Ventricular Septal Defect (cont.)

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What if the VSD is small?

Small defects (less than 0.5 square cm) are common. With a small VSD, there is minimal shunting of blood and the pressure in the right ventricle remains normal. Since the right ventricular pressure is normal, there is no damage to the lung arterioles. The heart functions normally. A prominent murmur heard through a stethoscope is usually the only sign that brings the VSD to attention. This murmur is commonly noted during the first week of life.

How is a small VSD treated?

One-third to one-half of all small VSDs close spontaneously (on their own). This seemingly miraculous event occurs most often before the baby is 1 year old, almost always before age 4 (75% by 2 years of age). The closure is due to the small VSD being located between heart fibers that increase in size in time, thus encroaching upon the opening in the ventricular septum.

Even if a small VSD does not close spontaneously, surgical repair is usually not recommended. However, long-term follow-up is required.

What if the VSD is large?

With a large VSD (usually one greater than 1 cm2), there is significant shunting of blood from the left ventricle into the right ventricle. Thus extra blood volume puts a strain on the right ventricle and causes an increase in the blood pressure of the lungs called "pulmonary hypertension." The child may have labored breathing, difficulty feeding, poor growth, and have pallor.

How is a large VSD treated?

Ultimately, the patient with a large VSD will need surgery to "patch the hole" in the ventricular septum. The timing of surgery is an individualized decision based upon several factors. These include

  1. The extent and duration of increased pulmonary artery pressure. Chronic pulmonary arteriolar pressure may become irreversible and put a strain on the right ventricle. These side effects may be treated with medications until surgery is appropriate.

  2. A child with a large VSD often will not grow as robustly as his peers. The work of increased metabolic demands often requires additional calories when compared to children without such a cardiac defect. High-calorie dense supplements may be added to formula. Some infants may require nighttime continuous feedings using a tube that is passed through the nose to the stomach (nasogastic tube) to maximize growth. It is very rare to restrict fluid volumes in these children.

  3. Infants with iron-deficiency anemia should receive iron supplements to maximize the oxygen carrying capacity of their blood. Blood transfusions to address such an anemia are rare.
Medically Reviewed by a Doctor on 6/8/2015

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