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Dr. Alessandro Giardini
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Finding out your child has a ventricular septal defect raises an immediate question: does it need to be fixed? For most families, the answer is reassuring. The majority of VSDs either close on their own or remain small enough that they never require any intervention at all. Knowing which category your child falls into is precisely what a specialist assessment is designed to establish.
For a full explanation of what a VSD is, the different types, and how it is diagnosed, see the VSD overview page.
Size is the single most important factor. Small defects, particularly muscular VSDs sitting within the thick part of the septum, have a high chance of closing on their own. Most do so within the first two years of life. Those that stay open are frequently so small that the heart is not under any meaningful strain.
For these children, the approach is simply watchful monitoring: a periodic echocardiogram to confirm the defect is stable, no activity restrictions, and no medication. Some children are eventually discharged from cardiology follow-up entirely.
That is the most common outcome. Worth remembering.
Symptoms appear when the volume of blood crossing the defect is large enough to make the heart work too hard. This typically becomes apparent in the first weeks or months of life. As the natural resistance in the lung blood vessels falls after birth, more blood begins to cross the hole.
A baby with a significant VSD will tire quickly during feeds, struggle to finish a bottle or breastfeed, and fail to gain weight as expected. Laboured breathing is common. Fast or noisy breathing, sweating during feeding, and frequent chest infections are the other signs parents most often notice. On the echocardiogram, enlargement of the left ventricle confirms the heart is under excess strain. At that point, the decision shifts clearly toward intervention.
There is one exception worth knowing about. Outlet VSDs sit just below the aortic valve and are referred for closure even when they are small and causing no symptoms. This is important. Their position carries a risk of the aortic valve gradually prolapsing over time. The threshold for acting is lower here, regardless of how the child feels.
When a baby is symptomatic but not yet ready for surgical repair, diuretics such as furosemide help reduce the fluid load on the lungs. Breathing becomes easier. High-calorie formula or fortified breast milk addresses the weight gain problem directly. These medicines do not close the VSD. They are a bridge, used to support the baby while a decision is being made or while the child grows toward an optimal weight for surgery.
Surgery is the standard treatment when intervention is needed. The surgeon closes the hole with a patch of synthetic material or pericardium, the natural lining around the heart, while the heart is temporarily supported by a bypass machine. The repair is permanent. The heart's own tissue grows over the patch in the following weeks.
At experienced centres, the operative mortality for elective VSD closure is well under 1%, and the long-term success rate is very high. Most children spend a few days in intensive care and are home within about a week. Dr Giardini works closely with the surgical team at Great Ormond Street Hospital and the Portland Hospital, where VSD closure is a well-established procedure. Volume and experience matter here.
Selected VSDs, most often muscular defects positioned away from the heart valves and conduction tissue, can be closed without open-heart surgery. A small closure device is guided through a catheter in the groin and deployed across the hole under echocardiographic and fluoroscopic guidance. There is no chest scar.
This approach is not appropriate for perimembranous VSDs, the most common type. Their proximity to the aortic valve and the electrical conduction system makes catheter closure higher-risk in that location, and surgery remains the preferred option. Where catheter closure is suitable, the reduced recovery time is a genuine advantage. Whether it applies to your child depends on the anatomy of the specific defect. Dr Giardini explains this based on the echocardiogram findings.
In very small or premature babies who are not yet safe for a full repair, a temporary operation called pulmonary artery banding may be used. It is a staging approach. A band placed around the main pulmonary artery reduces blood flow to the lungs while the baby grows. The band is removed when definitive repair becomes possible. This is used far less commonly than direct closure.
Successful VSD closure carries an excellent outlook for the great majority of children. Recovery tends to be quicker than families expect. The heart returns to a normal size within months. Most children go on to live completely unrestricted, active lives with no long-term medication required. No ongoing antibiotics before dental procedures are needed either, a common misconception that changed with updated guidelines some years ago.
Follow-up after a straightforward repair involves a check-up every two to five years. Dr Giardini sees children at all stages of the VSD journey and always aims to give families a clear picture of what lies ahead.
For babies with a large VSD causing symptoms, surgery is typically planned within the first three to six months of life. This is once the child has been stabilised with medication and reached an appropriate weight. Children whose VSD is identified later, or where symptoms have been mild and managed conservatively, can have surgery at any age. Timing is always tailored to the individual child. Dr Giardini discusses the reasoning in detail during the consultation so families understand the plan and the rationale behind it.
Most spontaneous closures happen in the first two years of life, particularly for muscular VSDs. After this point, the probability of natural closure decreases, though it does not fall to zero. Some small perimembranous VSDs continue to reduce in size slowly into childhood, occasionally closing by the age of four or five. If a VSD remains present and haemodynamically insignificant at school age, the decision about monitoring versus planned closure is made individually. Type, size, and any changes to the heart over time all feed into it.
Surgical closure is open-heart surgery performed under general anaesthetic using a heart-lung bypass machine. It is the standard approach for most VSDs, including the common perimembranous type, and has a very long track record of safety and effectiveness. Catheter-based closure avoids open-heart surgery entirely: a device is threaded through a blood vessel in the groin and positioned across the hole without a chest incision. Recovery is faster and there is no sternotomy scar. However, catheter closure suits only selected defects, mainly muscular VSDs in certain positions. The best approach depends on the specific anatomy of the defect, and Dr Giardini will explain this based on the echocardiogram findings.
A permanent pacemaker is needed in fewer than 1% of VSD repairs at experienced centres. The risk exists because the heart's electrical conduction system runs close to the ventricular septum, and there is a small chance of injury during surgery. In most cases where the conduction system is affected, any rhythm disturbance is temporary and resolves within days. At specialist centres with a high volume of VSD repairs, permanent pacemaker implantation is an uncommon complication.
Most children spend two to four days in intensive care following VSD surgery and a further three to four days on the cardiac ward. Home within a week is typical. The chest heals over six to eight weeks, during which time children are advised to avoid contact sports and rough play. After the initial recovery period, with a normal post-operative echocardiogram, there are no activity restrictions for the great majority of children. Full recovery in terms of the heart returning to normal size and function typically takes two to three months.
Author: Dr. Alessandro Giardini, MD, PhD
Written 29/05/2026