Atrial Septal Defect (ASD)

Ventricular Septal Defect (VSD)

What is a ventricular septal defect?

A ventricular septal defect is an opening in the dividing wall (septum) between the two lower chambers of the heart known as the right and left ventricles. VSD is a congenital (present at birth) heart defect. As the fetus grows, a problem with how the heart develops during the first 8 weeks of pregnancy results in a VSD.

Normally, oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle, then is pumped into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped out to the body through the aorta.

A ventricular septal defect allows oxygen-rich (red) blood to pass from the left ventricle, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right ventricle.

What are the different types of VSD?

There are 4 basic types of VSD:

  • Membranous VSD. This is an opening in the upper section of the ventricular septum, near the aortic and tricuspid valves. This type of VSD doesn't usually close spontaneously so surgery is often needed.

  • Muscular VSD. This is an opening in the muscular portion of the lower section of the ventricular septum. Many of these muscular VSDs close spontaneously and do not require surgery.

  • Atrioventricular canal type VSD. This VSD is associated with atrioventricular canal defect. The VSD is located next to the tricuspid and mitral valves. It requires surgical repair.

  • Conal septal VSD. The rarest type of VSD located in the ventricular septum just below the pulmonary valve.

Ventricular septal defects are the most commonly occurring type of congenital heart defect, accounting for about half of congenital heart disease cases.

What causes ventricular septal defect?

The heart forms during the first 8 weeks of fetal development. It begins as a hollow tube, then partitions within the tube to develop the septa (or walls) dividing the right side of the heart from the left. Ventricular septal defects occur when the partitioning process does not occur completely, leaving an opening in the ventricular septum.

Some congenital heart defects may have a genetic link causing heart problems to occur more often in certain families. Most ventricular septal defects occur by chance, with no clear reason for their development.

Why is ventricular septal defect a concern?

If not treated, this heart defect can cause lung disease. When blood passes through the VSD from the left ventricle to the right ventricle, a larger volume of blood than normal must be handled by the right side of the heart. Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs. The larger the opening, the more blood that flow to the lungs, and the higher the pressure.

The lungs are able to cope with this extra pressure for while, depending on exactly how high the pressure is. Eventually, however, the blood vessels in the lungs can become diseased by the extra pressure.

As pressure builds up in the lungs, the flow of blood from the left ventricle, through the VSD, into the right ventricle, and on to the lungs will diminish. This helps preserve the function of the lungs, but causes yet another problem. Blood flow within the heart goes from areas where the pressure is high to areas where the pressure is low. If a ventricular septal defect is not repaired, and lung disease begins to occur, pressure in the right side of the heart will eventually exceed pressure in the left. In this instance, it will be easier for oxygen-poor (blue) blood to flow from the right ventricle, through the VSD, into the left ventricle, and on to the body. When this happens, the body does not receive enough oxygen in the bloodstream to meet its needs.

Some ventricular septal defects occur with other heart defects (such as in transposition of the great arteries, tetrology of Fallot, or truncus arteriosus).

What are the symptoms of a ventricular septal defect?

The size of the opening in the ventricular septum will affect the type and severity of symptoms, and the age at which they first occur. A VSD permits extra blood to pass from the left ventricle through to the right side of the heart, and the right ventricle and lungs become overworked as a result. The larger the opening, the greater the amount of blood that can pass through and overload the right ventricle and lungs.

Symptoms often occur in infancy. The following are the most common symptoms of VSD. However, each child may experience symptoms differently. Symptoms may include:

  • Fatigue

  • Sweating

  • Rapid breathing

  • Heavy breathing

  • Congested breathing

  • Disinterest in feeding, or tiring while feeding

  • Poor weight gain

The symptoms of VSD may look like other medical conditions or heart problems. Always consult your child's doctor for a diagnosis.

How is a ventricular septal defect diagnosed?

Your child's doctor may have heard a heart murmur during a physical exam. If so, you may have been referred to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noise caused by the turbulence of blood flowing through the opening from the left side of the heart to the right.

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects, as well as heart problems that may develop later in childhood. The cardiologist will do a physical exam, listen to the heart and lungs, and make other observations that help in the diagnosis. The location within the chest where the murmur is heard best, as well as the loudness and quality of the murmur (such as, harsh or blowing) will give the cardiologist an initial idea of which heart problem your child may have. Other tests may include :

  • Chest X-ray. A diagnostic test that uses X-ray beams to make images of internal tissues, bones, and organs onto film. With a VSD, the heart may be enlarged because the left ventricle receives more blood than usual. Also, there may be changes in the lungs due to extra blood flow that can be seen on an X-ray.

  • Electrocardiogram (ECG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and detects heart muscle stress.

  • Echocardiogram (echo). A procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves. An echo can show the pattern of blood flow through the septal opening, and determine how large the opening is, as well as help estimate how much blood is passing through it.

  • Cardiac catheterization. A cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. Blood pressure and oxygen measurements are taken in the four chambers of the heart, as well as the pulmonary artery and aorta. Contrast dye is also injected to more clearly visualize the structures inside the heart.

Treatment for ventricular septal defect

Specific treatment for VSD will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Small ventricular septal defects may close spontaneously as your child grows. A larger VSD usually requires surgical repair. Once a ventricular septal defect is diagnosed, your child's cardiologist will evaluate your child periodically to see whether it is closing on its own. A VSD will be repaired if it has not closed on its own to prevent lung problems that will develop from long-time exposure to extra blood flow.

Treatment may include:

  • Medical management. Some children have no symptoms, and require no medication. However, some children may need to take medications to help the heart work better, since the right side may be under strain from the extra blood passing through the VSD. Medications that may be prescribed include the following:

    • Digoxin. A medication that helps strengthen the heart muscle so it can pump more efficiently.

    • Diuretics. The body's water balance can be affected when the heart is not working as well as it could. These medications help the kidneys remove excess fluid from the body.

    • ACE inhibitors. Medications that lower the blood pressure in the body, making it easier for the blood to be pumped from the left ventricle into the body (because of its lowered blood pressure) rather than across the VSD into the right ventricle and into the lungs.

  • Adequate nutrition. Infants with a larger VSD may become tired when feeding, and may not be able to eat enough to gain weight. Options that can be used to ensure your baby will have adequate nutrition include the following:

    • High-calorie formula or breast milk. Special nutritional supplements may be added to formula or pumped breast milk to increase the number of calories in each ounce, thereby allowing your baby to drink less and still consume enough calories to grow properly.

    • Supplemental tube feedings. Feedings given through a small, flexible tube that passes through the nose, down the esophagus, and into the stomach, can either supplement or take the place of bottle feedings. Infants who can drink part of their bottle, but not all, may be fed the remainder through the feeding tube. Infants who are too tired to bottle feed may receive their formula or breast milk through the feeding tube alone.

  • Surgical repair. The goal is to repair the septal opening before the lungs become diseased from too much blood flow and pressure and to restore normal weight gain in infants with difficulty feeding. Your child's cardiologist will recommend when the repair should be done based on echocardiogram and possibly cardiac catheterization results.

    The operation is done under general anesthesia. Depending on the size of the heart defect and your doctor's recommendations, the ventricular septal defect will be closed with stitches or a special patch. Consult your child's cardiologist for more information.

  • Interventional cardiac catheterization. In certain circumstances, your child's VSD may be repaired by a cardiac catheterization procedure. One method currently being used to close some small muscular VSDs is the use of a device called a septal occluder. During this procedure, the child is sedated and a small, thin flexible tube is inserted into a blood vessel in the groin and guided into the heart. Once the catheter is in the heart, the cardiologist will pass the septal occluder across the VSD. The septal occluder closes the ventricular septal defect providing a permanent seal.

Care in the hospital after VSD repair

In most cases, children will spend time in the intensive care unit (ICU) after a VSD repair. During the first several hours after surgery, your child will most likely be drowsy from the anesthesia that was used during the operation, and from medications given to relax him or her and to help with pain. As time goes by, your child will become more alert.

While your child is in the ICU, special equipment will be used to help him or her recover, and may include the following:

  • Ventilator. A machine that helps your child breathe while he or she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he or she is too sleepy to breathe effectively on his or her own. Many children have the ventilator tube removed right after surgery, but some other children will benefit from remaining on the ventilator for a few hours afterwards so they can rest.

  • Intravenous (IV) catheters. Small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medications that help your child recover from the operation.

  • Arterial line. A specialized IV placed in the wrist, or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU.

  • Nasogastric (NG) tube. A small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery.

  • Urinary catheter. A small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys remove excess fluids from the body.

  • Chest tube. A drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours, or even a few days after surgery.

  • Heart monitor. A machine that constantly displays a picture of your child's heart rhythm, and monitors heart rate, arterial blood pressure, and other values.

Your child may need other equipment not mentioned here to provide support while in the ICU, or afterwards. The hospital staff will explain all of the necessary equipment to you.

Your child will be kept as comfortable as possible with several different medications; some of which relieve pain, and some of which relieve anxiety. The staff may also ask for your input as to how best to soothe and comfort your child.

After discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while, and these will be explained to you. The staff will give you written instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged.

Care for your child at home after VSD repair

Most infants and older children feel fairly comfortable when they go home. Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable. Your child's doctor will discuss pain control before your child is discharged from the hospital.

Often, infants who fed poorly prior to surgery have more energy after the recuperation period, and begin to eat better and gain weight faster.

After surgery, older children usually have a fair tolerance for activity. For a short period, your child may become tired quicker than before surgery, but usually will be allowed to play with supervision, while avoiding blows to the chest that might cause injury to the incision or breastbone. Within a few weeks, your child should be fully recovered and able to participate in normal activity.

You may receive additional instructions from your child's doctors and the hospital staff.

Long-term outlook after VSD repair

Most children who have had a ventricular septal defect repair will live normal, healthy lives. Activity levels, appetite, and growth will return to normal in most children. Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis for a specific time period after discharge from the hospital.

Outcomes also depend on the type of VSD, as well as how early in life the VSD was diagnosed and whether or not it was repaired. With early diagnosis and repair of a VSD, the outcome is generally excellent, and minimal follow-up is necessary. When a VSD is diagnosed later in life, if complications occur after surgical closure, or the VSD is never repaired, the outlook may be poor. There is a risk for developing irreversible pulmonary hypertension (high blood pressure in the blood vessels of the lungs) or Eisenmenger’s syndrome. These individuals should receive follow-up care at a center that specializes in congenital heart disease.

Consult your child's doctor regarding the specific outlook for your child.

Atrial Septal Defect (ASD)

What is an atrial septal defect?

The atrial septum is the wall between the two upper chambers of the heart (right and left atria). An atrial septal defect (ASD) is an abnormal hole in this wall. ASD is a heart problem that is present at birth (congenital).

ASDs can happen on their own. Or they can happen in children born with other congenital heart defects. Girls have ADS twice as often as boys. Doctors don't know why this is.

What causes an atrial septal defect?

The heart forms during the first 8 weeks of pregnancy. It starts as a hollow tube and divides into 4 chambers. These chambers are separated by walls (septa). It's nornal for the walls to have openings as the fetus grows. The openings usually close shortly before or just after birth. If they don't all close, the atrial septum will have a hole in it. This is called an ASD.

Some congenital heart defects may be passed down in certain families. Most atrial septal defects occur by chance. Doctors can find no clear reason that they occurred.

What are the symptoms of an atrial septal defect?

Many children have no symptoms and seem healthy. If the ASD is large, your child may have symptoms. Your child may:

  • Tire easily
  • Have fast breathing
  • Have shortness of breath
  • Grow slowly
  • Have respiratory infections often

The symptoms of ASD can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is an atrial septal defect diagnosed?

Your child's healthcare provider  may have heard a heart murmur when listening to your child's heart with a stethoscope. The heart murmur is from the abnormal flow of blood through the heart.

Your child may need to see a pediatric cardiologist for a diagnosis. This is a doctor with special training to treat heart problems in children. The doctor will examine your child and listen to your child's heart and lungs. The doctor will find out where the murmur is best heard and how loud it is. Your child may have some tests, such as:

  • Chest X-ray. This test may show an enlarged heart. Or it may show changes in your child's lungs because of the blood flow changes caused by an ASD. 
  • Electrocardiogram (ECG). This test records the electrical activity of the heart. It shows abnormal rhythms (arrhythmias) that may be caused by an ASD. It can also find heart muscle stress caused by an ASD.
  • Echocardiogram (echo). This test uses sound waves to make a moving picture of the heart and heart valves. An echo can show the blood flow through the atrial septal opening and find out how big the opening is.
  • Cardiac catheterization. This tests uses a thin, flexible tube (catheter) put near the heart. Contrast dye is used to get even clearer pictures. In some children, this procedure may be used to close the ASD.

How is an atrial septal defect treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The most common type of ASD may close on its own as your child grows.

Once an atrial septal defect is diagnosed, your child's cardiologist will check your child to see if the defect is closing on its own. An ASD will usually be fixed if it has not closed by the time a child starts school. The decision to close the ASD may also depend on the size of the defect.

Treatment may include:

  • Medicine. Many children have no symptoms and don't need medicine. But medicine can help some children's hearts work better. For example, water pills (diuretics) help the kidneys get rid of extra fluid from the body.
  • Surgery. Your child's ASD may be repaired by surgery. The surgery is done under general anesthesia. The defect may be closed with stitches or a special patch.
  • Device closure. Some children are helped with this procedure. The doctor uses cardiac catheterization to put a special device (septal occluder) in the open ASD. The device stops blood from flowing through the ASD.

What are the complications of an atrial septal defect?

Large ASDs may cause lung problems over time if not treated. This is because the extra blood passing through the defect and then into the lungs may harm the vessels in the lungs.

Living with an atrial septal defect

All children with an ASD need to be cared for by a pediatric cardiologist. Most children who have had an ASD repair will live healthy lives. After the repair, your child's doctor may want your child to take antibiotics. This will prevent an infection of the heart lining (bacterial endocarditis).

With early diagnosis and repair of an ASD, children usually do very well. They don't need much follow-up care. Children are more likely to have problems if an ASD is diagnosed later in life and never repaired. Or they may have problems if complications occur after closing the defect. 

Some children develop high blood pressure in the lungs (pulmonary hypertension). These children should have follow-up care at a center that specializes in congenital heart disease.

Talk with your child's healthcare provider about the outlook for your child. 

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child has new symptoms or symptoms that get worse. Symptoms may include:

  • Tiredness that gets worse
  • Troubled breathing
  • Fast breathing

Key points about atrial septal defect

  • An atrial septal defect is an opening in the wall dividing the two upper chamber of the heart.
  • Symptoms of an atrial septum defect include tiring easily, fast breathing, shortness of breath, poor growth, and respiratory infections that happen often.
  • Atrial septum defects range from small to large.
  • Small atrial septum defects may close on their own.
  • Atrial septum defects that are large or cause symptoms can be repaired.
  • Most children who have had an atrial septal defect repair will live healthy lives. 

Next steps

Tips to help you get the most from a visit to your child’s health care provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.


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