Frequently Asked Questions  

What is a Ventricular Septal Defect?

A Ventricular Septal Defect (VSD) also called a “hole in the heart” is a heart malformation present at birth. The septum is a wall that separates the left and right side of the heart. A defect in between the lower chambers of the heart (ventricles) is called “ventricular septal defect”. It is the most commonly diagnosed congenital heart defect.

It can be an isolated defect or may coexist with other heart defects (eg. Atrial Septal Defect, Tetralogy of Fallot, patent ductus arteriosus (PDA), coarctation of the aorta, transposition of great arteries)

What happens if you have a ventricular septal defect?

In the normal blood circulation, the used blood (unoxygenated) goes back to the heart through the right chamber ( right atrium and ventricle) and is pumped to the lungs through the pulmonary artery to get oxygen (pulmonary circulation). Blood (oxygenated) goes back to the left chamber (left atrium and ventricle) and the left ventricle then pumps the blood to distribute it to the body (systemic circulation).
In VSD, there is a hole in between the two ventricles. Since the left ventricle (systemic ventricle) has a higher pressure than the right ventricle, some of the blood is forced through the defect to the right ventricle (left to right shunt) instead of pumping all the blood to the systemic circulation. This causes an increase in the pulmonary (lungs) blood flow, more blood returning to the left ventricle resulting to volume overload. The heart will then pump more blood and may enlarge due to the added workload. High blood pressure may develop in the lungs’ blood vessels due to the increase in blood volume. Eventually, this increased pulmonary pressure may permanently damage the blood vessel walls.

How will you suspect if you have a ventricular septal defect?

The patient’s clinical presentation depends on the degree of the left to right shunting of blood. The larger the defect, the more blood goes to the right ventricle, the earlier and more symptoms the patient will experience. With a small defect, patient may remain asymptomatic and may only be diagnosed on routine check-up. For larger defects, patient will present with signs and symptoms of congestive heart failure (eg. easy fatigability, shortness of breath, heart enlargement, frequent respiratory infections) and /or failure to gain adequate weight.

How is VSD diagnosed?

A patient with VSD has a characteristic heart murmur. With small VSD, chest x-ray and electrocardiogram may show normal findings. With larger defect, heart enlargement and enlargement of the pulmonary artery will be evident. An echocardiogram will confirm the presence of VSD. Cardiac catheterization is usually not indicated except in cases where there is uncertainty about the degree of the left to right shunt in a moderate-sized defect or development of pulmonary vascular obstructive disease, especially in patients who present after 1 year of age.

What happens if VSD is left untreated?

50% of patients with VSD diagnosed in infancy will close spontaneously. If closure does not occur, those with small VSD (restrictive) will remain clinically well. Those with moderate to large- size VSD (non- restrictive) will develop signs and symptoms of heart failure and failure to gain weight. If left untreated, the increase in blood flow to the pulmonary circulation (lungs) will result to thickening of the walls of the pulmonary arteries thereby increasing the resistance to blood flow (pulmonary hypertension). The right ventricle will now pump at a higher pressure until such a time that it can no longer pump against the increasing pulmonary vascular resistance. In this case, there will be a reversal of the shunt flow. Since the pressure of the right ventricle is now higher than the left ventricle, blood from the right ventricle (unoxygenated blood) will now be forced through the defect to the left ventricle (right to left shunt). The patient at this time will develop bluish discoloration (cyanosis) due to the mixing of oxygenated and unoxygenated blood (Eisenmenger’s complex). When this occurs, the defect is beyond repair since closing the defect will result to an acute right heart failure.

When is surgery recommended?

The development of congestive heart failure in an infant with an isolated VSD generally shows that the defect is large and that spontaneous closure is unlikely. Surgical closure can be delayed if the heart failure is easily controlled with medications and the infant grows appropriately. Repair is recommended early if the patient demonstrates failure to thrive, continued heart failure or recurrent pulmonary infections. There are evidences that early closure of large VSD results in excellent growth after repair. Large defects should be repaired in the first year of life and no later than 2 years of age because of the hazard of developing unacceptable rise in pulmonary vascular resistance.

Small to moderate- sized VSDs can be followed closely until 5 to 7 years of age. After this age, spontaneous closure is unlikely.

Do all VSDs need surgery?

Moderate to large size VSDs need to be repaired. Controversies arise when it comes to management of small VSDs. Some centers will recommend closure while others will not since they are clinically well. The risk of developing bacterial endocarditis favors closure of the defect in other centers.

How is a VSD repaired?

VSD is repaired by an open heart procedure using a heart lung machine. The heart is made to stop beating with the use of a chemical solution called “cardioplegia”. Once the heart stops beating, it is opened and the VSD is repaired by suturing (sewing) a piece of cloth-like material to seal the defect (VSD patching). During this procedure, the patient is connected to an artificial heart- lung machine that supplies blood and oxygen to the whole body. Once the defect is sealed, the heart is closed, and is made to beat again. When the heart is fully recovered, the heart- lung machine is then disconnected from the body.

Will I live a normal life after repairing the VSD?

Patients operated with small VSDs or moderate to large VSDs at an early age will live a normal life since the changes brought about by the defect may still be reversible. Most patients who were diagnosed late in the stage of their disease (moderate to severe pulmonary hypertension) and underwent surgical repair need to be maintained on prolonged or lifetime medications even after repair.

What are the risks of VSD surgery?

The parents/patients should be made aware of the risks of bleeding, stroke, infection, blood transfusion reaction that may happen in any type of heart operations even though the chance of developing it is small.

Is there an alternative to surgery?

Yes. With the improvement in technology, device closure is being done in some institutions. This is a non- surgical type of sealing the VSD by inserting a device within the defect to seal it. However, it is done only in selected cases. Surgery is still the gold standard in the closure of VSD.

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