A ventricular septal defect (VSD) is an opening or hole in the wall that separates the two lower chambers of the heart. This wall is the ventricular septum. The hole causes oxygen-rich blood to leak from the left side of the heart to the right side. This causes extra work for the right side of the heart, since more blood than necessary is flowing through the right ventricle to the lungs. VSDs vary in size, number, and location within the interventricular septum and this information is of importance as it has direct clinical implications on the cardiac functions. These septal anomalies lead tocongestive heart failure (CHF) and retarded growth, pulmonary diseases ( known as Eisenmenger syndrome), frequent infections, endocarditis, sudden death etc.
There are two types of surgery available to correct a VSD: the intra-cardiac technique and the trans-catheter technique. The surgical technique is chosen based upon the nature of the VSD and associated side effects on the patient's heart and lungs. The intra-cardiac approach is the most common technique and is done while the patient is under cardiopulmonary bypass (a "heart-lung machine") and is an open-heart operation. This is the procedure of choice for most children and at most paediatric surgical centres. A patch of fabric or pericardium (the normal lining around the outside of the heart) is sewn over the VSD to close it completely and permanently. Over the period of time it gets covered by the normal tissue within the heart and get permanently fixed. A small repairs of the patch or minor defects can be corrected in cath-lab under the radio-imaging techniques using a catheter.
For smaller VSDs, no special precautions are needed. For large VSDs, child care is necessary and it is important to undertake the surgery as early as possible for regaining the normal heart function and growth of the child. Once the VSDs are closed by surgery no special precautions are required and the child can lead a normal life. Special precautions, restricting physical activities need to be evaluated based on the location and type of the VSD. Parents must inform all the possible symptoms and signs to the paediatric cardiologist so that appropriate medical support can be provided before the surgery. Post-procedure continued periodic monitoring by the cardiologist is important and must be strictly followed.
VSD closures are difficult and intricate surgeries but once successful they offer a new lease of life to the patients. Over the past few decades, the diagnosis and treatment of VSDs have greatly improved and the procedures have great success rates. The patients can lead a normal healthy life without any complications.
Is it necessary to close VSDs by surgery only?
No. Small VSDs do not need surgical closure. Many of them may even close spontaneously. Only the large ones that produce symptoms and/or cause overload on the heart need to be closed surgically. Minor repars are possible in a cath-lab.
What are the common symptoms in VSD?
Shortness of breath, poor growth, feeding difficulties, fatigability and bluish discolouration of the lips and nails are few of the symptoms.
Till what time are these holes expected to close on their own?
Most of the holes that will eventually close are expected to close by 5 years of age. Thereafter, spontaneous closure of the VSD is unlikely.
Are there any special precautions necessary if the child is borne with VSD?
Yes; certainly. The babies borne with this defect are deprived of oxygen and receive less than normal levels as the cardiovascular system is compromised. The heart works under pressure and this has effects on the overall health of the baby. Parents of such children need to vigilant and must take all the necessary precautions in terms of hygiene, nutritional support so that they do not catch infections and do not indulge in activities that cause breathlessness. Miner VSDs close spontaneously and are usually asymptomatic. But for large VSDs, that need to be operated and good health status is utmost important to undertake the intervention.
Can surgically fixed VSDs in infancy open during the adulthood?
The surgical fixation of the VSD is permanent and usually does not open unless and until there are some other cardiac issues that may have similar symptoms.
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