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Published Date: 30-Nov-2008

Ventricular Septal Defect (VSD)

What is a ventricular septal defect?

Anatomy of the heart, normal

A normal heart is comprised of two sides: the right (containing blood low in oxygen) and the left (containing blood high in oxygen). Each side has two parts – an upper chamber or atrium and a lower chamber or ventricle. A molecular wall called the ventricular septum separates the two ventricles.



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. This causes increased blood flow to the lungs or pulmonary overcirculation.

Anatomy of a heart with ventricular septal defect

What are the different types of VSD?

There are four basic types of VSD:

  • perimembranous VSD - an opening in a particular area of the upper section of the ventricular septum (an area called the membranous septum), near the valves. This type of VSD is the most commonly operated upon since most perimembranous VSDs do not spontaneously close.

  • muscular VSD - an opening in the muscular portion of the lower section of the ventricular septum. This is the most common type of VSD. A large number of these muscular VSDs close spontaneously and do not require surgery.

  • atrioventricular canal type VSD - a VSD associated with atrioventricular canal defect. The VSD is located underneath the tricuspid and mitral valves.

  • conal septal VSD - the rarest of VSDs which occur in the ventricular septum just below the pulmonary valve.

Ventricular septal defects are the most commonly occurring type of congenital heart defect, accounting for 25 percent of congenital heart disease cases.

What causes ventricular septal defect?


Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene or a chromosome abnormality, causing heart problems to occur more often in certain families. Some may be caused by environmental exposure but most ventricular septal defects occur sporadically (by chance), with no clear reason for their development.

Why is a ventricular septal defect a concern?



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



Some ventricular septal defects are found in combination with other heart defects (such as in transposition of the great arteries, tetralogy of fallot, truncus arteriosus and atrioventricular canal defect).

What are the symptoms of a ventricular septal defect?



  • fatigue

  • rapid breathing

  • heavy breathing

  • disinterest in feeding, or tiring while feeding

  • poor weight gain

  • sweating


How is a ventricular septal defect diagnosed?






  • cardiac catheterization - a cardiac catheterization is an invasive procedure that gives very detailed information about the structures and pressures 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 while an X-ray is taken to more clearly visualize the structures inside the heart.

Treatment for ventricular septal defect:


  • 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. Regardless of the type, once a ventricular septal defect is diagnosed, your child's cardiologist will evaluate your child periodically to see whether the defect is closing on its own. A VSD may be repaired if it has not closed on its own - to prevent lung problems that can develop from long-time exposure to extra blood flow. Treatment may include:

  • medical management


    • diuretics - the body's water balance can be affected when the heart is not pumping extra blood to the lungs. 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 that blood being pumped from the left ventricle across the VSD into the right ventricle then into the lungs.

  • adequate nutrition

    • high-calorie formula or breast milk

    • supplemental tube feedings

  • surgical repair


    • interventional cardiac catheterization
      Your child's VSD may be repaired by a cardiac catheterization procedure. One method currently being used to close some 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 into the VSD. The septal occluder closes the ventricular septal defect providing a permanent seal.

    • hybrid procedure
      In some cases a combination of surgical procedures and interventional catheterization is required.

Postoperative care for your child:










  • NIRS - near infrared spectroscopy is a way to measure the oxygen content within the body’s tissues. This requires a special sensor to be placed on the forehead or back.




Care for your child at home following VSD repair:





Long-term outlook after VSD repair:


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 large and never repaired, the outlook is generally poor. There is a risk for developing 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 physician regarding the specific outlook for your child.

Last Review Date: 04/01/2010
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