: A Common Congenital Heart Defect

A VSD, or ventricular septal defect, is a fancy medical term to describe a hole in the heart that isn’t supposed to be there. VSDs are relatively common and are one of the top 3 causes of heart murmurs that I see in my clinic. While VSDs can be part of other/bigger heart defects, they happen as isolated defects as well. I’m going to address only the isolated problems. Isolated VSDs make up about 20% of all congenital heart defects (which is a huge percentage considering all the possible heart problems). VSDs happen in 2-7% of all live births.

Where exactly is the hole in the heart?

As you probably already know, the heart is a muscle about the size of your fist. It has 4 chambers or compartments. Think of the heart like a box. The upper 2 boxes are “atria” and the lower 2 boxes are “ventricles.” The blood is supposed to flow between the atria and ventricles (through a little one-way valve), essentially up and down in the box analogy. The 2 compartments of atria have a big wall of muscle that separates them and prevents them from sharing blood. Again using the box analogy, it prevents side-to-side flow. The ventricles have a similar wall of muscles between their 2 chambers, preventing the ventricles from communicating. When there is a hole or defect in the wall separating the two ventricles (the lower half of the boxes in the heart), the ventricles can have blood flow back and forth. When the blood goes from ventricle to ventricle (a path it’s not supposed to go), the blood that is flowing the wrong way will usually make a sound or murmur.

Is it something to worry about?

Generally the answer is no. Many VSDs are relatively small and will close up on their own. The VSDs that cause worry are the ones that cause other associated symptoms (e.g., feeling tired, sweating-especially during feeds, poor weight gain, or fast breathing). These other symptoms indicate complications (e.g., congestive heart failure)

How are VSDs diagnosed?

Most of the time, a parent will be made aware of the problem when a pediatrician listens with a stethoscope to a child’s heart and discovers a murmur. The definitive diagnosis is then made by a test called an echocardiogram, or echo (which is essentially an ultrasound of the heart).

How it is treated?

Small VSDs are usually treated with “watchful waiting.” This is medical lingo for “do nothing, but keep an eye on it to make sure things don’t get worse.” Often, small VSDs will close on their own, so nothing needs to be done. Sometimes larger VSDs can lead to congestive heart failure (CHF) and will require medications to manage that. Severe cases (that involve the pulmonary blood flow) will need surgery.

Should I see a cardiologist (heart specialist)?

Simple VSDs that resolve on their own, do not always require the expertise of a specialist. However, if there is anything concerning sounding about the murmur or history that is concerning, it is prudent to seek the care of specialist. Your pediatrician will help guide you on if/when to see a cardiologist.

Will my child need surgery for it?

Most cases of children with VSDs do not need surgery. Only children who have moderate-to-large defects that are causing increased blood flow to the lungs usually require surgery.

Did I do something to cause my baby to have this?

The last thing a mother needs is to hear is that she is responsible for her baby’s birth defect. Mothers are already plagued with enough guilt. However, the truth is, some maternal conditions increase the risk of having a child with a heart defect. Maternal diabetes is a well-recognized risk factor for congenital heart defects. Maternal alcohol consumption has also been linked to babies that have VSDs (specifically, a certain subtype called muscular VSDs).

Are VSDs genetic?

The short answer is yes, sort of. The genetic transmission isn’t a direct line like some conditions, but having a family history of previous congenital heart defects (in either parents or siblings), greatly increases the risk (about 3 times) of subsequent children having congenital heart defects. There are also some genetic conditions that are associated with heart defects (e.g., Down syndrome).

PDA: The Hole You’re Born With In Your Heart

Did you know that essentially everyone is born with a hole in the heart? When people hear about “holes in the heart,” they instantly think of major heart problems. But I’m here to assuage some of the worry. One particular hole, called the Patent Ductus Arteriosus (a.k.a., PDA) is a life-saving necessity in utero. The thing that changes the hole from being normal to abnormal is when and if it closes.

Quick anatomy background

You’ll probably remember from high school biology, the basics about blood flow. Blood (with little oxygen) comes from the body to the heart. The heart pumps the blood to the lungs to get oxygen. The blood, now full of oxygen, comes back from the lungs to the heart. The heart then pumps the blood back to the rest of the body.

When a woman is pregnant, a baby’s lungs aren’t really working. They are full of fluid. So the heart has a little hole, essentially a little bypass system to skip the lungs, when the baby is inside mom.

What exactly is a PDA?

A PDA is a patent ductus arteriosus. Meaning the duct (a.k.a, hole) that allows the heart to pump blood past the lungs stays patent or open (when it should have closed). Technically speaking the ductus connects the aorta and the pulmonary artery.

Why does it happen?

When a baby is born, the baby takes his/her first great grand breath. The fluid in the lungs moves out and there is a big pressure shift. Essentially these forces all act at once (like a change in pressure), to close the hole in the heart.

Sometimes, birth doesn’t go exactly as planned in nature. Sometimes the birth is very fast (so there isn’t time for the fluids to shift exactly like they are supposed to). Sometimes we cut babies out (C-Section) which isn’t exactly “natural” either. In no way am I saying that docs shouldn’t do C-sections (in fact, they are often life-saving), but they can create a few new sets of problems. In these sets of circumstances what usually happens is that over the course of the first few days of life, the hole gradually closes (instead of dramatic close right at birth). The pediatrician will note this by stating that a particular sounding heart murmur, noted at birth, goes away with time.

How is it diagnosed?

A PDA is a usually a clinical diagnosis. An experienced pediatrician will listen to your baby and the nature of the murmur will alert the doctor to the condition. The murmur often sounds like a continuous machine, but can change volume throughout also (a crescendo, decrescendo). The murmur is a systolic one (meaning that it happens during the contracting phase of the heart pumping). It can be confirmed by an echocardiogram (a.k.a., echo) if there is question about the diagnosis. An echo is essentially an ultrasound of the heart; so it is non-invasive test and there is zero radiation.

Is there a treatment?

Treatment of a PDA depends on lots of factors. In full-term infants, most of the PDAs close on their own in the first 72 hours of life. If they don’t close spontaneously, we generally suggest closing them with a procedure to prevent long-term problems. PDAs can be closed with either cardiac catheterization (essentially fishing the closure device up through a blood vessel) or a surgical ligation (opening the chest to access the heart).

If the affected infant was born premature, then the significance of the PDA (because everything may not be exactly matured/formed like it was supposed to) becomes a bit more complicated.  In those circumstances, sometimes a medication (called Indomethacin) is used and sometimes surgery is performed. The individual circumstances of the premie play into the decision on how to treat.

How worried should I be?

The short answer is that it depends. Typical, small PDAs that close up on their own are nothing to worry about. However, if they don’t close or are really big, then that is when you can run into more serious problems. Generally speaking, if you’re going to have a heart issue, this is not a bad one to have (as it often clears up on its own or is fixable). Just make sure that your pediatrician helps you manage it and decides when and if you need to see a cardiologist.