Ventricular Septal Defect (VSD)
Synonyms: Hole in the Heart, Septal Defect of the Heart
What is Ventricular Septal Defect?
Ventricular Septal Defect also commonly known as 'Hole in the Heart' is a hole in the wall or septum that separates the lower chambers or ventricles of the heart. This allows blood to flow from one ventricle to the other. Ventricular Septal Defect is a Congenital Heart Disease, which means that it is present at birth. In children with a Ventricular Septal Defect, blood usually flows through the defect from the left ventricle to the right ventricle. This causes extra blood (volume overload) in the pulmonary arteries and lungs, and in the right atrium and right ventricle.
Where can I get surgical repair for Ventricular Septal Defect?
Cost of procedure performed in the US: $48,000.
All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.
Some terms to remember re: Congenital Heart Diseases
- Atrioventricular Septal Defect (AVSD) - This includes an Atrial Septal Defect, Ventricular Septal Defect and abnormal development of the atrioventricular valves (tricuspid and mitral). This causes blood to flow abnormally inside the heart. An AVSD is also known as an atrioventricular canal defect.
- Atrial Septal Defect (ASD) - This is a hole in the wall that separates the upper chambers (atria) of the heart. This causes blood to leak from one atrium to the other.
- Patent Ductus Arteriosus (PDA) - In this condition there is a persistent connection between the aorta and the pulmonary artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours to days after birth. In some children, this vessel fails to close.
- Problems with the Heart Valves
- Aortic Valve Stenosis is a defect of the aortic valve in the heart that often causes it to open incompletely. This reduces blood flow to the body.
- Pulmonary Valve Atresia is a defect where a solid sheet of tissue forms instead of the pulmonary valve. This prevents oxygen-poor blood in the right side of the heart from traveling normally to the lungs to pick up oxygen.
- Pulmonary Valve Stenosis is a narrowing of the pulmonary valve. This slows the flow of blood from the right side of the heart to the lungs. The heart must pump harder to push blood through the smaller opening to the lungs where the blood picks up oxygen.
- Tricuspid Atresia is a defect where a solid sheet of tissue forms instead of the tricuspid valve. The tricuspid valve is between the right atrium and right ventricle of the heart. Without the tricuspid valve, oxygen-poor or blue blood entering the right atrium cannot travel normally to the lungs to pick up oxygen.
- Ebstein's Anomaly is a defect where the tricuspid valve is both displaced and abnormally formed. The valve is leaky and allows blue blood to flow back into the right atrium instead of to the lungs to pick up oxygen.
- Transposition of the Great Vessels - This is a defect where the location of the aorta and pulmonary artery coming off the heart is switched. The aorta comes off the right ventricle instead of the left ventricle. The pulmonary artery arises from the left ventricle instead of the right ventricle. Therefore, blood without oxygen is continually pumped to the body, instead of blood with oxygen.
- Tetrology of Fallot - is a combination of four defects:
- Pulmonary valve stenosis (narrowing)
- Ventricular Septal Defect
- Overriding of aorta where the aorta is positioned between the left and right ventricles, over the Ventricular Septal Defect.
- Right ventricular hypertrophy is the thickening of the right ventricle.
- Truncus Arteriosus - This is a defect of the aorta and pulmonary artery. The aorta and pulmonary artery do not form as separate arteries. Instead, a large artery, called the truncus, comes from the heart. As the truncus leaves the heart, it may branch into arteries that carry blood to the body and to the lungs.
- Coarctation of the Aorta - In this condition there is a narrowing of the aorta. It slows or blocks the flow of blood from the heart to the body.
What are the types of Ventricular Septal Defects?
Ventricular Septal Defect can be divided in to 3 types:
- Size of the Ventricular Septal Defect
- Small Ventricular Septal Defect
- Moderate (or medium-sized) Ventricular Septal Defect
- Large Ventricular Septal Defect
- Location of the Ventricular Septal Defect
- Membranous Ventricular Septal Defect are located near the heart valves.
- Muscular Ventricular Septal Defect are found in the lower part of the septum
- Inlet Ventricular Septal Defect are located close to where blood enters the heart.
- Outlet Ventricular Septal Defect are found in the part of the ventricle where the blood leaves the heart
- Number of defects
- Presence or absence of a ventricular septal aneurysm
What is life without surgical repair of Ventricular Septal Defect?
For children who have Ventricular Septal Defect, life can be quite restricting and not fun at all. Serous health problems can occur that can make life extremely debilitating. Some of the problems include:
- Failure to thrive - Your child may not be growing and developing physically as well as mentally according to his/her age. They may also experience poor appetite, low energy level and social withdrawal.
- Congestive Heart Failure - Extra blood flows from the left ventricle through the right ventricle to the lungs and back to the left atrium and on to the left ventricle. This causes the left atrium and left ventricle to handle an increased amount of blood and the workload on the heart increases. The increased workload on the heart also increases the heart rate and the body's demand for energy. The extra blood flow in the lungs may cause rapid breathing, also increasing the body's demand for energy.
- Bacterial Endocarditis - This is an infection of the lining of the heart, valves, or arteries. Endocarditis often occurs following dental and medical procedures.
- Irregular heart beats - Irregular heart beats or arrhythmias can develop a fast heartbeat with symptoms such as dizziness or fainting.
- High blood pressure in the pulmonary artery (Pulmonary Hypertension) - Sustained pressure in the flow of blood through the pulmonary artery can make them stiff and thickened resulting in increased resistance to blood flow into the pulmonary arteries.
What does the surgical repair of Ventricular Septal Defect involve?
Ventricular Septal Defect is repaired under general anesthesia in a hospital setting usually when your child is about one year old. The surgeon uses the Open Heart Surgery approach to open the chest wall by cutting through the breast bone or sternum (sternotomy). Your child is placed on a heart/lung bypass machine during surgery. The heart is stopped and the heart/lung machine takes over for the heart, pumping red blood throughout the body. The heart/lung machine also brings blue blood back to the machine where it picks up oxygen. The surgeon uses a special patch or stitches to close the Ventricular Septal Defect. The surgeon puts the patch over the Ventricular Septal Defect and sews it into place. Once the repair is completed, the heart is restarted. The child is taken off the heart/lung bypass machine. The surgeon closes the skin incision. Within 6-8 weeks, heart tissue will grow over the patch so that it will not need to be replaced as your child grows.
What is the recovery period like following surgery to repair Ventricular Septal Defect?
Immediately following the Open Heart Surgery for Ventricular Septal Defect, your child will spend a few hours in the ICU under observation for immediate post-operative complications. Your child will spend 4 - 5 days in the hospital until the surgical staff is satisfied with outcome of the surgery to repair Ventricular Septal Defect. The recovery is generally complete in about 3 months. Your child will be prescribed pain and anti-coagulant medication to reduce the risk of clot formation. Follow the nurses instructions carefully on how to care for your child e.g. bathing, activity level, direct injuries to the chest while playing, medications to be given at home and when your child can return to school.
What is the outcome of surgery for Ventricular Septal Defect?
In 99% of cases, there are successful results with no complications following surgical closure of Ventricular Septal Defect in children as they have a remarkable ability to heal and recover quickly. There is usually no residual leakage. After the Open Heart Surgery to repair Ventricular Septal Defect, there might be some pain and discomfort which will soon subside. Your child will be able to participate in all the normal activities pretty soon leaving all the memories of pain and discomfort behind.
B . R . A . N . D . of surgery for Ventricular Septal Defect
Benefits of surgery for Ventricular Septal Defect
- Once fully recovered from surgery, most children are able to participate in normal activities. Children who ate poorly before surgery often start to eat better and gain weight, and are more active. Surgical repair of Ventricular Septal Defect is safe and has very few complications, as the surgeons are using sophisticated surgical equipment and techniques these days. A big bonus of surgical repair of Ventricular Septal Defect is that effects of future episodes of infective endocarditis can be prevented. Most importantly, you will enjoy the peace of mind that your child is disease free and has no sequel to fear in the future.
Risks of surgery for Ventricular Septal Defect
- Allergic reaction to anesthesia
- Heart attack
- Bacterial endocarditis - Bacterial infection of the heart valve.
Alternatives to surgery for Ventricular Septal Defect
- Medications - Diuretics, Digoxin and antibiotics may be used as palliative measures to stabilize people with Ventricular Septal Defect.
- Septal Occluder - This procedure is similar to Cardiac Catheterization used to implant a Stent in the coronary artery. In this procedure, an umbrella shaped mesh is inserted to occlude or block the Ventricular Septal Defect. This mesh is inserted via a blood vessel in the groin and is threaded through it with the help of a thin tube called catheter.
Now or Never
- Surgical closure of Ventricular Septal Defect has very few chances of complications. Once the defect has closed spontaneously or has been repaired surgically, most children do not need additional treatment or medications and can live normal, healthy lives.
Decision to have surgery for Ventricular Septal Defect
- Ventricular Septal Defect can have several damaging effects over time, including enlargement of the ventricle, damage to the arteries and blood vessels in the lungs, congestive heart failure, and irregular heartbeats or arrhythmia. Ventricular Septal Defect that do not close on their own (spontaneously) can often be closed through Open Heart Surgery or Cardiac Catheterization procedure (Trans-cath closure). Surgical closure of Ventricular Septal Defect is usually successful with excellent long-term results.
Your Questions Answered on Ventricular Septal Defect
B.R.A.N.D. of Ventricular Septal Defect
Cardiothoracic Surgery References