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Ventricular Septal defect is a congenital (present at birth) heart condition characterised by a hole in the heart wall separating the lower chambers.
The hole can form in the ventricles during pregnancy if the wall of the septum is not fully developed. A common congenital heart defect, VSD, can occur in isolation or be associated with other congenital heart defects. Recent data shows that 42 of every 10,000 babies have a ventricular septal defect. The cause of the condition is still unknown at the moment. However, certain conditions during pregnancy can predispose to an increased risk of the child being born with VSD. Treatment of this heart condition depends on the size of the hole and the consequences of the extra blood flow to the lungs and the heart.
VSD is categorised based on the location and the size of the defect. There are four types of ventricular septal defects, depending on their location. These may include:
Depending on the size, VSDs can be categorised as small, medium or large.
The normal heart has four chambers, the lower two chambers, called the ventricles, are responsible for pumping the blood. In the normal course of events, blood low in oxygen returns to the right side of the heart. The right ventricle pumps blood into the lungs, where it is enriched with oxygen. This oxygen-rich blood returns to the left ventricle and pumps it to the whole body. A wall (ventricular septum) separates the right from the left side of the heart. A VSD will allow oxygen-rich blood to cross over (shunt) to the right, as the left-sided pressures are higher.
This leads to extra blood in the lungs and imposes an additional load on the heart. Depending on the size of the hole and hence, the shunt, varying degrees of symptoms can manifest in the child.
If the ventricular septal defect is small, signs may not appear until childhood. The symptoms and signs of the disease are often linked to the size of the hole and the type of VSD that occurs in the heart. Small defects may manifest only as an abnormal sound (murmur) on examination.
Infants with moderate to severe ventricular septal defect may exhibit the following symptoms:
The larger the defect, the earlier and more severe the symptoms, and large defects usually present within a few weeks of the birth.
If the hole is small, it usually closes on its own, and the infant may not show any symptoms of the condition. The ventricular septal defect (VSD) diagnosis often starts with a physical examination. The doctor uses a stethoscope and hears a heart murmur during the exam. Next, the doctor may order the following tests to confirm the presence of VSD. These may include:
Infants born with smaller ventricular septal defects (VSD) generally don't require surgery. Instead, the doctor may observe the baby and treat the symptoms. At the same time, they wait to see if the defect closes independently. Infants with larger VSDs require medications to help treat the condition.
On diagnosing a VSD, the paediatric cardiologist will initiate medication and give dietary advice.
Medications are used to reduce the symptoms of the ventricular septal defect. The goal of therapy is to reduce risk of congestive heart failure, promote weight gain, help with sweating and fast breathing, development, and more. In addition, the doctor may use angiotensin-converting enzyme inhibitors to decrease the workload of the left ventricle. In contrast, Digoxin is used sparingly to support the heart muscles.
In patients with large VSD with poor growth and congestive heart failure not controlled with medication closure is indicated as soon as possible and preferably before 6 months of age. In patients with moderate VSD who are asymptomatic, closure by 2 years is indicated. If symptomatic earlier closure is advisable.
Any VSD associated with Aortic Valve Prolapse and leakage mandates closure.
Surgical Closure with a patch is the gold standard for VSD closure. Rarely, pulmonary artery banding may be considered a staging procedure for patients with multiple VSDs and patients with contraindications for cardiopulmonary bypass.
Some VSDs, like muscular VSD, can be closed non-surgically with a catheter-based device closure.
The outlook for patients with VSD Closure is excellent. Infective Endocarditis prophylaxis is recommended for 6 months after the procedure. However, all patients are also advised to maintain good oro-dental hygiene after this period.
If the hole is small, it usually doesn't cause any severe problems or complications. However, if the ventricular septal defect is medium or large and is left untreated, it may result in complications that may be life-threatening. These may include:
Max Healthcare is home to 4800+ eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
Max Healthcare is home to 4800+ eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
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