VSDs - are a "hole" in the wall between the two lower chambers of the heart - the ventricles. This hole may be small, medium-sized or large, and may be single or multiple. The defect may occur in different parts of the muscular wall between the lower heart chambers, and may sometimes be found along with other heart defects.
The muscular wall between the lower heart chambers is meant to separate blood passing through each (i.e. "ventricle"). This separation prevents unhealthy mixing of blue blood from the veins with red, oxygen-rich blood going to the arteries. When the muscular wall (i.e. septum) is incomplete or "broken", mixing occurs. In most situations, this leads to red blood passing across the defect and mixing with the blue blood on the right side of the heart. This is called a left-to-right-shunt and leads to abnormally high blood flow into the lungs. Just as in atrial septal defects (ASD), this causes frequent "chest colds" and breathing difficulty in children. When the VSD is large in a very small child, lung blood flow may be so enormous that the tiny ventricles cannot pump such a volume. This causes congestive heart failure. Heart failure in a child produces fast shallow breathing, excessive sweating, inability to feed well, irritability, constant crying, and a failure to grow at a normal pace.
One effect seen in VSD - but not in ASD - is the rapid development of changes in the blood vessels of the lungs. These arteries and veins become thick walled and hard early in life. The reason for this is perhaps because blood from the left ventricle, which is the most powerful chamber of the heart, is pumped under high pressure across the VSD into the lungs. To withstand such force, the tiny branches of the pulmonary artery become thickened and obstructive. This condition is known as Pulmonary Hypertension or Pulmonary Vascular Obstructive Disease (PVOD). The consequences of leaving a large VSD open is the eventual development of PVOD which may render the patient inoperable at some point in life.
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