Ventricular Septal Defect (VSD): Complete Guide to Symptoms, Causes, Diagnosis & Treatment

5 days ago

14 min read

Updated: 51 minutes ago

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026

A ventricular septal defect (VSD) is a hole in the heart present at birth (congenital heart defect), located in the wall that separates the heart's lower chambers (ventricles). The hole lets oxygen-rich blood move back into the lungs instead of being pumped to the body. A small VSD may cause no problems and many small VSDs close on their own. Babies with medium or larger VSDs may need surgery, often in their first year. Symptoms in babies include poor eating, slow growth, fast breathing, easy tiring, and a heart murmur; adults may notice shortness of breath during exercise.

Quick Answer: What Is a Ventricular Septal Defect?

A ventricular septal defect (VSD) is a hole in the heart that is present at birth, located in the wall between the heart's lower chambers (ventricles). It allows oxygen-rich blood to flow back into the lungs instead of out to the body, which can make the heart work harder and raise blood pressure in the lungs. Many small VSDs close on their own without treatment. Medium or large VSDs may need surgery, often during a baby's first year, and most people with VSD can go on to lead healthy, active lives.

What Is a Ventricular Septal Defect (VSD)?

A ventricular septal defect (VSD) is a hole in the heart. It is a common heart problem present at birth (congenital heart defect). The hole occurs in the wall that separates the heart's lower chambers (ventricles).

A VSD changes how blood flows through the heart and lungs. Oxygen-rich blood gets pumped back to the lungs instead of out to the body. The oxygen-rich blood mixes with oxygen-poor blood. These changes may increase blood pressure in the lungs and require the heart to work harder to pump blood.

A small ventricular septal defect may cause no problems. Many small VSDs close on their own. Babies with medium or larger VSDs may need surgery early in life to prevent complications.

Key Fact	Detail
What it is	A hole in the heart present at birth (congenital heart defect)
Location	In the wall between the heart's lower chambers (ventricles)
What goes wrong	Oxygen-rich blood moves back into the lungs instead of out to the body
Blood mixing	Oxygen-rich blood mixes with oxygen-poor blood
Heart workload	The heart must work harder; blood pressure in the lungs may rise
Small VSD outlook	May cause no problems; many close on their own
Medium/large VSD	Babies may need surgery early in life

How the Heart Normally Works

To understand a VSD, it helps to know how the heart typically works. A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves keep blood flowing in the right direction.

The right side of the heart moves blood to the lungs, where blood picks up oxygen. The lungs pump the oxygen-rich blood to the heart's left side, and the left side pumps the oxygen-rich blood to the rest of the body. A VSD changes the direction of blood flow: the hole lets oxygen-rich blood go back into the lungs instead of going out to the body. If the defect is large, blood pressure in the lung arteries may increase, and a large VSD can also increase the amount of blood flow in the lung arteries, causing congestion.

VSD Symptoms

Symptoms of serious heart problems present at birth often appear during the first few days, weeks, or months of a child's life. VSD symptoms depend on the size of the hole and whether there are any other heart problems. A small VSD may never cause symptoms.

In general, symptoms in a baby may include poor eating, slow or no physical growth (failure to thrive), fast breathing or breathlessness, easy tiring, and a whooshing sound heard when listening to the heart with a stethoscope (heart murmur).

Symptoms of a ventricular septal defect in adults may include shortness of breath, especially when exercising, and a heart murmur.

Baby Symptoms	Description
Poor eating	Difficulty feeding or taking in less than expected
Failure to thrive	Slow or no physical growth
Fast breathing	Rapid breathing or breathlessness
Easy tiring	Fatigues easily with little exertion
Heart murmur	Whooshing sound heard with a stethoscope

Adult Symptoms	Description
Shortness of breath	Especially when exercising
Heart murmur	Whooshing sound heard with a stethoscope

When to See a Doctor

Call your healthcare provider if your baby tires easily when eating or playing, is not gaining weight, becomes breathless when eating or crying, or breathes rapidly or is short of breath.

Call your provider if these symptoms develop in you: shortness of breath, a rapid or irregular heartbeat, or fatigue or weakness.

What Causes a Ventricular Septal Defect?

A VSD occurs as the baby's heart is developing during pregnancy. The muscular wall separating the heart into left and right sides doesn't form fully, leaving one or more holes. The size of the hole or holes can vary.

There is often no clear cause. Genetics and environmental factors may play a role. A VSD can occur alone or with other heart problems present at birth. Rarely, a ventricular septal defect can occur later in life after a heart attack or certain heart procedures.

Cause Fact	Detail
When it forms	As the baby's heart develops during pregnancy
What fails to form	The muscular wall between the left and right sides of the heart doesn't form fully
Number of holes	One or more holes; sizes vary
Clear cause	Often no clear cause; genetics and environmental factors may play a role
Associated conditions	Can occur alone or with other congenital heart problems
Adult onset	Rarely occurs later in life after a heart attack or certain heart procedures

Risk Factors

Risk factors for a ventricular septal defect include premature birth, Down syndrome and other genetic conditions, and a family history of heart problems present at birth (congenital heart defects).

A baby born with a VSD may have other heart problems, such as an atrial septal defect, coarctation of the aorta, double outlet syndrome, patent ductus arteriosus, or tetralogy of Fallot. If you already have a child with a congenital heart defect, a genetic counselor can discuss the risk of your next child having one.

Risk Factor	Note
Premature birth	Babies born early are at higher risk
Down syndrome and other genetic conditions	Genetic factors contribute to risk
Family history	Family history of congenital heart defects raises risk

Complications

A small VSD may never cause any problems. Some medium or large VSDs may be life-threatening. Treatment can help prevent many complications.

Complications of a ventricular septal defect can include heart failure. In a heart with a medium or large VSD, the heart works harder and the lungs have too much blood pumped to them; without treatment, heart failure can develop.

An unrepaired hole can also lead to Eisenmenger syndrome after many years. Irregular blood flow causes the blood vessels in the lungs to become stiff and narrow, and blood pressure rises in the lungs' arteries (pulmonary hypertension). This syndrome permanently damages the blood vessels in the lungs.

Endocarditis is a rare complication of VSD. An infection causes life-threatening inflammation of the inner lining of the heart's chambers and valves. Other heart problems can include heart valve disease and irregular heart rhythms (arrhythmias).

Complication	What Happens
Heart failure	The heart works harder and the lungs receive too much blood; without treatment, heart failure can develop
Eisenmenger syndrome	Unrepaired hole causes lung blood vessels to stiffen and narrow, raising blood pressure in the lung arteries (pulmonary hypertension) and permanently damaging them
Endocarditis	Rare; infection causes life-threatening inflammation of the heart's inner lining and valves
Other heart problems	Heart valve disease and irregular heart rhythms (arrhythmias)

Prevention

Because the cause is unclear, it may not be possible to prevent a ventricular septal defect. But getting good prenatal care is important.

If you have a VSD and are planning to become pregnant, get early prenatal care — even before you are pregnant — and talk to your provider about your health, recommended lifestyle changes, and any medications you are taking. Taking a multivitamin with 400 micrograms of folic acid daily has been shown to reduce birth defects in the brain and spinal cord, and it may help reduce the risk of heart defects as well.

Avoid alcohol, because drinking during pregnancy increases the risk of congenital heart defects. Don't smoke or use illegal drugs; smoking during pregnancy increases the risk of a congenital heart defect in the baby. Get recommended vaccinations — having rubella (German measles) during pregnancy can cause problems in a baby's heart development, and a blood test before pregnancy can determine whether you are immune. Keep diabetes under control, because careful blood sugar control before and during pregnancy can reduce the risk of congenital heart defects in the baby, though gestational diabetes generally does not increase the risk. Check with your provider before taking any medications, since some can cause birth defects.

If you have a family history of heart problems present at birth, consider talking with a genetic counselor and a cardiologist before getting pregnant.

Prenatal Step	Why It Helps
Early prenatal care	Discuss health, lifestyle changes, and medications before and during pregnancy
400 mcg folic acid daily	Reduces brain and spinal cord birth defects; may reduce heart defect risk
Avoid alcohol	Drinking during pregnancy increases congenital heart defect risk
Don't smoke or use illegal drugs	Smoking raises the baby's risk of a congenital heart defect
Recommended vaccinations	Rubella during pregnancy can affect heart development; immunity can be checked
Keep diabetes under control	Careful blood sugar control reduces the baby's risk
Medication review	Some medications can cause birth defects

How Is a VSD Diagnosed?

Some VSDs are diagnosed soon after a child is born. However, VSDs may not be diagnosed until later in life. Sometimes a VSD can be detected by a pregnancy ultrasound before the baby is born. If a VSD is present, the healthcare provider may hear a whooshing sound (heart murmur) when listening to the heart with a stethoscope.

Echocardiogram

An echocardiogram is the most commonly used test to diagnose a ventricular septal defect. Sound waves are used to create pictures of the heart in motion. It can show how well blood is moving through the heart and heart valves.

Other Diagnostic Tests

An electrocardiogram (ECG) is a quick and painless test that records the electrical activity of the heart and can show how fast or slowly the heart is beating. A chest X-ray shows the condition of the heart and lungs and can tell whether the heart is enlarged and whether the lungs have extra fluid. Pulse oximetry uses a sensor placed on the fingertip to record the amount of oxygen in the blood; too little oxygen may be a sign of a heart or lung problem.

Cardiac catheterization inserts a thin, flexible tube (catheter) into a blood vessel at the groin or arm and guides it through the blood vessels into the heart, allowing doctors to diagnose congenital heart defects and determine the function of the heart valves and chambers. A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart, typically requested if more information is needed after an echocardiogram. A CT scan uses a series of X-rays to create detailed images and may be done if an echocardiogram didn't provide as much information as needed.

Test	What It Shows
Echocardiogram	Most commonly used; sound waves create pictures of the moving heart and how blood flows through it and the valves
Electrocardiogram (ECG)	Records electrical activity; shows how fast or slowly the heart beats
Chest X-ray	Condition of the heart and lungs; whether the heart is enlarged or the lungs have extra fluid
Pulse oximetry	Oxygen amount in the blood via a fingertip sensor
Cardiac catheterization	Diagnoses congenital heart defects; determines valve and chamber function
Cardiac MRI	Detailed heart images when more information is needed after an echocardiogram
CT scan	Detailed heart images if an echocardiogram wasn't enough

Ventricular Septal Defect Treatment

VSD treatment may include regular health checkups, medications, and surgery. Many babies born with a small ventricular septal defect won't need surgery to close the hole, and some small VSDs close on their own.

If the VSD is small, regular health checkups may be all that's needed, and medication may be prescribed to treat any symptoms. Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow, and some babies may require medication to help treat heart failure symptoms.

Medications

Medications won't repair a ventricular septal defect, but they may be given to treat symptoms or complications. The specific medications used depend on the symptoms and their cause. Water pills (diuretics) are used to decrease the amount of fluid in the body and reduce the strain on the heart. Oxygen may also be given.

Surgeries and Other Procedures

Surgery may be done if the VSD is medium or large or if it is causing severe symptoms. Babies who need surgery to repair the hole often have the procedure in their first year. A surgeon may close small VSDs if their location in the heart could cause damage to nearby structures, such as the heart valves.

Open-heart surgery is the preferred procedure for repairing most ventricular septal defects. A surgeon uses a patch or stitches to close the hole between the lower heart chambers. This type of VSD surgery requires a heart-lung machine and an incision in the chest.

Some VSDs can be repaired using thin, flexible tubes (catheters) without open-heart surgery. The provider inserts a catheter into a blood vessel, usually in the groin, and guides it to the heart. A small device is inserted through the catheter to close the hole.

After ventricular septal defect surgery, regular checkups are needed for life, ideally by a cardiologist. Checkups often include imaging tests to determine how well surgery is working.

Treatment	How It Works
Regular checkups	May be all that's needed for a small VSD
Medications	Won't repair the hole; diuretics decrease fluid and heart strain; oxygen may be given
Extra nutrition	For babies with large VSDs who tire easily during feeding
Open-heart surgery	Preferred for most; patch or stitches close the hole; requires a heart-lung machine
Catheter procedure	A small device closes the hole through a catheter from the groin, without open-heart surgery
Lifelong follow-up	Regular checkups after repair, ideally with a cardiologist, often including imaging tests

Self-Care and Daily Living

Lifestyle changes may be recommended to keep the heart healthy and prevent complications. Because heart problems can increase the risk of infection in the lining of the heart or heart valves (endocarditis), antibiotics may be recommended before dental procedures if you have low oxygen due to a large VSD, a surgically repaired VSD with a patch that still has some blood flow across it, or a recent catheter-based repair. For most people with a VSD, good oral hygiene and regular dental checkups can prevent endocarditis.

Many people with a ventricular septal defect can lead healthy, active lives without restrictions, though some may need to limit exercise and sports activities. Ask your healthcare provider which sports and types of exercise are safe for you or your child. People with Eisenmenger syndrome should avoid strenuous physical activity.

If you have a VSD and are pregnant or hoping to be, talk to your provider about possible risks. A small VSD or a repaired one without complications doesn't pose a large additional pregnancy risk. However, a large, unrepaired VSD, irregular heart rhythms, heart failure, or pulmonary hypertension increase the risk for pregnancy complications. Pregnancy is considered very high risk for those with Eisenmenger syndrome and is not recommended.

Coping and Support

You may find that talking with others who have experienced similar events or situations can be helpful. Support groups offer parents, families, and caregivers a place to share concerns and find encouragement. Ask your healthcare provider if there are any support groups in your area.

Preparing for Your Appointment

If a baby has a large VSD, it will likely be diagnosed soon after birth — sometimes before birth during a pregnancy ultrasound. If you think your child has a VSD that wasn't recognized at birth, make an appointment with your child's healthcare provider; you may be referred to a cardiologist.

Before the appointment, write down any symptoms (including ones that seem unrelated to heart problems), when the symptoms started and how often they occur, important medical information including a family history of congenital heart defects, all medications including over-the-counter ones with dosages, and questions to ask. If possible, ask a family member or friend to come along to help remember what the provider says.

Questions to ask at the first appointment include what is likely causing the symptoms, whether other causes are possible, what tests are needed, and whether a specialist should be consulted. Questions to ask if you're referred to a cardiologist include how large the hole in the heart is, the risk of complications, how to monitor for complications, what treatment is recommended, how often follow-up exams should occur, the long-term outlook, and whether any activity restrictions apply.

What to Bring	What the Doctor May Ask
Any symptoms, including seemingly unrelated ones	Your symptoms and when they began
When symptoms started and how often they occur	Whether symptoms have gotten worse over time
Family history of congenital heart defects	Whether you're aware of heart problems in your family
All medications, including over-the-counter, with dosages	Other conditions being treated recently
Questions to ask	Whether you're planning to become pregnant

Conclusion

A ventricular septal defect is one of the most common congenital heart defects — a hole in the wall between the heart's lower chambers that lets oxygen-rich blood flow back into the lungs instead of out to the body. Symptoms in babies include poor eating, slow growth, fast breathing, easy tiring, and a whooshing heart murmur, while adults may notice shortness of breath during exercise. Many small VSDs cause no problems and close on their own, but medium and large defects often need surgery, frequently during a baby's first year, using open-heart repair or a catheter-based device. The echocardiogram is the most commonly used diagnostic test, and lifelong follow-up with a cardiologist is recommended after repair. Risk factors include premature birth, Down syndrome and other genetic conditions, and family history. While VSD usually can't be prevented, good prenatal care — including 400 micrograms of folic acid daily, avoiding alcohol and smoking, and controlling diabetes — helps reduce overall congenital heart defect risk. Most people with a repaired or small VSD can lead healthy, active lives. If your baby tires easily while feeding or isn't gaining weight, talk to your pediatrician.

Take the next step: If you or your child has been diagnosed with a VSD, ask about a cardiology referral and long-term follow-up plan. Learn more in our related guide on heart failure.

Frequently Asked Questions

What is a ventricular septal defect?

A ventricular septal defect (VSD) is a hole in the heart that is present at birth (congenital heart defect). The hole occurs in the wall that separates the heart's lower chambers (ventricles), allowing oxygen-rich blood to move back into the lungs instead of being pumped to the rest of the body.

Is a VSD serious?

A small VSD may never cause problems, and many small VSDs close on their own. Some medium or large VSDs may be life-threatening without treatment, and babies with medium or larger VSDs may need surgery early in life to prevent complications such as heart failure.

What are the symptoms in babies?

Symptoms may include poor eating, slow or no physical growth (failure to thrive), fast breathing or breathlessness, easy tiring, and a whooshing sound heard with a stethoscope (heart murmur). Symptoms usually appear during the first few days, weeks, or months of life.

What are the symptoms in adults?

Adults may experience shortness of breath, especially when exercising, and a heart murmur. Some VSDs are not diagnosed until later in life.

What causes a VSD?

A VSD occurs as the baby's heart develops during pregnancy — the muscular wall separating the heart into left and right sides doesn't form fully. There is often no clear cause, though genetics and environmental factors may play a role. Rarely, it can occur later in life after a heart attack or certain heart procedures.

Who is at risk?

Risk factors include premature birth, Down syndrome and other genetic conditions, and a family history of congenital heart defects. Babies with a VSD may also have other heart problems, such as atrial septal defect, coarctation of the aorta, or tetralogy of Fallot.

How is a VSD diagnosed?

The echocardiogram is the most commonly used test, using sound waves to create pictures of the moving heart. Doctors may also use an ECG, chest X-ray, pulse oximetry, cardiac catheterization, cardiac MRI, or CT scan. Some VSDs are detected by pregnancy ultrasound or soon after birth through a heart murmur.

How is a VSD treated?

Small VSDs may only need regular checkups, and many close on their own. Medications such as diuretics treat symptoms but don't repair the hole. Medium or large VSDs are repaired with open-heart surgery (using a patch or stitches) or a catheter procedure with a small device. After repair, regular checkups for life, ideally with a cardiologist, are needed.

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Medical disclaimer: This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional for any questions about a heart condition in you or your child.