Ventricular Septal Defect (VSD)
The heart has four chambers: a right and left upper chamber called an atrium and a right and left lower chamber called a ventricle. The hole occurring in the wall that separates the heart's lower chambers (ventricles) and allows blood to pass from the left to the right side of the heart is termed as a ventricular septal defect (VSD). A small VSD may cause no problems, and many small VSDs close on their own. Medium or larger VSDs may need surgical repair early in life to prevent complications. VSD are known to be one of the most frequently reported congenital heart defects, with an incidence of 0.1% to 0.4% of all live births and contributing to approximately 20% to 30% of all congenital heart lesions.
Ventricular Septal Defect Symptoms
Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child's life. VSD symptoms in a baby may include:
- Poor weight gain
- Fast breathing or breathlessness.
- Fatigue, increase sweating
- Shortness of breath or a heart murmur hears when listening to the heart with a stethoscope.
The doctor may not become aware of signs of a VSD at birth. If the defect is small, symptoms may only be evident in childhood. Signs and symptoms also vary depending on the size of the hole and other associated heart defects.
A doctor may first become suspicious of the presence of a heart defect only during a regular check-up if he or she notices a murmur while listening to the baby's heart using a stethoscope. Sometimes VSDs can even be detected by a fetal ultrasound even before the baby’s birth. A VSD is not sensed until a patient reaches adulthood in other cases.
Ventricular Septal Defect Causes
There is no clear cause of VSD. Genetics and environmental factors are thought to play a role. VSDs can occur alone or in conjunction with other congenital heart defects. A VSD occurs when the muscular wall which divides the heart into left and right sides fails to form completely between the lower chambers of the heart, during fetal development.
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 of multiple sizes and may be present in more than a few locations in the wall between the ventricles at the same time.
It is also possible to get a VSD during adulthood, generally post a heart attack or may even occur as a complication of some heart interventions.
Ventricular Septal Defect Risk Factors
VSD may be due to a familial cause or may occur alongside other genetic problems such as Down’s syndrome.
Ventricular Septal Defect Complications
A small VSD may rarely cause any troubles. Comparatively larger defects can lead to mild or even life-threatening disabilities. Treatment can prevent many complications.
- Heart failure: Because of a medium or large VSD, the heart requires to work more than usual to pump enough blood to the body. As a result, heart failure can develop if these defects are not treated.
- Pulmonary hypertension: Elevated blood flow to the lungs because of VSD leads to high blood pressure amongst the arteries of lung with a possibility of permanent damage. This condition can lead to a blood flow reversal through the hole, referred to as Eisenmenger syndrome.
- Endocarditis: Rare occurrence.
- Other heart problems, including abnormal heart rhythms and valvular problems.
Ventricular Septal Defect Prevention
In most cases, one cannot do anything to prevent having a baby born with a VSD. However, it is important to do everything possible to have a healthy pregnancy.
- Get early prenatal care, even before pregnancy onset: Talk to your doctor about the health and discuss any lifestyle changes that he/she may recommend for a healthy pregnancy. Also, be sure about any medications one is taking.
- Eat a balanced diet: Include a vitamin supplement that contains folic acid and curb caffeine intake.
- Exercise regularly: Talk with the doctor to develop an exercise plan.
- Avoid consumption of substances that are known risk factors: These include harmful substances such as alcohol, tobacco and banned drugs.
- Avoid infections: Be sure one is up-to-date on all vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.
- Keep diabetes under control: If one has diabetes, work with the doctor to be sure it is well-controlled before getting pregnant.
Ventricular Septal Defect Diagnosis
VSD often leads to a heart murmur that your doctor can observe while examining using a stethoscope. If your doctor experiences such a heart murmur, he/she may refer several tests including:
- Echocardiogram: In this test, sound waves produce a video image of the heart. Doctors may use this test to diagnose a ventricular septal defect and determine its dimensions, site and severity. It may also be used to see if there are any other heart problems. Echocardiography can also be used on a fetus (fetal echocardiography).
- Electrocardiogram (ECG): This test records the electrical activity of the heart through electrodes glued to the skin and helps diagnose heart defects or rhythm problems.
- Chest X-ray: An X-ray image helps the doctor to view the heart and lungs. This can help doctors see if the heart is enlarged and if the lungs have extra fluid.
- Cardiac catheterization: In this test, a thin, flexible tube is inserted into a blood vessel at the groin or arm and guided through the blood vessels into the heart. Through cardiac catheterization, doctors can diagnose congenital heart defects and determine the function of the heart valves and chambers.
- Pulse oximetry: A tool by which small clip on the fingertip measures the amount of oxygen present in the blood.
Ventricular Septal Defect Treatment
Small VSDs may not cause symptoms and not need treatment. In some cases, they may also close on their own as your child grows. Larger VSDs may need treatment or surgery.
- Catheterization procedure: VSD closure during catheterization does not need opening the chest. Instead, the doctor threads a thin tube into a blood vessel in the abdominal region and directs it to the heart. The doctor then uses a specifically sized mesh to close the hole.
- Surgical repair: This procedure usually involves open-heart surgery under general anaesthesia. The surgery requires a ventilator and an incision in the chest. The doctor uses a patch or stitches to close the hole.
- Hybrid procedure: A hybrid procedure uses a combination of surgical and catheter-based techniques. Access to the heart is generally via a small incision, and the procedure may be performed without ceasing the heart and using the ventilator. A device closes the VSD via a catheter placed through the incision.
Ventricular Septal Defect Follow-up Care
A cardiologist should examine the patient regularly. If the patient’s VSD is small or was closed as a child and no other problems are detected, visits annually if possible.
What will the patient need in the future?
Medications may be required only if you the patient has heart failure (which is very uncommon) or if the patient has pulmonary hypertension. The cardiologist can monitor the patient with non-invasive tests if needed. These include electrocardiograms, exercise stress tests and echocardiograms.
Most patients won't need to limit their activity. However, if a patient has pulmonary hypertension, a consult cardiologist should be consulted in order to manage the patient’s activity.
Prevention of Endocarditis
Unserviceable ventricular septal defect do not need endocarditis prophylaxis, as per the contemporary American Heart Association’s treatment recommendations. After the VSD is successfully closed, preventive treatment is needed only during for a six-month healing period.
As soon as closure of ventricular septal defect is achieved and no unwanted pulmonary hypertension exists, the risk from pregnancy is low. It will be essential to consult the cardiologist, if VSD closure is not achieved.