Ventricular septal defect
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The most common congenital heart defect known as ventricular septal defect (VSD) cause a hole in the wall (septum) that divide the lower chambers (ventricles) of the heart. The hole allows the blood to flow from the left to the right chamber of the heart which cause the heart to work harder since the oxygen-rich blood is returned to the lungs rather than to the rest of the body.
A minor VSD may close on its own without any intervention and may not cause any issues. The doctor will regularly evaluate if the hole closes on its own or if any symptoms have developed. If the hole becomes bigger, it may need to be intervene early during childhood through a surgery to avoid difficulties and further complications.
Symptoms
The symptom of VSD may be present at birth or may not appear until in childhood depending on the size of the hole and other associated heart defects. The signs and symptoms vary depending on the size of the hole.
Signs and symptoms of a VSD in infant can include:
- Poor feeding
- Fast breathing or breathlessness
- Tiredness
Sign and symptoms of a VSD in adulthood can include:
- Shortness of breath
- Heart murmur
Seek medical help if the baby or child experience the following:
- Getting tired or exhausted quickly when eating or playing
- Not gaining weight
- Breathless when eating or crying
- Fast breathing or shortness of breath
- Rapid or irregular heartbeat
- Fatigue or weakness
Causes
The cause of congenital heart defects is still unknown. The problem may arise during early development of the heart which can be affected by several risk factors such as genetics, mother’s diet and medicine intake during pregnancy and the environment. Some children can have other heart defects along with VSD.
It is during fetal development that the wall (septum) designed to separate the two lower chambers of the heart (right and left ventricles) and it fails to form which leads to ventricular septal defect.
In a baby with a normal heart, the left side of the heart pumps oxygen-rich blood to the rest of the body while the right side only pumps blood to the lungs to get oxygenated blood. In a child with VSD, the blood can flow from the left ventricle to the right ventricle and into the lungs. This raises blood pressure and leads to extra blood flow in the lung arteries which requires the heart and lungs to work harder than usual.
VSDs can exist in different locations in the wall between ventricles. The hole or opening could be one or more and of different sizes.
VSDs can also develop from complications of a heart surgery or after experiencing a heart attack which usually occurs as we grow older.
Risk factors
Ventricular septal defects can occur in families with known genetic syndromes such as Down syndrome. If you have a known risk for a heart defect, a genetics specialist can provide you with assessment and recommendations to further understand the risks associated with this condition.
Diagnosis
VSD may be detected during pregnancy when an ultrasound examination or a special heart imaging investigation is performed on the fetus’s heart. A heart murmur is often the first indicator of ventricular septal defects (VSDs). Your doctor will use a stethoscope to listen to your baby’s heart to check for a heart murmur or other signs and may request several further investigation which include:
- Echocardiogram: a noninvasive test which uses sound waves to produce real time images of the heart and is used by doctors to identify and assess the size, location, and severity of a ventricular septal defect as well as other abnormal structure of the heart.
- Electrocardiogram (ECG): uses sensors that record the electrical activity of the heart allowing the doctor to see an abnormal rhythm and if the heart muscle is experiencing stress.
- Chest X-ray: shows the heart and lungs and the changes in the lungs due to extra blood flow and the abnormal size of the heart.
- Cardiac catheterization: the doctor inserts a very small, flexible, hollow tube (called a catheter) into a blood vessel in the groin, arm, or neck and then passes it up to the heart to obtain information about the heart and its vessels which provides better diagnosis on any underlying congenital heart defect.
- Pulse oximetry: use of a small clip placed on a fingertip that measures and monitors blood oxygen level.
Treatment
Many infants with a minor ventricular septal defect (VSD) at birth will not require surgery to close the opening or hole and instead should be monitored after birth to treat any symptoms that may occur while waiting to see if the defect closes on its own.
Surgery for babies who require it is frequently performed during the first year of life. It could be required to close a ventricular septal defect in children and adults who have a medium or large defect or one that is producing noticeable symptoms.
The location of the VSD can also create complications such as damage to heart valves. To avoid these issues, smaller VSDs may need to be surgically repaired if indicated. Many persons with mild VSDs lead fulfilling lives with minimal concomitant problems.
Babies with large VSDs or babies who become easily exhausted during feeding may require additional nutrition support to their growth. It is possible that some infants will need medicine to manage heart failure.
Medications
The severity of heart failure symptoms affects the medications given for ventricular septal defect which are used to lessen the volume of fluid in the lungs and bloodstream. Medications include diuretics, such as furosemide. Some medicines can also help strengthen the heart muscle and lower blood pressure.
Surgeries or other procedures
The goal of the surgery is to correct ventricular septal defect through plugging or patching the hole between the heart’s lower chambers. If you or your child needs surgery to fix a ventricular defect, it is essential that you have surgeons and cardiologists who have the experience to carry out the operation.
Procedures to repair VSD may include:
- Surgical repair: This procedure typically requires an open-heart surgery while undergo general anesthesia. A chest incision and a heart-lung machine are required for the procedure. Depending on the size and location of the hole, the doctor may stitch to close the hole or patch it using a graft.
- Catheter procedure: Chest incision is not required in performing catheterization to fix the ventricular septal defect. Instead, the physician places a thin tube (catheter) into a groin blood vessel and directs it into the heart. The hole is subsequently sealed by the doctor using a mesh device called an occluder. Not all VSDs can be closed using this method.
The cardiologist will set up routine check-ups to make sure that the ventricular septal defect stays closed and monitor for any possible complications. Frequency of visits of the child will based on the severity of the condition and the existence of any additional issues. The doctor will also provide with instructions on how to take care of the child. Ideally, children should be fully recovered few weeks after the surgery.
