Pediatric Cardiology

Ventricular Septal Defect (VSD) in Children: Symptoms and Treatment

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

Ventricular Septal Defect (VSD) in children is the presence of a congenital hole or opening in the wall between the ventricles of the heart. This anatomical condition causes clean blood to leak back into the lungs instead of being distributed throughout the body, increasing the workload of the heart and lungs. This anomaly, which is the most common among congenital heart diseases, is now successfully managed thanks to proper specialist follow-up and modern treatment approaches. With early diagnosis, the vast majority of children can go through a completely healthy and energetic developmental process without experiencing any physical limitation.

Why and How Does Ventricular Septal Defect (VSD) Occur During the Development of Babies in the Womb?

The development of a baby in the womb is one of nature’s most complex and delicate processes. During this process, the heart begins to form very early in pregnancy, between the fourth and eighth weeks. The heart, which initially has the form of a simple tube, gradually folds onto itself and divides into chambers, forming its famous four-chambered structure. The wall that separates the lower chambers of the heart and is called the “septum” is actually not a single piece. This wall is formed by the fusion of four main tissue groups that come from different regions of the heart and move toward each other like pieces of a puzzle. If these tissue groups cannot meet at the center point exactly on time and with millimetric precision, a gap remains between them, and this gap creates the condition known as a congenital heart hole.

Modern medicine delves into the depths of genetic codes to understand the causes of these fusion errors. Even the slightest deviation in the genes that control certain proteins and cell movements involved in the construction of the heart wall can prevent this wall from closing. However, this condition is not limited only to genetics; sometimes environmental factors can also affect the process. Still, the most important fact families should know is that in most cases, the formation of this hole is a completely random developmental error. Although some febrile illnesses experienced by the mother during pregnancy or exposure to certain external factors may increase this risk, today this condition has become a health issue that can be resolved to a very large extent with modern surgical and follow-up methods. As the baby’s development continues, some of these holes tend to shrink on their own, because the body can also use its growth energy to close these openings.

Some factors that may be effective during the formation of the heart wall are as follows.

  • Differences in genetic codes
  • Chromosomal changes
  • Viral infections in the womb
  • Uncontrolled use of certain medications
  • Consanguineous marriages
  • Diabetes in the mother

Which Types of Ventricular Septal Defect (VSD) Exist According to the Location of the Hole in the Heart?

Openings in the heart wall are classified according to where they are located in the wall, and this classification determines the route of treatment. Part of the wall consists of thick muscle tissue, while another part has a thinner, membranous structure. By looking at the location of the hole, specialists can predict whether that hole will close as the child grows or whether a surgical intervention is necessary and how urgent it is. Since the location of these holes can also directly affect their proximity to the electrical system of the heart and the health of the valves, anatomical diagnosis is the most critical stage of the process.

Commonly seen types of holes are as follows:

  • Perimembranous
  • Muscular
  • Inlet
  • Outlet

The perimembranous type is the most common type and is located in the membranous tissue in the upper parts of the heart. The most advantageous aspect of this type of hole is that it has the potential to close spontaneously over time with the help of the surrounding valve tissues. Muscular holes are located entirely within the muscle tissue; sometimes they may be seen not as a single hole but as many small holes spread between the muscle fibers, and these types of holes can be treated both by angiography and surgically. Inlet-type holes are located just below the inlet valves of the heart and generally do not tend to close spontaneously; they are also usually not suitable for angiographic treatment. Outlet-type holes are very close to the great vessels leaving the heart, so they carry the risk of disrupting the structure of the vessel valves and therefore need to be closely monitored, or even treated early; these types of holes can be treated both by angiography and surgically.

How Does the Size of the Hole in the Heart Affect the Circulatory System in Ventricular Septal Defect (VSD) Cases?

In VSD cases, how much the heart will be strained and how much the lungs will be challenged depends directly on the width of the hole. Since the left side of the heart is responsible for pumping blood to the body, it is much stronger and the pressure inside it is quite high. The right side works at lower pressure because it sends blood only to the lungs. The presence of a hole in the wall between them causes an inevitable blood leakage from the high-pressure left side to the right side. This leakage means that the amount of blood going to the lungs rises far above normal. As a result, both the pulmonary vessels swell under this excess blood load and the left side of the heart begins to enlarge by spending more energy to handle this extra workload.

The effects that develop according to the size of the hole are listed below.

  • In small holes, circulation remains normal.
  • In medium-sized holes, the heart enlarges slightly.
  • In large holes, severe cardiac fatigue occurs. Pulmonary pressure tends to rise. The efficiency of the heart’s blood pumping may decrease. The amount of clean blood going to the body may be affected.

Small holes usually remain only as a sound (murmur) and do not impair the child’s quality of life. However, in large holes, the amount of blood going to the lungs is so high that over time this condition may permanently damage the structure of the pulmonary vessels. In the first few weeks after the baby is born, the pressure in the pulmonary vessels naturally begins to decrease, and it is during this period that the amount of blood passing through the hole reaches its maximum. Therefore, in babies with large holes, complaints usually become more pronounced after the first month. Specialists monitor millimetric increases in the diameters of the heart chambers to understand how the heart copes with this excess load.

With Which Clinical Symptoms Can Families Understand That Their Babies Have Ventricular Septal Defect (VSD)?

Not every baby with a hole in the heart may appear ill from the outside; especially if the hole is small, the child may follow a completely healthy developmental process. However, if the hole is large and the workload of the heart has significantly increased, the baby reflects this strain in the body outwardly through certain behavioral and physical signals. The moments families should pay the most attention to are the times when the baby exerts effort. For babies, the greatest effort is feeding; the act of sucking is the physical activity that consumes the most energy for a baby. A baby with a tired heart may sweat like an athlete during this activity and tire quickly.

Common clinical symptoms are as follows:

  • Frequent pauses during sucking
  • Sweating and difficulty on the scalp while feeding
  • Rapid and shallow breathing
  • Inability to gain the expected weight
  • Frequent recurrent lung infections
  • Rapid rising and falling of the chest wall

A typical sign is the baby getting tired after a few sips during feeding, leaving the breast, and wanting to continue again after resting for a while. Because of this fatigue, the baby cannot get enough nutrition and the growth curve begins to fall behind that of peers. In addition, the excess amount of blood in the lungs makes this area more vulnerable to infections; therefore, children with VSD carry a higher risk of having bronchitis or pneumonia more frequently. If the spaces between your baby’s ribs sink inward while breathing or if the baby breathes very rapidly, this may be an indication that the heart and lungs are waiting for support.

Which Methods Are Used in Modern Medicine for the Definitive Diagnosis of Ventricular Septal Defect (VSD)?

The diagnostic process usually begins when the pediatrician hears a murmur in the heart during a routine examination. A murmur is the sound waves created as blood passes through the hole. However, hearing only the sound is not enough; the exact location and size of the hole and its effect on the heart must be seen. In modern pediatric cardiology practice, the gold standard for this diagnosis is the echocardiography device. This device displays the internal structure, chambers, and vessels of the heart on the screen like a live film with the help of radiation-free sound waves. During this completely painless procedure, the baby sleeping or remaining calm provides a great advantage for making clear measurements.

The main tools used in the diagnostic stage are as follows:

  • Transthoracic echocardiography
  • Electrocardiography (ECG)
  • Chest X-ray (in necessary patients)
  • Cardiac catheterization (in necessary patients, to treat or to start treatment by making a diagnosis)
  • Magnetic resonance imaging (MRI) (in necessary patients)

With echocardiography, the diameter of the hole is measured millimetrically and the amount of enlargement on the left side of the heart is determined. While ECG checks whether there is strain in the electrical system of the heart, chest X-ray is used to observe increased blood flow in the pulmonary vessels and the overall size of the heart. In some very rare and complex cases or in cases where pulmonary pressure must be measured precisely, catheterization may be performed in the angiography laboratory, and in suitable patients the hole can also be closed angiographically. Thanks to these advanced methods, a child-specific roadmap is drawn for each patient, unnecessary interventions are prevented, and the most appropriate treatment timing is determined.

Which Medical Treatments and Medications Are Used for Ventricular Septal Defect (VSD) in the Pre-Surgical Process?

Not every heart hole requires an immediate operation; sometimes time is needed for the heart and the baby to grow. During this waiting period or during the period when the hole is expected to close spontaneously, medication therapy is used to reduce the load on the heart. These medications do not actually close the hole; instead, they make the heart’s work easier, allowing the baby to breathe more comfortably and gain weight by becoming stronger. The most important goal during this period is to bring the baby to the healthiest and strongest form even if surgery is needed. Specialists adjust medication doses very precisely according to the baby’s weight and monitor their effects with regular check-ups.

The methods commonly preferred in treatment are as follows.

  • Diuretics that remove excess fluid from the body
  • Medications that dilate vessels
  • Supportive agents that support the heart muscle
  • Medications that balance potassium levels
  • Iron supplements that prevent anemia
  • Vitamin support administered when necessary

Diuretics, known as water pills, help the baby’s breathing become significantly easier by removing excess fluid in the lungs from the body. Vasodilator medications help reduce the amount of blood leaking to the right side through the hole by making it easier for blood to spread throughout the body. In this process, it is important for families to fully comply with medication times and monitor the baby’s urine output for the success of treatment. As weight gain improves in babies under medication therapy and the enlargement in their hearts stops, the need for intervention may be postponed and, in some cases, may even disappear completely.

How Should the Nutrition of Babies with Ventricular Septal Defect (VSD) Be Planned in Daily Life?

The energy requirement of babies with a heart hole is much higher than that of a normal baby. The heart working faster and the increased effort of breathing cause the body to burn more calories. However, these babies have difficulty getting enough calories because they become tired. Therefore, nutrition is at least as critical a part of VSD treatment as medications. The aim is to ensure that the baby receives the highest calories in the shortest time without getting tired. Thanks to this strategy, the baby’s growth rate increases and the body contributes to the closure of the hole or the reduction of surgical risks by repairing its tissues.

The main approaches that improve the feeding routine are as follows:

  • Special high-calorie formulas
  • Increasing the number of meals
  • Short-term and frequent breastfeeding
  • Supplements that increase the calories of breast milk
  • Choosing an easy-flow bottle nipple
  • Using an upright position during feeding

To reduce the effort the baby spends while sucking, breast milk can be expressed and given with an easier-flow bottle, but do this by asking your doctor. If the baby cannot receive enough nutrition orally, specialists may recommend nutritional support for a temporary period with the help of a thin tube extending from the nose to the stomach (feeding tube). This method allows the baby to receive the energy needed without getting tired, even while sleeping. The general condition of a baby whose weight gain becomes regular improves rapidly, the immune system strengthens, and signs of heart failure begin to regress. Families are advised to observe the baby’s signs of fatigue during feeding carefully and establish a routine suitable for the baby’s pace without forcing the baby.

How Is the Angiography Method Applied in the Closure of Ventricular Septal Defect (VSD) with Developing Technology?

Thanks to revolutionary developments in medicine, not every heart hole now has to be closed with major surgeries. Especially suitable holes located in the muscular part of the heart can be treated with the angiography method (transcatheter closure) performed by entering through the groin. Since this method eliminates the need to open the chest wall, the recovery process is much faster and it does not leave a permanent surgical scar on the body. The procedure is performed by specialist teams under advanced imaging techniques, and patients can generally be discharged shortly after the procedure and return to their daily lives.

The main elements used in the angiographic closure process are as follows:

  • Specially designed closure devices
  • Flexible and thin carrier tubes
  • Advanced X-ray systems
  • Ultrasound monitoring performed during the procedure (a procedure that can be performed by entering with a camera through the mouth, TEE)
  • Vascular access through the groin
  • Mild and safe anesthesia application

In this procedure, umbrella-like devices that sit on both sides of the hole and act as a type of plug are used. After the device is placed, the heart tissue covers this device with its own cells over time, and the device becomes a natural part of the heart. Not every hole may be suitable for closure with angiography; if the location of the hole is too close to the valves or if the vascular structure is not suitable, specialists may prefer the surgical route. However, in suitable cases, this method is an extremely safe and modern option that allows the child to return home completely healthy within just a few days.

How Is Open Heart Surgery Performed for Ventricular Septal Defect (VSD) in Cases Requiring a Definitive Solution?

In large holes, in cases where medication therapy is insufficient, or in cases where the risk of permanent damage has developed, surgical repair is the most definitive and reliable method. Today, pediatric heart surgery has advanced so much that these operations can be performed with high success rates even in very small babies. The aim of the surgery is to completely close the hole with the help of a patch and restore the normal blood circulation pattern of the heart. During the operation, the surgical team works with microscopic precision to avoid damaging the electrical system and valves of the heart.

Some details that stand out in the surgical process are as follows.

  • Use of a heart-lung machine
  • Special synthetic patch materials
  • Repairing the heart after stopping it
  • Short-term follow-up in intensive care
  • Microsurgical suture techniques
  • Pain control-focused recovery protocol

Thanks to systems that temporarily take over the function of the heart during the operation, the surgeon can close the hole millimetrically in a motionless heart. Most children are transferred to the ward a few days after surgery and discharged within approximately one week. Thanks to the closed hole, excess blood flow to the lungs is immediately stopped and the heart rapidly begins to return to normal size. In the postoperative period, children usually begin to gain weight with a great appetite, because their hearts no longer have to work extra and the energy spent is directed directly toward growth.

What Undesirable Outcomes May Occur in Ventricular Septal Defect (VSD) Cases with Delayed Treatment?

In cases diagnosed with VSD but whose follow-up has been disrupted or whose intervention timing has passed, the body may become unable to carry this burden any longer. The most feared condition is the permanent increase in pressure in the pulmonary vessels. Pulmonary vessels exposed to high blood flow for a long time begin to thicken and stiffen to protect themselves. This condition may become irreversible after a certain point. Therefore, specialists aim to intervene at the right time before the lungs lose their flexibility. Regular follow-up is the only way to prevent these undesirable conditions.

Risks that may occur in cases that are not followed up are as follows:

  • Permanent increase in pulmonary pressure
  • Worsening of the heart failure picture
  • Right-to-left passage of deoxygenated blood
  • Bluish discoloration of the lips and fingers
  • Enlargement of the liver and fluid accumulation
  • Development of permanent vascular occlusions

In these advanced-stage conditions, even closing the hole may no longer benefit the patient and may even cause harm. Therefore, after diagnosis, following the appointment intervals recommended by the physician is of vital importance. In children who receive early intervention, almost all of these risks disappear and the pulmonary vessels completely preserve their normal structure. Thanks to the possibilities offered by medical technologies, the rate of such delayed cases today has become quite low; however, raising awareness and understanding the importance of the process is still the greatest responsibility for families.

How Should Long-Term Follow-Up Be Performed for Ventricular Septal Defect (VSD) Patients After Successful Treatment?

After the hole in the heart heals either by spontaneous closure or medical intervention, the vast majority of children lead a life no different from their peers. They can do sports, go to school, and participate in all kinds of activities. However, after the heart has gone through this process, remaining under specialist supervision at certain intervals is necessary to ensure that everything is going well. During these follow-ups, the rhythm of the heart, the condition of the valves, and the compatibility of the suture or device area are checked. Long-term success is not only the closure of the hole but the preservation of the child’s lifelong heart health.

The issues considered in long-term follow-up are as follows:

  • Annual periodic echo checks
  • Protection of oral and dental hygiene
  • Monitoring heart rhythm with ECG and intermittent 24-hour rhythm Holter monitoring at home
  • Measurement of physical activity capacity
  • Preventive measures against infective endocarditis (in some patients)
  • Healthy nutrition and exercise habits

Dental health is especially important for these children; because infections in the mouth may enter the bloodstream and carry the risk of reaching heart tissues. Therefore, regular dental examinations and good brushing habits are as valuable as heart check-ups. In many cases, no medication use is required after surgery or angiography, and the child grows completely freely. Families should see this history in their child’s heart not as an obstacle, but as a memory left behind with the success of modern medicine.

Güncellenme Tarihi: 13.10.2026

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