A ventricular septal defect (VSD) is an abnormal opening in the wall (septum) that divides the two lower chambers of the heart (ventricles). This opening allows blood from either side of the heart to cross into the opposite ventricle. Usually, because the left side of the heart is at a higher pressure than the right side, the blood from the left ventricle flows to the right ventricle and, subsequently, backs to the lungs. This abnormal shunting of oxygen-rich blood back to the oxygen-poor right side of the heart is referred to as a left-to-right shunt. Normally, this will not cause cyanosis (bluish coloration of the skin caused by oxygen-poor blood reaching the general circulation). However, because the right side of the heart and the blood vessels in the lungs are not built to withstand increased volumes and pressures, left-to-right shunting eventually may result in heart failure and pulmonary hypertension (elevated blood pressure in the pulmonary blood vessels).
Types of
Doctors classify VSDs based on the:
- Size of the defect.
- Location of the defect.
- Number of defects.
- Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. It is harmless and can help a VSD close on its own.
VSDs range in size from small to large.
- Small VSDs usually allow only a small amount of blood flow between the ventricles. Because of this, they are sometimes called restrictive. Most small VSDs:
- Do not cause symptoms in infants and children
- Close on their own, often by school age
- Rarely need surgery or other procedures to close the defect
- Moderate (or medium-sized) VSDs are less likely than small defects to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.
- Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle and are sometimes called nonrestrictive. A large VSD is less likely to close completely on its own, but it may get smaller. A large VSD can cause more symptoms in infants and children, and surgery is usually needed to close it.
VSDs are found in different parts of the septum.
- Membranous VSDs are located near the heart valves. They can close at any time if a ventricular septal aneurysm is present.
- Muscular VSDs are found in the lower part of the septum. They are surrounded by muscle, and most close on their own during early childhood.
- Inlet VSDs are located close to where blood enters the heart. They are less common than membranous and muscular VSDs.
- Outlet VSDs are found in the part of the ventricle where the blood leaves the heart. This is the rarest type of VSD.
Procedure of
Ventricular septal defect closure is considered open-heart surgery, meaning the heart will have to be opened and the patient’s blood flow will have to be diverted to a heart-lung bypass machine during the repair. The chest is opened via a sternotomy incision, and the patient is connected to the heart-lung bypass machine. Depending on the location of the defect, an incision will be made in the right atrium, the pulmonary artery or the outflow tract of the right ventricle (infundibulum). A patch is created by the surgeon from either the patient’s pericardial tissue or a synthetic material such as Dacron. The patch then is sutured into place to close the defect. The atrial, pulmonary artery or infundibular incision is closed with sutures, and the remainder of the operation is completed. If the patient has no other cardiac defects, this operation usually is considered a cure and no further surgeries should be needed.
What happens after the surgery of ?
The patient will be transferred to the cardiovascular intensive care unit (CVICU) by the cardiovascular anesthesiologist and the team of operating room nurses. The CVICU is situated directly adjacent to the cardiovascular operating rooms to maximize patient safety. This makes the transition from the operating room to the CVICU a smooth process. Once the patient arrives in the CVICU, a thorough report of the surgical procedure is given to the cardiologist and the CVICU nursing team who will be managing care in the CVICU. The surgeon will update the family on the operation once the patient is settled into the CVICU. Family members may usually visit the patient within an hour after arrival to the CVICU. While in the CVICU, the patient will continue to be monitored closely. In addition to monitoring heart rate and rhythm, and respiratory rate, the monitor will also display other pressures and waveforms, which assist the cardiologist in managing care. A chest x-ray (CXR) and lab work will be performed on arrival and periodically throughout the stay in the CVICU. . Medication will be given to reduce any pain or anxiety they may experience after their surgery. These medications are initially given by IV and then gradually changed to medications that can be taken by mouth. Once the patients are awake enough to breathe on their own, the breathing tube (ETT or endotracheal tube) is removed. Depending on the surgery performed, this may take anywhere from a few hours to a few days following surgery. Once the surgical dressing is removed, the incision will remain open to air. A small gauze dressing will be placed over the insertion sites of the chest tubes, intracardiac lines, and pacing wires. Gradually the tubes, wires, and intravenous lines will be removed as the patient’s condition improves. As the patient improves, their activity level will gradually increase until they are doing well enough to be discharged from the hospital. Before leaving, the family will be instructed in how to care for the patient at home, including information on medications, incisional care, and activity limitations.
Long-term outlook after :
Most children who have had a ventricular septal defect repair will live healthy lives. Activity levels, appetite, and growth will return to normal in most children child’s cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis for a specific time period after discharge from the hospital. Outcomes also depend on the type of VSD, as well as how early in life the VSD was diagnosed and whether or not it was repaired. With early diagnosis and repair of a VSD, the outcome is generally excellent, and minimal follow-up is necessary. When a VSD is diagnosed later in life, if complications occur after surgical closure, or the VSD is never repaired, the outlook is generally poor. There is a risk for developing pulmonary hypertension (high blood pressure in the blood vessels of the lungs) or Eisenmenger’s syndrome. These individuals should receive follow-up care at a center that specializes in congenital heart disease.
Why go to India for
Cardiology is a field in which has India has earned expertise with its doctors and state of the art heart institutions. The medical treatments available in India include the best cardiac treatments for children. Cardiology departments of the best hospitals in the country ensure that children with congenital heart defects or other complication receive the best treatment. Apart from cardiac angioplasty and other surgeries available for adult sufferers, the super specialty hospitals in India have world-class pediatric heart treatment care facilities. Since heart defects are critical in case of neonates, the PCCS care offered has offered comfort to many babies as well as their parents. With noted pediatric cardiac surgeons and other specialists offering the best acre for children, the Pediatrics Cardiac Surgery at Apollo is counted as among the best in the world. The Intracardiac Echo Technique employed by the hospital offers minimally invasive pediatrics cardiac surgery. In addition to Pediatrics Cardiac Surgery, hospitals around India offer special intervention programs to minimize the need for surgery in very young children. India has achieved specialization in the field of Cardiac Care with world-class institutions Innovative techniques such as robotic surgery are used for cardiac treatments in India.
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