About ventricular septal defect
What is ventricular septal defect?
What is a ventricular septal defect (VSD)?
A ventricular septal defect (VSD) is a heart malformation present at birth. Any condition that is present at birth can also be termed a "congenital" condition. A VSD, therefore, is a type of congenital heart disease (CHD). The heart with a VSD has a hole in the wall (the septum) between its two lower chambers (the ventricles).
How common is a VSD?
The most frequent types of congenital malformations affect the heart. It is estimated that approximately eight in 1,000 newborns have CHD. A VSD is the most frequent of the various types of CHD (25%-30% of all CHD). Approximately one infant in 500 will be born with a VSD.
What is the normal design of the heart?
The heart is made up of four separate chambers. The upper right chamber (atrium) receives blood back from the body with much of the oxygen extracted by the body organs and tissues. The blood is then pumped through a one-way valve into the lower right chamber (ventricle) from which it is pumped to the lungs to be again enriched with oxygen. This highly oxygenated blood then returns to the upper left sided chamber (atrium) and next passes through a one way valve into the lower left chamber (ventricle). From there, the oxygenated blood is pumped out into a large blood vessel (the aorta) and is distributed throughout the body through arteries.
The two upper chambers (right and left atria) are separated by a wall of muscle called the septum. Similarly the two lower chambers (right and left ventricles) are also separated by a separate muscular septum. These septa (plural of septum) keep the lower oxygenated blood that has returned from the body from mixing with the highly oxygenated blood which has returned from the lungs.
A VSD is a hole in the ventricular septum.
What are the symptoms for ventricular septal defect?
Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child's life.
Ventricular septal defect (VSD) symptoms in a baby may include:
- Poor eating, failure to thrive
- Fast breathing or breathlessness
- Easy tiring
You and your doctor may not notice signs of a ventricular septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if at all. Signs and symptoms vary depending on the size of the hole and other associated heart defects.
Your doctor may first suspect a heart defect during a regular checkup if he or she hears a murmur while listening to your baby's heart with a stethoscope. Sometimes VSDs can be detected by ultrasound before the baby is born.
Sometimes a VSD isn't detected until a person reaches adulthood. Symptoms and signs can include shortness of breath or a heart murmur your doctor hears when listening to your heart with a stethoscope.
When to see a doctor
Call your doctor if your baby or child:
- Tires easily when eating or playing
- Is not gaining weight
- Becomes breathless when eating or crying
- Breathes rapidly or is short of breath
Call your doctor if you develop:
- Shortness of breath when you exert yourself or when you lie down
- Rapid or irregular heartbeat
- Fatigue or weakness
What are the causes for ventricular septal defect?
Congenital heart defects arise from problems early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role. VSDs can occur alone or with other congenital heart defects.
During fetal development, a ventricular septal defect occurs when the muscular wall separating the heart into left and right sides (septum) fails to form fully between the lower chambers of the heart (ventricles).
Normally, the right side of the heart pumps blood to the lungs to get oxygen; the left side pumps the oxygen-rich blood to the rest of the body. A VSD allows oxygenated blood to mix with deoxygenated blood, causing the heart to work harder to provide enough oxygen to the body's tissues.
VSDs may be various sizes, and they can be present in several locations in the wall between the ventricles. There may be one or more VSD.
It's also possible to acquire a VSD later in life, usually after a heart attack or as a complication following certain heart procedures.
What are the treatments for ventricular septal defect?
Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. After birth, your doctor may want to observe your baby and treat symptoms while waiting to see if the defect closes on its own.
Babies who need surgical repair often have the procedure in their first year. Children and adults who have a medium or large ventricular septal defect or one that's causing significant symptoms may need surgery to close the defect.
Some smaller ventricular septal defects are closed surgically to prevent complications related to their locations, such as damage to heart valves. Many people with small VSDs have productive lives with few related problems.
Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow. Some babies may require tube feeding.
Medications for ventricular septal defect may include those to:
- Decrease the amount of fluid in circulation and in the lungs. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).
- Keep the heartbeat regular. Examples include beta blockers, such as metoprolol (Lopressor), propranolol (Inderal LA) and others, and digoxin (Lanoxin, Lanoxin Pediatric).
Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles. If you or your child is having surgery to repair a ventricular defect, consider having surgery performed by surgeons and cardiologists with training and expertise in conducting these procedures. Procedures may include:
- Surgical repair. This procedure of choice in most cases usually involves open-heart surgery under general anesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses a patch or stitches to close the hole.
- Catheter procedure. Closing a ventricular septal defect during catheterization doesn't require opening the chest. Rather, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart. The doctor then uses a specially sized mesh device to close the hole.
- Hybrid procedure. A hybrid procedure uses surgical and catheter-based techniques. Access to the heart is usually through a small incision, and the procedure may be performed without stopping the heart and using the heart-lung machine. A device closes the ventricular septal defect via a catheter placed through the incision.
After repair, your doctor will schedule regular medical follow-up to ensure that the ventricular septal defect remains closed and to look for signs of complications. Depending on the size of the defect and the presence of other problems, your doctor will tell you how frequently you or your child will need to be seen.
What are the risk factors for ventricular septal defect?
Ventricular septal defects may run in families and sometimes may occur with other genetic problems, such as Down syndrome. If you already have a child with a heart defect, a genetic counselor can discuss the risk of your next child having one.
Is there a cure/medications for ventricular septal defect?
A ventricular septal defect is the second most cardiac abnormality in adults, often congenital. The ventricular septum is a curved structure that demarcates the two ventricles of the heart. Developmental abnormality of septal formation during complex processes of cardiac morphogenesis leads to the defect. VSDs can occur due to genetic factors such as chromosomal aberrations, single genes, and polygenic mutations. Toxins like alcohol, marijuana, cocaine, and certain medications such as metronidazole and ibuprofen are potential risk factors.
1. In congenital incidences, ventricular septal defects close spontaneously within the first year of life.
2. In adults with asymptomatic, small VSDs without pulmonary arterial hypertension do not require treatment as they have a significant prognosis. On the other hand, patients with symptoms need treatment.
3. The treatment approach includes VSD closure, which is indicated for medium to large defects with a significant hemodynamic compromise, such as those who are symptomatic and have LV dysfunction.
4. Recent advances in technology have made percutaneous closure possible.
5. Percutaneous device closure is reserved for those with severe PAH, multiple comorbidities, and those who had prior cardiothoracic surgery such as residual or recurrent VSD.
6. Muscular VSDs are amenable to percutaneous procedures, while defects closer to the inlet valves are challenging.
7. Indications for surgical repair are
• Episode of endocarditis
• The ratio of pulmonary blood flow to the systemic blood flow (Qp/Qs) is equal to or more than 2 plus clinical evidence of LV fluid overload.
• LV systolic or diastolic dysfunction, or when the pulmonary artery pressure and pulmonary vascular resistance are less than two-thirds of systemic pressure and systemic vascular resistance, respectively.
Heart murmur (noise is louder when defect is small and vice versa), inability to exercise, shortness of breath,In severe cases with pulmonary arterial hypertension: shortness of breath, chest pains, chronic cough, low BP, dizziness, fatigue, inability to exercise, swellings in legs