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Ventricular Septal Defect | Diagnosis, Treatment options, Cost & Planning

Treatment of Ventricular Septal Defect in Infants

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What is a ventricular septal defect (VSD) in infants?

A ventricular septal defect is a congenital heart disease in which the child is born with a hole in the wall of the muscle that separates the heart’s two chambers i.e the left and the right ventricles. This condition is also called “a hole in the heart.” The opening or hole may be in different parts of the heart wall, called the septum. In some cases, there may be more than one hole.

The severity of VSD and how it’s treated depends on the size of the hole and its location within the septum. The defect can occur anywhere in the muscle that divides the two sides of the heart and it can be present in several locations in the wall between the ventricles.  

How can the ventricular septal defect (VSD) affect the heart?

To understand about the Ventricular septal defect (VSD), we need to know how a normal heart functions. The left side of the heart will pump the blood only to the body, and the right side of the heart will pump blood only to the lungs. But in a child with VSD, the blood travels from the left side of the heart (left ventricle) to the right side of the heart (right ventricle) and out into the lung arteries. This causes high pressure in the blood vessels in the lungs because more blood than normal is being pumped there.

If the VSD is large, the extra blood that is pumped into the lung arteries makes the heart and lungs work harder and the lungs become congested. This can make the heart work harder than it should and, over time, may lead to enlargement and HEART FAILURE.

The other complications of VSD are:

  • Pulmonary hypertension: Increased blood flow to the lungs due to the VSD will cause high blood pressure in the lung arteries (pulmonary hypertension), which can damage them permanently. This complication will cause reversal of blood flow through the hole (Eisenmenger syndrome).
  • Endocarditis: This heart infection is a rare complication.
  • Abnormal heart rhythms 
  • Heart valve problems.
  • Lung problems
  • Poor growth and development

How does the ventricular septal defect affect my child?

If it is a smaller hole, it will not cause symptoms because the heart and lungs will not have to work harder. A small ventricular septal defect may not cause any medical problems and it closes naturally on its own. 

If the defect is a larger hole, the child may breathe faster and harder than normal. The symptoms may not occur until several weeks after birth. This condition may cause higher pressure in the heart or reduced oxygen to the body. In time this will cause permanent damage to the lung blood vessels. Therefore, medium or larger VSDs may need surgical repair early in life to prevent complications.

What are the signs and symptoms of ventricular septal defect in infants?

A child’s symptoms of a hole in the heart depends on the size and where it is located along the septum. Many children seem to have no symptoms. They grow and gain weight normally. 

Other ventricular septal defect signs include:

  • Difficulty gaining weight
  • Shortness of breath or a heart murmur when doctor hears your heart with a stethoscope
  • Babies may experience profuse sweating during feeding
  • Frequent respiratory infections
  • Rapid heart rate
  • Poor weight gain
  • Difficulty breathing
  • Pale skin
  • A bluish skin color around the lips and fingernails

If your baby or child develops any of these symptoms, contact your doctor immediately.

What are the causes of ventricular septal defects?

Ventricular septal defects in infants are formed when the septum doesn’t completely seal while a baby is developing in the womb. The tendency to develop VSD may be genetic and a hole in the heart could occur with genetic problems such as Down syndrome.

In some cases, the causes of a VSD are severe blunt trauma to the chest. For example, a serious car accident or repeated trauma to the chest may cause a hole in the heart to form. It is also possible to acquire a VSD later in life, usually after a heart attack or after a complication of certain heart procedures. The congenital heart defects arise from problems early in the heart’s development.

What are the different types of Ventricular Septal Defect?

There are four basic types of VSD, the type your child has depends on which part of the wall between the ventricles is involved. They are as follows:

  • Membranous VSD: This type of VSD is commonly used in operation as most membranous VSDs do not close spontaneously.
  • Muscular VSD: A large number of these muscular VSDs close spontaneously and do not need surgery.
  • Atrioventricular canal type VSD: A VSD which is associated with atrioventricular canal defect, this VSD is located underneath the tricuspid and mitral valves.
  • Conal septal VSD: This is a rare VSD which occurs in the ventricular septum just below the pulmonary valve.

How are ventricular septal defects diagnosed?

Most ventricular septal defects are first identified by a child’s pediatrician during a routine checkup. The blood passing irregularly from the left ventricle to the right causes a loud murmur noise which can be heard with a stethoscope by listening to the heart. Some ventricular septal defects may be identified on a fetal ultrasound exam before a baby is born.

If your doctor suspects that your child may have VSD, further tests will be required to identify the size and location of the septal hole. Common tests for VSD include:

  • Chest X-ray
  • EKG
  • Echocardiogram (ECHO)

What are the Treatment options for ventricular septal defect for children?

If your child has a ventricular septal defect, your pediatric cardiologist will want to carefully monitor him or her to make sure that the condition is not causing damage to the heart. Treatment will depend on your child’s age, symptoms and the size and location of the hole within the septum. You will likely need frequent appointments and repeated tests for this condition.

Medication:

If your child has symptoms such as shortness of breath or trouble nursing, then they will be given medications to help to treat these symptoms. A small ventricular septal defect may not cause any medical problems and it closes naturally on its own. However, there is no medicine or other treatment that will make the VSD smaller or close any faster than it might do naturally. 

In case if your child has symptoms despite the medications or if the hole is too large to close on its own, surgery should be performed to close it. However, some VSDs should be closed regardless of their size, because of their position within the heart wall.

Heart surgery:

Larger VSDs will need surgical repair in the first few months of the child’s life to prevent long-term complications. In this case, ventricular septal defects are usually repaired with open heart surgery by a pediatric cardiac surgeon. In some situations, minimally invasive surgical approaches may be used. This type of surgery is usually a low-risk and most children are discharged within 3-5 days after surgery.

During this surgery, a surgeon makes an incision on the chest and divides the breastbone to reach the heart. A heart-lung machine is then used to pump blood and the heart-lung machine will function as the lungs during the surgery. Then the surgeon patches the hole between the ventricles. In time, the child’s own cells grow over the patch, anchoring it in place even more. 

The goal of surgery is to close the septal opening before the lungs are damaged. Surgery will also help babies who have trouble feeding and gain a normal amount of weight.

Cardiac catheterization:

VSD may be fixed by a cardiac catheterization. In this test, a tool called a septal occluder is used with a catheter. The doctor guides the catheter to the heart through the blood vessels. Once the catheter is in the heart, the doctor closes the defect with the septal occluder. Only certain types of VSDs may be closed in this method. This procedure should be done in centers that have experience in doing transcatheter VSD repair.  

Living with a ventricular septal defect: 

Depending on the location of the hole, the pediatric cardiologist will examine your child periodically in order to look for problems, such as a leak in the aortic valve. In some cases, older children with small VSDs may also require surgery, if they develop a leak in this heart valve. 

After VSD surgery, a pediatric cardiologist will examine your child regularly. The cardiologist will make sure that the heart is working normally. Usually no medicines or additional surgery are needed.

After surgery, older children can be active without getting too tired and your child should be fully recovered within a few weeks. Most children who have surgery for VSD should be able to do normal activities. Their activity levels, appetite, and growth returns to normal. If the hole in the heart is small or it has been closed with surgery, your child may not need any precautions regarding physical activity and can participate in normal activities without any risk.

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