A ventricular septal defect is a hole-shaped defect in the interventricular wall of both ventricles. During normal development, the ventricular septum closes before birth so that oxygen-rich blood does not mix with oxygen-deficient blood after birth. If this defect is not closed, it may lead to increased pressure on the heart or reduce the oxygen supply to the organism. I. Etiology For most children, the cause is unknown.VSD is a very common heart defect disorder, and some children may have a combination of other heart malformations. Effects on the heart Normally, the left ventricle is responsible for pumping blood throughout the body only, and the right ventricle is responsible for pumping blood to both lungs. In children with VSD, blood can be shunted through the defect from the left ventricle to the right ventricle into the pulmonary arteries. If the VSD is very large, the extra blood shunting into the pulmonary arteries can increase the burden on the heart and lungs leading to pulmonary congestion. III. Effects of VSD on the child If the defect is very small, there are often no symptoms due to the compensatory function of the heart and lungs, and the only sign is a heart murmur (audible by stethoscope). If the defect is large, the affected child tends to breathe sharply and with more effort than normal children. The infant will often have difficulty feeding and poor development. Symptoms often appear only after a few weeks. Increased blood flow to the lungs leads to increased pressure in the blood vessels in the lungs. Over time, there is ongoing damage to the blood vessels in the lungs. IV. What we can do about VSD Small defects do not cause increased work done to the heart and lungs and often do not require surgery or other treatment. Small VSDs tend to close on their own, and there are no medications or treatments that can shrink or speed up the closure of VSD defects. Large defects generally require open-heart surgery to close the defect to prevent serious complications. Infants with large defects may develop severe symptoms, so surgery is usually required in the first few months of life. Other types of infants may delay surgery appropriately. Medications may temporarily relieve symptoms but will not cure VSD or prevent ongoing pulmonary vascular damage. Open-heart surgery to repair large VSD defects, even if the child has mild symptoms, is best performed in infancy or childhood to prevent later complications. A fibrous or pericardial (normal membrane tissue covering the surface of the heart) patch is usually sutured to the defect to completely close it. The patch is slowly covered by the normal lining of the heart and becomes an intrinsic part of the heart. A portion of the defect does not require open patch repair and can be sealed by peripheral vascular intervention without incision. If the infant is very ill, or has more than one defect, or if the defect is in a rare area, temporary surgery is required to relieve symptoms and pulmonary pressure. Surgery (pulmonary artery annuloplasty) reduces blood flow to the lungs by annuloplasty of the pulmonary artery. When the child is older, an open-heart VSD repair is performed by surgically releasing the annulus. V. What sports can the child do If the VSD defect is small, or if it is cured by surgery. The child does not need any special precautions in sports activities and can participate in normal activities without high risk. VI. What the child needs to be aware of in the future Depending on the location of the VSD, the child’s pediatric cardiologist will give the child a thorough physical examination to detect special problems, such as aortic valve closure insufficiency. In rare cases, older children with VSD who have combined heart valve regurgitation may need surgery, and after VSD surgery, the cardiologist will give the child a routine physical exam. This is to ensure that the heart is in proper working order, that the long-term prognosis is good and that no oral medications or reoperation is usually needed. The cardiologist will ask the child to take antibiotics before oral surgery for a period of time after the VSD repair, to prevent the risk of endocarditis.