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Ventricular septal defect (VSD)

Definition


Disease: Ventricular septal defect (VSD) Ventricular septal defect (VSD)
Category: Surgical diseases

Disease Definition:

One of the common congenital defects is a ventricular septal defect (VSD), also known as a hole in the heart. A baby with a small ventricular septal defect might not have any problems, while a baby with a larger ventricular septal defect or related heart defects might have a telltale bluish tint to the skin due to oxygen-poor blood, which is usually most visible in the fingernails and lips. Ventricular septal defect is readily treatable. Smaller ventricular septal defects either don’t cause any problems or close on their own. Others require surgical repair, in times not until the condition is initially detected or symptoms initially grow in adulthood. Only having few related problems, many people with ventricular septal defects have normal and productive lives.
 

Work Group:


Symptoms, Causes

Symptoms:

Serious heart defects usually cause signs and symptoms during the child’s first few days, weeks and months of life. A large ventricular septal defect may cause some of these signs and symptoms in a baby:

  • Fast breathing or breathlessness
  • A bluish tint to the skin, fingernails and lips (cyanosis)
  • Easy tiring
  • Rapid heart rate
  • Swelling of legs, abdomen or feet
  • Poor eating, failure to thrive

 

These signs may be caused by a congenital heart defect; however, they can also be the result of other conditions. 
The person and the doctor himself might not notice signs of a ventricular septal defect at birth. In case the defect is small, symptoms might not come up until later in childhood, if ever. Depending on the size of the hole, signs and symptoms differ. During a regular checkup while listening to the baby’s heart with a stethoscope, the doctor might at first suspect a heart defect. In some cases, until a person reaches adulthood and starts experiencing signs or symptoms of heart failure, like shortness of breath, a ventricular septal defect may not be detected. Parents should call the doctor if the baby or child:

  • Isn’t gaining weight
  • Breathes rapidly or is short of breath
  • Tires easily when eating or playing
  • Has bluish tint to their skin, specifically around the fingernails and lips
  • Becomes breathless when eating or crying
  • A person should call the doctor if he/she experiences:
  • Rapid or irregular heartbeat
  • Shortness of breath when exerting themselves or when they lie down
  • Swelling (edema) in the legs, ankles and feet
  • Fatigue and weakness
     

Causes:

Errors early in the heart’s development causes heart defects that come up at birth (congenital), but the cause is usually unknown. Genetics and environmental factors might possibly play a role. When the septum, which is the muscular wall that divides the heart into left and right sides, fails to form fully between the lower chambers of the heart (ventricles) throughout fetal development, a ventricular septal defect occurs. The new (oxygenated or “red”) blood and used (deoxygenated or “blue”) blood will be mixed because of this opening.  Blood overfills the lungs and overworks the heart as a result. The blood pressure in the lungs will increase (pulmonary hypertension) and the ventricles will enlarge and no longer be able to work efficiently in case the defect is severe and left untreated. This could ultimately lead to permanent damage to the lung arteries and then to heart failure. In some cases, ventricular septal defect occurs with other genetic problems, like Down syndrome; and it seems to run in families. In case a person has a child suffering from a heart defect, a genetic counselor could anticipate the rough odds that the person’s next child would have one. A woman’s risk of having a baby with a heart defect will be increased in case she has the following conditions during pregnancy:

 

Rubella infection:

The risk of fetal heart defects is increased in case a pregnant woman becomes infected with the rubella virus (German measles) because this virus crosses the placenta spreading through the fetus’ circulatory system and damaging blood vessels and organs, including the heart.

 

Poorly controlled diabetes:

The fetus’ blood sugar is affected when the mother has uncontrolled diabetes, resulting in various damaging effects to the growing fetus.

 

Drug or alcohol use or exposure to certain substances:

The developing fetus may be harmed in case the pregnant mother used certain medication, alcohol or drugs, or if she’s exposed to chemicals or radiation.

 

Complications

Complications:

While a small ventricular septal defect might not cause any problems, but a larger defect could result in various disabilities that range from mild to life-threatening. Many of these complications could be prevented with treatment.

 

EISENMENGER’S SYNDROME:

High blood pressure in the lung arteries (pulmonary hypertension) could be caused by an increased blood flow to the lungs when a large ventricular septal defect remains untreated. Pulmonary hypertension could become irreversible over time in case the lung arteries develop permanent damage. This complication, referred to as Eisenmenger’s syndrome, might take place in early childhood, or it could develop over several years. In people suffering from Eisenmenger’s syndrome, the majority of the blood flow through the ventricular septal defect, travel from the right ventricle to the left and bypass the lungs; that is how deoxygenated blood is pumped to the body leading to a bluish discoloration of the fingers, lips and toes (cyanosis) and other complications. Since irreversible damage to the lung arteries would have been already done, so when the person has Eisenmenger’s syndrome, it would be too late to be able to surgically repair the hole.

 

OTHER COMPLICATIONS: 

A ventricular septal defect may also end up causing some of these complications: 

 

Heart failure:

Heart failure, the chronic condition in which the heart can’t pump effectively, may result due to the increased blood flow through the heart caused by a ventricular septal defect.

 

Endocarditis:

Endocarditis is the infection of the heart. The risk of developing endocarditis is increased in people with a ventricular septal defect.

 

Stroke:

Due to a blood clot passing rhough the hole in the heart and going to the brain, the risk of a stroke is increased in people with large defects, particularly those that occur with Eisenmenger’s syndrome. 

 

Other heart problems: 

Valve problems and arrhythmias may also result from a ventricular septal defect. 

 

PREGNANCY AND VENTRICULAR SEPTAL DEFECT:

Getting pregnant is usually a worry for women born with a heart defect. While having ventricular septal defect repaired without any complications or having a very small defect doesn’t lay any additional risk in pregnancy; but a high risk is posed to the mother and the fetus in the case of having an unrepaired larger defect, heart failure, cyanosis or other heart defects. Woman suffering from Eisenmenger’s syndrome are strongly advised not to become pregnant because they are at an increased risk of complications. A woman without congenital heart disease has about 1% chance of giving birth to a child with a heart defect. Women born with a heart defect might also be worried about the risk of the baby being born with a heart defect as well; their risk increases to between 2 and 20 %.
Any woman with a congenital heart defect repaired or not, considering pregnancy, should discuss it beforehand with a cardiologist. This is very essential in case the woman is taking medications. It’s also crucial to see both an obstetrician and a cardiologist throughout pregnancy.
 

Treatments:

Several babies born with a small ventricular septal defect won’t even need to have the defect surgically closed. After birth, the doctor might want to observe the baby and treat any symptoms while waiting to find out whether the defect will close on its own or not. Surgery is often needed to close the defect in children and adults that have a ventricular septal defect that is large or is causing significant symptoms. In case an infant has a ventricular septal defect that requires surgical repair, the process will probably be scheduled in the baby’s first year of life.

 

MEDICATIONS:

Medications for ventricular septal defect might include the followings that:

 

Keep the heartbeat regular: 

Examples include digoxin and beta blockers.

 

Increase the strength of the heart's contractions:

One example is digoxin.

 

Decrease the amount of fluid in circulation:

This will reduce the volume of blood that must be pumped. These medications, called diuretics, include furosemide.

 

PROCEDURES:

Plugging or patching the abnormal opening between the ventricles is involved in surgical treatment for ventricular septal defects. The two approaches currently used are:

 

Surgical repair:

In most cases this is the procedure of choice. Open heart surgery done under general anesthesia is often involved in the surgical repair of a ventricular septal defect. An incision in the chest, as well as a heart-lung machine is required in this surgery. To close the whole, patches or stitches could be used. 

 

Catheter procedure:

When surgical repair isn’t possible, this technique might be used to close a ventricular septal defect. Patching throughout catheterization doesn’t need opening the chest. The doctor inserts a thin tube (catheter) into a blood vessel in the groin guiding it to the heart, instead of opening the chest. A small mesh patch or plug is then used to close the hole. The process is related to higher rate of complications than is surgical closure and more research is required to fully understand its efficacy and safety. To ensure that the ventricular septal defect stays closed, the doctor will schedule regular medical follow-up after the repair. The doctor will suggest how often the patient or a child, require to be seen, depending on the size of ventricular septal defect and the presence or absence of any other problems.
Surgery used to close a ventricular septal defect in general, has very good long-term results.

 

PREVENTIVE ANTIBIOTICS:

Today experts believe that endocarditis is much more likely to take place from exposure to random germs than from a typical dental exam or surgery. A doctor should be consulted in case a person has been told in the past that they or their child should take antibiotics before dental or medical processes to decrease the risk of infective endocarditis. Preventive antiobiotic treatment is recommended only for those at an increased risk of serious complications from infective endocarditis. Preventive antibiotics might still be recommended in case the patient:

  • Has had a repair with artificial (prosthetic) material
  • Has other heart conditions or artificial valves
  • Has a large ventricular septal defect that’s causing a low blood oxygen level

 

Practicing good oral hygiene and getting regular dental checkups is the most effective method for avoiding endocarditis in most people suffering from a ventricular septal defect.
 

Prognosis:

Not available

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