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Hole in the Heart (Ventricular Septal Defect)

The information you are going to get from this Article are:
1. Introduction of the hole in the heart, normal anatomy of the heart, introduction of the most common type of congenital heart defect the ventricular septal defect VSD.
2. Types of VSD.
3. What is fetal echocardiography and its relation with the VSD.
4. Signs and symptoms of VSD.
5. Treatment for VSD.

Hole in the Heart (VSD)

1. Congenital Heart Defect

Congenital (present from birth) heart disease is one or more defects in the heart existing from birth. About one baby out of a hundred is born with congenital heart defects. The defect can change the way blood flows in the heart. It is also known as holes in the heart. There are about 18 congenital heart defects, but the most common is Ventricular septal defect (VSD). For a better understanding of this defect, it’s important to know the normal structure of the heart.

2. Normal Anatomy (Structure) of the Heart

The heart has four chambers, left and right atrium, and left and right ventricles. The left and right atriums are present on the top side of the heart and left and right ventricles on the lower side. These chambers hold blood. The structures that separate the left and right sides of the heart are called the septums. The ventricular septum separates the left and right ventricles and the atrial septum separates the left and right atrium. The deoxygenated (not carrying oxygen) blood enters the right atrium of the heart then it is pumped into the right ventricle and moves out of the heart through the pulmonary artery to the lungs where it becomes oxygenated. The oxygenated blood then moves into the left atrium and is pumped into the left ventricle. After that, the blood moves out of the heart through the aorta and circulates the whole body.

3. Ventricular Septal Defect (VSD)

This is a type of congenital heart defect in which there is deformation in the ventricular septum. Due to this defect, the oxygenated blood from the left ventricle moves into the right ventricle where the oxygenated blood mixed with the deoxygenated blood and put pressure on the pulmonary blood vessels. This abnormal blood flow is called a shunt which is usually from the left to right ventricle. The left to right flow is due to higher pressure on the left side of the heart because it is responsible for pumping blood to the whole body as compared to the right side that only pumps the blood into the lungs. When the defect is small the shunt does not cause any symptoms but when it is large then the right side gets overloaded due to which serious problems occur. This defect is most common in babies and less common in adults because in most cases the hole or (VSD) is small and close by its own in early childhood without any surgery.


1. Perimembranous (VSD)

It is the most common type of (VSD). It occurs at the upper part of the ventricular septum, below the aortic valve (the valve through which the blood flows out of the heart into the body). In many cases, the hole closed on its own in childhood. larger defects may gradually become small with the age.

2. Trabecular (Muscular) Ventricular Septal Defect (VSD)

The thicker part of the ventricular septum is called the muscular septum. The defect occurs when there is a hole in the muscular area of the septum. This defect is subdivided into the mid-muscular, apical, posterior, and inner. When multiple or uncountable muscular (VSDs) occur in the heart then the condition is called “Swiss Cheese”. Like perimembranous (VSD) most of the muscular (VSDs) also closed in early childhood.

3. Outlet or Conoventricular (VSD)

It is a hole that occurs just before the pulmonary and aortic valves. It means that the hole is present where blood exits the ventricular chambers.

4. Inlet (VSD)

It is a hole that occurs below the tricuspid valve in the right ventricle and the mitral or bicuspid valve in the left ventricle. (The tricuspid valve is present between the two right chambers and it consists of three flaps (covering) of tissues. The bicuspid valve is present between the two left chambers and consists of two flaps of tissues). It means that the hole is present where the blood enters the ventricular chambers. 

Fetal Echocardiogram

It is a very safe test that uses ultrasound technology which produces video images of the heart to diagnose any heart condition. This test is done when the baby is still in the mother’s womb. It is done in the second trimester or 18 to 24 weeks of pregnancy. This test is recommended by the obstetrician (Surgeon or physician) when one suspects a heart defect in the fetus.

Signs & Symptoms of VSD

Rapid shortness of breath, easily getting tired, due to excessive flow of blood into the lungs the signs of congenital heart failure will increase. The signs of heart failure include weight loss. The symptoms also include the sound of a murmur that can be heard by using a stethoscope. 

Treatments of VSD

Most babies don’t need any treatment but if the hole doesn’t close on its own then cardiac surgeries are available for treatment. A percutaneous catheter intervention is a technique that requires no surgery and doctors used the catheter to enter the heart by pulmonary blood vessels and use button-like devices to close the holes. The doctor opens the abnormal valves by using balloons and placing the stems in the narrow arteries

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