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Complications
By Mayo Clinic staffA small ventricular septal defect may never cause any problems. Larger defects can cause a wide range of disabilities — from mild to life-threatening. Treatment can prevent many of these complications.
Eisenmenger's syndrome
Ultimately, if a large ventricular septal defect goes untreated, increased blood flow to the lungs causes high blood pressure in the lung arteries (pulmonary hypertension). Over time, permanent damage to the lung arteries develops and the pulmonary hypertension can become irreversible.
This complication, called Eisenmenger's syndrome, may occur in early childhood, or it can develop slowly over many years. In people with Eisenmenger's syndrome, the majority of the blood flow through the ventricular septal defect goes from the right ventricle to the left and bypasses the lungs. This means deoxygenated blood is pumped to the body and leads to a bluish discoloration of the lips, fingers and toes (cyanosis) and other complications. Once a person has Eisenmenger's syndrome, it's too late to surgically repair the hole because irreversible damage to the lung arteries has already occurred.
Other complications
Other complications may include:
- Heart failure. The increased blood flow through the heart due to a ventricular septal defect can also lead to heart failure, a chronic condition in which the heart can't pump effectively.
- Endocarditis. People with a ventricular septal defect are at increased risk of an infection of the heart (endocarditis).
- Stroke. People with large defects, especially occurring with Eisenmenger's syndrome, are at risk of a stroke due to a blood clot passing through the hole in the heart and going to the brain.
- Other heart problems. Ventricular septal defects can also lead to abnormal heart rhythms and valve problems.
Ventricular septal defect and pregnancy
Becoming pregnant is often a concern for women born with a heart defect. Having a repaired ventricular septal defect without any complications or having a very small defect doesn't pose any additional risk in pregnancy. However, having an unrepaired larger defect, heart failure, cyanosis or other heart defects poses a high risk to both mother and fetus. Women with Eisenmenger's syndrome are at the highest risk of complications. Doctors strongly advise these women not to become pregnant.
Women born with a heart defect may also be concerned about the risk that the baby will be born with a heart defect as well. A woman without congenital heart disease has about a 1 percent chance of giving birth to a child with a heart defect. According to the American Heart Association, that risk increases to between 2 and 20 percent for a woman with congenital heart disease.
Doctors recommend that any woman with a congenital heart defect, repaired or not, who is considering pregnancy carefully discuss it beforehand with a cardiologist. This is especially important if you're taking medications. It's also important to see both an obstetrician and a cardiologist during pregnancy.
- What are holes in the heart? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/holes/holes_whatare.html. Accessed Aug. 4, 2009.
- Ventricular septal defect (VSD). American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=11066. Accessed Aug. 4, 2009.
- Webb GD, et al. Congenital heart disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec134&displayedEid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec166&uniq=152762796&isbn=978-1-4160-4106-1#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50064-9%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed Aug. 4, 2009.
- Dummer KB, et al. Pathophysiology and clinical features of isolated ventricular septal defects in infants and children. http://www.uptodate.com/home/index.html. Accessed Aug. 4, 2009.
- McMackin,CJ, et al. Ventricular septal defect. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008. http://www.mdconsult.com/das/book/body/152762796-4/871305879/1701/628.html#4-u1.0-B978-0-323-04134-8..50025-2--subchapter8_13432. Accessed Aug. 4, 2009.
- Congenital heart defects. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4565. Accessed Aug. 4, 2009.
- Dummer KB, et al. Management of isolated ventricular septal defects in infants and children. http://www.uptodate.com/home/index.html. Accessed Aug. 4, 2009.
- Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation. 2007;116:1736.
- Genetic counseling for adults with congenital heart disease. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=11083. Accessed Aug. 20, 2009.
