Ventricular Septal Defect (VSD)
Information for teenagers and adults with a ventricular septal defect
A ventricular septal defect (VSD) is a hole in the wall (septum) between the two lower pumping chambers of the heart — the right and left ventricles.
VSDs are among the most common congenital heart conditions. Many small VSDs close naturally during childhood, while others remain open into adult life. Some people have had their VSD repaired surgically or with a device during childhood.
For most adults with a small or successfully repaired VSD, the outlook is excellent. However, some people require ongoing follow-up because a VSD can occasionally be associated with heart valve problems, abnormal heart rhythms, enlargement of the heart or increased pressure in the lung circulation.
How your circulation works
Normally, the right and left ventricles are separated by a muscular wall called the ventricular septum. The right ventricle pumps blood to the lungs, while the left ventricle pumps oxygen-rich blood around the body.
With a VSD, blood can pass through an opening in this wall. Because pressure is normally higher in the left ventricle, blood usually travels from the left ventricle to the right ventricle.
The effect of a VSD depends largely on its size and location.
A small VSD may allow only a small amount of blood to cross and often causes no symptoms or significant effect on the heart.
A large VSD can result in substantially increased blood flow through the lungs and may cause enlargement of the heart. If a large VSD remains untreated for many years, high pressure can develop in the blood vessels of the lungs (pulmonary hypertension).
Are there different types of VSD?
Yes. VSDs are classified according to where they occur within the ventricular septum. Common types include:
Perimembranous VSD — located near the heart valves and the most common type in adults.
Muscular VSD — located within the muscular part of the ventricular septum. Some people have more than one.
Outlet VSD — located near the valves leading out of the ventricles and sometimes associated with problems involving the aortic valve.
Inlet VSD — located towards the lower part of the septum near the atrioventricular valves and sometimes occurring as part of an atrioventricular septal defect.
The location of a VSD can influence its potential complications and whether treatment is required.
Does a VSD need to be closed?
Not every VSD needs treatment.
A small VSD that is not causing enlargement of the heart, pulmonary hypertension or problems with the heart valves can often simply be monitored.
Closure may be recommended when a VSD causes a significant increase in blood flow through the lungs and enlargement of the left side of the heart. Treatment may also be considered in some people who develop complications such as aortic valve leakage.
Most VSDs requiring treatment are repaired surgically, although selected VSDs can sometimes be closed using a device inserted through a catheter.
In people who have developed severe and irreversible pulmonary hypertension, closing a VSD may not be appropriate. Specialist assessment is particularly important in this situation.
Your congenital cardiologist can determine whether your VSD requires treatment or simply ongoing observation.
Aortic valve problems
Some VSDs — particularly those located close to the aortic valve — can affect the valve over time.
One of the aortic valve leaflets can gradually be drawn towards the VSD, which may cause the valve to leak. This is known as aortic regurgitation.
For this reason, even a relatively small VSD may require follow-up if it is close to the aortic valve.
How to stay well
Keep up with your heart checks
Your cardiologist will advise how often you need follow-up.
Some adults with a small VSD and no associated problems need only occasional review. People with previous VSD surgery, a residual VSD, valve disease, pulmonary hypertension or other congenital heart abnormalities may require more regular specialist congenital heart disease follow-up.
Stay active
Most people with a small or successfully repaired VSD can undertake normal physical activity and exercise without restriction.
Exercise recommendations may be different if you have pulmonary hypertension, significant valve disease, abnormal heart rhythms or reduced heart function.
If you are considering very strenuous or competitive exercise, discuss this with your cardiologist.
Look after your teeth
Good dental hygiene is particularly important for people with congenital heart disease.
People with a VSD have a small increased lifetime risk of infective endocarditis, an infection involving the lining or valves of the heart. Maintaining healthy teeth and gums and having regular dental care are important ways to reduce this risk.
Most people with an uncomplicated VSD do not require antibiotics before routine dental treatment. Antibiotic prophylaxis is recommended only in specific higher-risk circumstances, such as some people with previous infective endocarditis or particular situations following repair with prosthetic material.
Your cardiologist or dentist can tell you whether this applies to you.
Don’t smoke or vape
Smoking increases your risk of cardiovascular and lung disease. Avoid smoking and vaping and seek help to quit if needed.
Pregnancy
Most women with a small or successfully repaired VSD and normal heart function can have a successful pregnancy with relatively low cardiovascular risk.
It is sensible to discuss pregnancy with your cardiologist beforehand, particularly if you have not had a recent cardiac assessment.
More specialised assessment is required for women with pulmonary hypertension, significant valve disease, reduced heart function or other associated congenital heart abnormalities.
Severe pulmonary arterial hypertension associated with a VSD can make pregnancy very high risk and requires specialist advice before pregnancy.
Symptoms to tell your doctor about
Contact your doctor or cardiology team if you develop:
New or increasing shortness of breath
A noticeable reduction in exercise capacity
Frequent or prolonged palpitations
Unexplained fainting or near-fainting
New swelling of your ankles or abdomen
Persistent fevers without an obvious explanation
A significant change in your usual symptoms
Persistent unexplained fever is particularly important because, although uncommon, it can be a symptom of infective endocarditis.
Emergency — get help immediately if
Seek urgent medical attention or call 000 if you develop:
Severe or sudden shortness of breath
Fainting associated with chest pain, breathlessness or sustained palpitations
A sustained rapid heartbeat associated with dizziness, chest pain or feeling very unwell
Severe chest pain or sudden significant deterioration
High fever with shaking chills and feeling seriously unwell, particularly if you have a history of infective endocarditis or recent dental or surgical procedures
Your regular check-ups
Depending on your VSD and whether it has been repaired, your follow-up may include:
Clinical review
Your cardiologist will ask about your exercise capacity and symptoms and examine your heart and circulation.
ECG
An electrocardiogram records the electrical activity and rhythm of your heart.
Echocardiogram
An ultrasound of the heart can assess the VSD, the amount and direction of blood flow through it, heart chamber size and function, pulmonary pressures and the heart valves — particularly the aortic valve.
Heart rhythm monitoring
A Holter monitor or longer-term rhythm monitor may be recommended if you experience palpitations, dizziness or fainting.
Cardiac MRI
MRI is not necessary for everyone but can provide additional information about heart size, function and blood flow when required.
Cardiac catheterisation
This is occasionally used when more detailed information about pressures and blood flow is needed, particularly if pulmonary hypertension is suspected, or when catheter-based closure is being considered.
Questions for your doctor
What type of VSD do I have?
Is there still blood flowing through my VSD?
Is my VSD affecting my heart size, aortic valve or lung pressures?
Do I need any restrictions on exercise, work, travel or pregnancy?
Do I need antibiotics before dental treatment?
How often should I have a heart check-up?
This information is intended as a general guide for teenagers and adults with a ventricular septal defect. Individual congenital heart conditions vary, and your cardiologist can provide advice specific to your anatomy, previous treatment and current health.
