What is a VSD?
A VSD is a hole in the wall between the two lower chambers of the heart. Normally, this wall (the interventricular septum) completely separates the right and left ventricles. With a defect, blood flows from the left ventricle to the right, creating extra load on the heart and lungs.
This is the most common congenital heart defect — occurring in approximately 3-4 children per 1,000 newborns. Every week in my practice I see children with this diagnosis.
"Parents often come to me believing the 'hole will close on its own.' Unfortunately, this only works for small defects. Defects of 4mm and larger require surgical treatment — and the sooner, the better for the child."
Symptoms in Children
Symptoms depend on the size of the defect. Small VSDs (up to 3-4mm) often show no symptoms. Larger defects cause:
- Heart murmur (heard by the pediatrician during examination)
- Child tires quickly during feeding, takes breaks while nursing
- Poor weight gain
- Frequent bronchitis and pneumonia
- Sweating during exertion
- Shortness of breath
When is Surgery Needed?
Size is not the only criterion. The main factor is the clinical picture: how the child is developing, how the heart is functioning, whether there is stress on the lungs. But according to international guidelines, a defect of 4mm is an indication for surgical treatment.
Important to know: Some doctors tell parents "wait, it will close on its own." This is only true for small muscular VSDs under 3mm. Perimembranous defects — the most common type — generally do not close on their own. Delay can lead to irreversible changes in the lungs — pulmonary hypertension — at which point surgery becomes impossible.
A Real Case from My Practice
A child was brought to me with a straightforward VSD — a defect that, when treated in time, yields excellent results. But due to the parents' fear of surgery and incorrect advice to "wait," time was lost. Pulmonary hypertension developed. The child became inoperable.
I always remember this case. That is why I speak openly: fear of surgery is understandable, but delay can cost a child their life.
How is Surgery Performed?
1. Endovascular Closure (Catheter Method)
A thin catheter is introduced through a vessel in the groin, delivering a special occluder device that closes the defect. No chest incision required. Suitable for defects of certain sizes and positions.
2. Open Heart Surgery
Classic open-heart surgery with cardiopulmonary bypass. The defect is closed with a patch or sutures. Used for large defects and complex anatomical positions.
I determine the method individually — based on echocardiography results and the child's clinical picture.
Treatment Outcomes
With timely surgery, the prognosis is excellent. Children after VSD closure live full lives — they play sports and are no different from their peers. The heart recovers completely.
Frequently Asked Questions
Can a VSD close on its own?
Small muscular VSDs (under 3mm) may close in the first 2 years of life. Perimembranous defects — the most common type — generally do not close on their own. An echocardiogram over time gives the definitive answer.
What is the best age for surgery?
Optimally before 1 year of age, if indicated. Early surgery prevents the development of pulmonary hypertension and gives better outcomes for the heart.
Is heart surgery dangerous for a child?
Any surgery carries risks. But the risk of delay with a large VSD is significantly higher than the risk of planned surgery. In the hands of an experienced surgeon, VSD closure is one of the most refined operations in pediatric cardiac surgery.
Can my child play sports after surgery?
Yes. After full recovery (usually 3-6 months) there are no restrictions. Children live full, active lives.
Should I seek a second opinion?
I always recommend it. This is exactly why I conduct consultations — I review the imaging, explain what the numbers mean, and help families make an informed decision.