You must have been very scared when the doctor told you that your little one has a hole in his heart, right? It is actually very common. But the most important thing is that this is the most common congenital heart disease seen among children in Sri Lanka. Most of the time, these are not dangerous. So don't be scared. Let's talk about this condition called VSD (Ventricular Septal Defect) in a simple way that you can understand.
Simply put, what is this VSD?
Our heart is like a small house with four chambers. Two upper chambers and two lower chambers. The two large, strong chambers at the bottom are what we call the ventricles . There is a thick wall between these two ventricles. This wall is called the septum . The function of this wall is to prevent the more oxygenated, clean blood on one side of the heart from mixing with the less oxygenated, impure blood on the other side.
Ventricular Septal Defect (VSD) is, simply put, a hole in the wall (septum). This hole occurs when this wall is not fully formed when a baby is developing in the womb. This hole allows oxygen-rich blood to mix with blood that is low in oxygen. This prevents the heart from working properly, which means the heart has to work harder.
Most of the time, these holes are very small and don't cause any symptoms. But sometimes, these holes can get bigger. In that case, the child may have some complications and need treatment.
Are there types of VSD?
Yes, this hole is divided into four main types depending on where it is located in the heart wall. You don't need to know these in depth, but it's good to have a general understanding.
| VSD type | Simple description |
|---|---|
| Membranous VSD | This is the most common type. The hole is located in the upper part of the heart wall. |
| Muscular VSD | This type of hole occurs in the lower, more muscular part of the wall. Sometimes there may be more than one hole. |
| Inlet VSD | This hole is located very close to the heart valves. |
| Outlet VSD | This hole is located close to the main vessels that carry blood out of the heart. |
What are the symptoms of this?
Most of the time, if the VSD hole is very small (less than 3 millimeters, about the size of a toothpick), there will be no symptoms. However, if the hole is medium-sized (3-5 millimeters) or large (6-10 millimeters, about the size of a pea), symptoms may occur.
| Age group | Common symptoms |
|---|---|
| Newborn babies |
|
| Older children and adults |
|
What causes a VSD?
The exact cause of this is not yet known, but sometimes VSD can occur in conjunction with other genetic conditions, such as Down syndrome .
It is also suspected that certain medications taken by the mother during pregnancy (e.g., antiepileptic drugs) or alcohol consumption may increase the risk. However, research is still lacking to confirm these causes.
What complications can this cause?
If the VSD hole is large, the heart has to work harder, which can damage the heart and lungs over time. This causes an increase in the amount of blood going from the right side of the heart to the lungs, causing high blood pressure in the lungs. This is called Pulmonary Hypertension .
The important thing is that if a large VSD is not treated before the child is 2 years old, the damage to the lungs can become irreversible and permanent. This is called Eisenmenger syndrome . Therefore, early treatment is very important.
Other complications:
- Heart failure
- Aortic regurgitation (leakage of blood from the heart valves)
- Enlargement of the ventricles of the heart
- Heart infection (Endocarditis)
- Abnormal heartbeat
- Stroke
How do you find this, Doctor?
Often, when the doctor examines the child and listens to the chest with a stethoscope, an extra sound called a "heart murmur" is heard. Listening to this sound can lead to suspicion of a VSD.
To confirm that suspicion, the doctor recommends several tests such as:
- Echocardiogram (Echo): This is the most important test. It's like a scan of a baby in the womb. It takes a video of the heart and shows the location of the hole, its size, and how the blood is flowing.
- Electrocardiogram (ECG/EKG): Tests the electrical activity of the heart.
- Chest X-ray: An X-ray examination of the chest.
- Cardiac MRI or CT scan: These are rarely needed.
- Cardiac Catheterization: A test in which a small tube is inserted into the heart. This is also not always necessary.
What are the treatments for VSD?
Whether or not this is treated, and how, depends on the size of the hole and the child's symptoms.
Watchful Waiting
Most of the time, that is, the majority of VSD holes are very small. These close on their own by the time the child is about 6 years old. In such cases, the doctor does not do any treatment, but regularly checks the child's growth and symptoms in the clinic.
Medicines
If your child has symptoms while the hole is healing, or is being prepared for surgery, the doctor may give you some medications.
- Diuretics: These help reduce the amount of extra fluid that builds up in the body and lungs.
- Heart disease medications: They help control the functioning of the heart.
Surgery and other methods
If the hole is large and causing problems for the baby, it will need to be closed. There are two main ways to do this.
1. Open-heart surgery: In this procedure, a surgeon closes the hole with stitches or an artificial "patch." Over time, the child's heart tissue grows around the patch, becoming part of the heart wall.
2. Transcatheter procedure: This does not involve an incision in the chest. Instead, a small tube (catheter) is passed through a large blood vessel in the leg to the heart, and a device is passed through it to close the hole. This is a simpler procedure than surgery.
When should you see a doctor immediately?
If your child has a VSD, always be on the lookout for the following symptoms.
If your child has severe difficulty breathing, or if the skin, lips, or fingernails turn blue/pale (cyanosis), take them to the nearest hospital's Emergency Department (ETU) immediately.
Additionally, talk to your doctor if you notice the following symptoms:
- If the child's weight is not increasing as expected.
- If you sweat or exert yourself excessively while drinking milk.
- If you frequently develop respiratory infections (chest mucus).
What can we expect in the future?
This is the best news. Most children with a VSD have a normal, healthy life expectancy. Especially if the hole is small or has been treated and healed completely, there is nothing to fear about the future.
However, if a large VSD is not treated promptly and causes lung damage (Eisenmenger syndrome), life expectancy can be shortened. That is why seeking medical advice in a timely manner is extremely important.
Take-Home Message
- VSD is the most common congenital heart condition in children. So don't worry, you're not alone.
- Most VSD holes are very small. They close on their own as the child grows, without any treatment.
- If the hole is large and there are symptoms, there are very effective treatments for it.
- The most important thing is to pay attention to your child's symptoms, see the doctor at the appropriate time, and follow his or her instructions.
- If you have any questions, fears, or doubts about this, discuss them openly with the doctor treating the child.
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