Ventricular Septal Defect Treatment in Delhi, India

A ventricular septal defect (VSD) is a congenital heart condition characterised by a hole in the wall separating the heart's lower chambers (ventricles). This opening allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle, causing the heart to work harder and potentially leading to complications such as heart failure, high blood pressure in the lungs, or delayed growth in children. While small VSDs often cause no issues and may close on their own over time, larger or moderate-sized defects may require surgical intervention to prevent complications.

There are four main types of ventricular septal defects (VSD) that are classified based on their location and the structure of the hole. Each type affects how blood flows between the heart’s ventricles and may require different approaches to management and treatment.

Membranous VSD 

This is the most common type, accounting for approximately 80% of cases. It occurs in the upper section of the wall (septum) that separates the heart’s lower chambers (ventricles). The size of the hole can vary, and in some cases, it may close on its own over time.

Muscular VSD 

Making up about 20% of VSD cases in infants, this type occurs in the lower, muscular portion of the septum. It is common for multiple small holes to be present rather than a single defect. Many muscular VSDs close naturally as the child grows.

Inlet VSD 

This type of defect is located just below the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. Due to its position, blood entering the ventricles must pass through the hole before moving through the heart. This type of VSD is often associated with other congenital heart conditions.

Outlet (Conoventricular) VSD

This defect occurs near the heart’s outflow tract, specifically just before the pulmonary valve in the right ventricle and the aortic valve in the left ventricle. Blood flowing out of the heart must pass through the hole, affecting circulation. This type of VSD is less common but may require surgical intervention if it causes significant complications.

A ventricular septal defect (VSD) develops during pregnancy as the baby's heart forms. It occurs when the muscular wall separating the left and right sides of the heart does not fully develop, leaving one or more openings. The size of these openings can vary.

The exact cause is often unknown, but genetic and environmental factors may contribute. VSDs can occur on their own or alongside other congenital heart conditions. In rare cases, a VSD may develop later in life due to a heart attack or certain heart procedures.

Several factors may increase the likelihood of a ventricular septal defect (VSD), including:

Premature birth

Babies born before full term may have underdeveloped heart structures, increasing the risk of congenital heart defects, including VSD. Their hearts may not have had enough time to form completely.

Genetic conditions 

Disorders such as Down's syndrome and other chromosomal abnormalities are linked to an increased risk of congenital heart defects, including VSD, due to genetic mutations affecting heart development.

Family history of congenital heart defects

A baby is more likely to be born with a VSD if there is a history of congenital heart defects in the family. Genetic factors can play a significant role in heart formation.

The symptoms of a ventricular septal defect (VSD) vary based on the size of the hole and the presence of other heart conditions. Small VSDs may not cause noticeable symptoms and can go undetected. However, larger defects may lead to significant health concerns.

Symptoms in Infants

• Poor eating– Babies with a VSD may have difficulty feeding due to increased energy demands on the heart and lungs. They may tire easily during feedings, leading to inadequate nutrition.
• Slow or no physical growth (failure to thrive)– Due to increased workload on the heart, babies with a VSD may struggle to gain weight and grow at a normal rate, as their bodies burn more calories to compensate for inefficient circulation.
• Fast breathing or breathlessness– Infants with a larger VSD may breathe rapidly or experience shortness of breath, especially during feeding or activity, due to increased blood flow to the lungs and reduced oxygen supply to the body.
• Easy tiring– Babies with a VSD may become exhausted quickly, even with minimal exertion, because their hearts work harder than usual to circulate oxygen-rich blood throughout the body.

Symptoms in Adults 

• Shortness of breath, especially during exercise – Adults with an undiagnosed or untreated VSD may experience difficulty breathing or fatigue during physical activity due to insufficient oxygen circulation and increased strain on the heart.
• Heart murmur– Similar to infants, a heart murmur may be present in adults with a VSD. The sound is produced by turbulent blood flow between the heart’s ventricles and can be detected with a stethoscope.

Some ventricular septal defects (VSDs) are diagnosed shortly after birth, while others may not be detected until later in life. In some cases, a VSD can be identified before birth during a pregnancy ultrasound.

To confirm a diagnosis, various tests may be performed, including:

Echocardiogram (Echo) 

This is the most commonly used test for diagnosing VSD. It uses sound waves to create moving images of the heart, showing how blood flows through the heart and its valves.

Electrocardiogram (ECG) 

A quick and painless test that records the heart’s electrical activity. It helps determine the heart rate and rhythm, detecting any irregularities in heartbeat patterns.

Chest X-ray 

This imaging test provides a view of the heart and lungs. It can reveal an enlarged heart or excess fluid in the lungs, which may indicate a VSD or other heart conditions.

Pulse Oximetry 

A small sensor placed on the fingertip measures oxygen levels in the blood. Low oxygen levels may suggest a heart or lung issue that requires further evaluation.

Cardiac Catheterisation 

In this procedure, a thin, flexible tube (catheter) is inserted into a blood vessel in the groin or arm and guided to the heart. It provides detailed information about heart structure, blood flow, and valve function.

Cardiac Magnetic Resonance Imaging (MRI) Scan 

This test uses magnetic fields and radio waves to create highly detailed images of the heart. It may be recommended if additional information is needed beyond what an echocardiogram provides.

Computerised Tomography (CT) Scan

A CT scan combines multiple X-ray images to create a detailed view of the heart. It is sometimes used when an echocardiogram does not provide enough information for a diagnosis.

Treatment for a ventricular septal defect (VSD) may include regular medical checkups, medications, or surgery, depending on the size of the defect and its impact on heart function. Many babies born with a small VSD do not require surgical intervention, as the hole may close on its own over time.

Nutritional support and medications

• Nutritional support– Babies with large VSDs or those who become tired easily during feeding may require additional nutrition to support healthy growth and development. Special feeding techniques or high-calorie formulas may be recommended.
• Medications– While medications cannot close a VSD, they help manage symptoms and complications. The type of medication prescribed depends on the severity of symptoms.
• Diuretics (Water Pills) – These medications help reduce excess fluid in the body, decreasing the workload on the heart and improving breathing.
• Oxygen Therapy – In some cases, supplemental oxygen may be provided to improve oxygen levels in the blood and reduce strain on the heart and lungs.

Surgical and catheter-based procedures

Surgery is recommended for medium or large VSDs that cause significant symptoms or complications. The timing of the procedure depends on the severity of the defect. Babies who need surgery often undergo the procedure within their first year of life.

• Open-heart surgery – This is the most common method. A surgeon makes an incision in the chest and uses stitches or a patch to close the hole between the lower heart chambers. The procedure requires a heart-lung machine to maintain circulation during surgery.
• Catheter-based procedure – Some VSDs can be closed without open-heart surgery using a catheter-based approach. A thin, flexible tube (catheter) is inserted into a blood vessel, in the groin, and guided to the heart. A small closure device is then placed over the hole to seal it.

After VSD repair, lifelong follow-up care with a cardiologist is essential. Regular checkups, including imaging tests, help monitor heart function and ensure that the repair remains effective over time.

A healthcare provider is the best source of information regarding the risks, complications, and potential side effects associated with a ventricular septal defect (VSD) and its treatment. This includes any medications, surgical procedures, or catheter-based interventions.

Common complications following surgery or transcatheter procedures for VSD may include:

Bleeding 

Excessive bleeding can occur during or after surgery due to the delicate nature of the heart and blood vessels. In some cases, additional treatment may be needed to control bleeding.

Infections 

The risk of infection is highest within the first six months after surgery, especially infections of the heart lining or valves (endocarditis). Proper wound care and antibiotics can help reduce this risk.

Heart valve disruption 

Nearby heart valves may be affected during surgery, leading to leakage or improper function. This can cause blood to flow in the wrong direction, potentially requiring further medical intervention.

Heart rhythm problems (arrhythmias or heart block) 

Irregular heartbeats may develop due to disruptions in the heart’s electrical system. In some cases, a pacemaker may be required, or long-term medication may be needed to manage the condition.

Recurring hole requiring follow-up surgery

In rare cases, the repaired hole may reopen or a new one may develop over time. If this occurs, an additional procedure may be necessary to close the defect completely.

Managing a ventricular septal defect (VSD) involves a combination of regular medical checkups, lifestyle adjustments, medications, and possibly surgical interventions, depending on the size of the hole and its impact on heart function.

Regular checkups and monitoring 

Patients with VSD, especially after surgery, require lifelong monitoring by a healthcare provider, ideally a cardiologist. Regular follow-up visits help assess the heart's condition, monitor for any signs of complications, and determine if additional interventions are needed.

Lifestyle adjustments

For children or adults with VSD, maintaining a healthy lifestyle is essential for supporting heart health. This includes a balanced diet, regular exercise as recommended by a heart surgeon, and avoiding strenuous physical activity if advised. It is also important to follow the doctor's advice regarding any limitations and necessary precautions.

Can a ventricular septal defect close on its own?

Yes, many small VSDs close naturally within the first few years of life as the heart grows. The likelihood of spontaneous closure depends on the size and location of the defect. Muscular VSDs are more likely to close on their own compared to perimembranous or larger defects. Regular check-ups with a paediatric cardiologist help monitor whether the defect is closing or requires medical intervention.

How long does it take for a small VSD to close naturally?

Small VSDs often close within the first two years of life, although some may take longer. In some cases, a VSD may remain open into adulthood without causing significant health issues. The process is gradual and depends on factors such as the child's growth and heart development. Regular monitoring through echocardiograms helps determine if intervention is necessary.

Is VSD a life-threatening condition?

The severity of a VSD varies widely. Small defects usually do not cause serious problems and may never need treatment. However, large VSDs can strain the heart and lungs, leading to complications such as heart failure, high blood pressure in the lungs (pulmonary hypertension), or arrhythmias. Early diagnosis and appropriate management help prevent life-threatening complications.

Does VSD always require surgery?

No, surgery is only needed for moderate to large VSDs that cause symptoms such as difficulty breathing, poor weight gain, or frequent lung infections. Small defects that do not interfere with heart function are usually left untreated and monitored over time. Some moderate defects may be closed using catheter-based procedures rather than open-heart surgery. The decision for surgery depends on the defect’s size, location, and impact on heart function.

Can VSD be detected before birth?

Yes, a VSD can sometimes be identified during a routine fetal echocardiogram, a specialised ultrasound that examines the baby’s heart during pregnancy. However, smaller defects may not be visible until after birth. If a VSD is detected before birth, doctors closely monitor fetal development and plan appropriate postnatal care. In some cases, additional tests may be recommended to check for other congenital heart conditions.

Are there different types of VSDs?

Yes, VSDs are classified based on their location in the ventricular septum. The four main types are perimembranous (near the heart valves), muscular (in the lower part of the septum), inlet (near the atrioventricular valves), and outlet (near the arteries leaving the heart). The type of VSD influences how it is treated, with some being more likely to close on their own and others requiring surgical intervention.

Can a person live a normal life with an untreated VSD?

Many people with small, asymptomatic VSDs can live normal, healthy lives without intervention. These defects often do not affect heart function and require only periodic monitoring. However, larger defects that remain untreated may cause long-term complications such as heart enlargement or high lung pressure, which can affect life expectancy and quality of life. Regular follow-ups with a cardiologist help ensure there are no emerging issues.

Does VSD affect physical activity?

In most cases, children and adults with small or repaired VSDs can participate in normal physical activities, including sports. However, those with larger defects, heart strain, or pulmonary hypertension may need to limit strenuous activities. A cardiologist can provide personalised recommendations based on heart function and overall health. In general, maintaining an active lifestyle is encouraged unless there are specific medical restrictions.

Can VSD cause issues in adulthood?

If a VSD remains untreated, it can lead to complications such as heart failure, irregular heartbeats (arrhythmias), or pulmonary hypertension in adulthood. Even after surgical repair, some individuals may need long-term follow-up to monitor for late complications such as valve problems or residual shunts. Adults with a history of VSD should have periodic cardiac evaluations to assess heart function and prevent potential issues.

Is VSD hereditary?

VSD can sometimes run in families, suggesting a genetic component. It is more common in individuals with chromosomal disorders such as Down syndrome. However, many cases occur spontaneously without a known genetic cause. If there is a family history of congenital heart defects, genetic counselling may be recommended for parents planning to have children.

What dietary considerations are important for a child with VSD?

Children with VSD, especially those with moderate to severe defects, may require extra calories due to the increased workload on the heart. A balanced diet with adequate protein, vitamins, and minerals helps support growth and development. For infants who struggle with feeding, fortified formula or supplemental feeding methods may be recommended. Parents should work with a paediatric cardiologist or nutritionist to ensure their child receives proper nutrition.

Can pregnancy be risky for women with VSD?

Women with a small or repaired VSD usually have a safe pregnancy, but those with larger, untreated defects or complications such as pulmonary hypertension may face higher risks. Pregnancy increases the workload on the heart, which can be dangerous for individuals with severe heart conditions. Women with a history of VSD should consult a cardiologist before planning pregnancy to assess their heart function and determine if special monitoring is needed.

Can VSD cause delayed growth in children?

Large VSDs can lead to poor weight gain and growth because the heart has to work harder, increasing energy expenditure. Additionally, increased blood flow to the lungs can make feeding difficult, leading to inadequate calorie intake. Once the defect is repaired, most children experience significant improvement in growth and development. Regular monitoring of weight and nutrition helps ensure proper growth milestones are met.

Are there long-term follow-ups needed after VSD surgery?

Yes, children and adults who have undergone VSD repair need periodic follow-ups to monitor heart function. Although most individuals recover well after surgery, some may develop residual defects, valve issues, or arrhythmias over time. Regular echocardiograms and cardiac check-ups help detect any late complications and ensure optimal heart health. The frequency of follow-ups depends on the individual’s condition and the success of the initial repair.

Does VSD increase the risk of heart infections?

Certain types of VSDs, especially those that cause turbulent blood flow, may increase the risk of infective endocarditis, a bacterial infection of the heart lining. People with a history of VSD repair may be advised to take antibiotics before dental procedures to reduce this risk. Maintaining good oral hygiene and seeking prompt treatment for infections can also help prevent complications. A cardiologist can guide patients on the necessary precautions based on their specific condition.

Reviewed By Dr. Vineet Bhatia, Director, Cardiac Sciences, Interventional Cardiology on 20 March 2025.