Ventricular septal defect (VSD)

A ventricular septal defect (VSD) is a hole in the wall between the right and left ventricles of the heart. This anomaly usually develops before birth and is most common in infants.

The ventricles are the 2 lower chambers of the heart. The wall that separates them is called a septum. A hole in the septum is called a septal defect.
If the hole is located between the upper cavities or atria, it is called the interatrial communication.
Babies can be born with one or both types of deformity. These conditions are commonly referred to as "holes in the heart".

Normally, deoxygenated blood from the body returns to the upper chamber of the right side of the heart, called the right atrium. It passes through the tricuspid valve into the right ventricle, which pumps blood to the lungs for oxygenation. After leaving the lungs, oxygenated blood returns to the left side of the heart, to the left atrium. It then passes through the mitral valve into the left ventricle, where it is pumped to supply oxygen to all body tissues.

A VSD can allow freshly oxygenated blood to flow from the left ventricle, where pressure is higher, to the right ventricle, where pressure is lower, and mix with deoxygenated blood. Blood mixed in the right ventricle flows back or is recirculated to the lungs. This means that the right and left ventricles are working harder, pumping more blood than usual.
Eventually, the left ventricle can work so hard that it starts to fail. He can't pump blood as well as he used to. Blood returning to the left side of the heart can be rushed back into the lungs, causing congestion in the lungs, and blood returning from the right side of the heart can be rushed further into the body, causing weight gain and fluid retention. In general, this is called congestive heart failure.
If the VSD is large and not corrected surgically, excess pressure can build up in the lungs, called pulmonary hypertension. The higher the lung pressure or lung pressure, the more likely blood will flow from the right ventricle through the VSD into the left ventricle, causing deoxygenated blood to be pumped back into the body through the left ventricle, causing cyanosis (blue-colored skin). ).
The risk of these problems depends on the size of the hole in the septum and how well the infant's lungs work.

A VSD may not be heard with a stethoscope until several days after birth. This is because the newborn's circulatory system changes during the first week, with a drop in pressure in the lungs or lungs creating a greater pressure differential between the two ventricles, which can increase left-to-right shunting and cause an audible hiss.

VSDs are the most common congenital heart defects in young children.

The condition occurs in approximately 25% of all children born with heart disease.
These defects are more common in premature babies.

Causes of VSDs

No one knows what causes VSDs, but they are likely related to a heart defect that occurs when a baby develops in the womb.

There may be one or more holes in the partition.
The septum itself is divided into several areas, including the membranous part, the muscular part, and other areas called inlet and outlet. Any or all of these parts may have a hole.
The location of the hole depends on where the malformation occurs during fetal development.

The most common type of VSD is the membranous variant. In this type, the opening is located below the aortic valve, which controls the flow of blood from the left ventricle to the body's main artery, the aorta.

Symptoms of a VSD

Small holes in the interventricular septum usually do not cause any symptoms, but a pediatrician often recognizes them when they hear a loud heart murmur along the left side of the lower sternum or sternum. Large holes usually cause symptoms 1 to 6 months after the baby is born. The left ventricle begins to fail, causing the following symptoms:

Fast breathing
Sweating
Pallor
Very fast heartbeats
Decreased feeding
Poor weight gain

If a VSD is not detected at an early age, it can cause more severe problems and symptoms over time. The greatest concern is the development of high pressure in the lungs (pulmonary hypertension). If the VSD is not closed surgically, irreversible pulmonary hypertension may develop and surgery may no longer help the child. Here are the typical symptoms of pulmonary hypertension:

Fainting
Shortness of breath
Chest pain
Bluish discoloration of the skin (cyanosis)

The skin becomes slightly bluish when the tissues do not receive enough oxygen. This condition is often referred to as "hypoxemia" or "hypoxia".

When to seek medical care

Any of the following should be reported to your child's doctor:
Poor weight gain or slowing of weight gain in the first months of life
Unusual behavior
Any of the other symptoms noted in the previous section

An immediate visit to the emergency room of the nearest hospital is warranted if you notice any of the following in your child:

Shortness of breath, breathing difficulty of any type, or worsening of an existing breathing problem
Bluish color of the skin, lips, or under the nails
Unusual or unexplained sweating

Exams and tests

If a VSD is found before your child is discharged from the hospital, several tests may be ordered before discharge.

An echocardiogram (ultrasound image of the heart), a chest x-ray, and blood tests can be done.
You will be asked to consult your child's doctor and will need to be closely monitored for signs and symptoms that suggest congestive heart failure or hypoxia.

A VSD is detected on physical examination by a systolic murmur heard with a stethoscope along the lower left edge of the sternum or sternum. This is due to oxygenated blood that “hisses” through a hole or VSD into the right ventricle.

The presence of a hole in the heart can be confirmed by an echocardiogram. This painless test uses ultrasound waves to create an animated picture of the heart. He can quantify the size of the left-to-right shunt from left ventricular enlargement, lung pressure, and actually estimate the extent of the shunt by an empirical formula.

A chest x-ray is useful to see if the overall size of the heart is enlarged and if signs of fluid in the lungs or congestion in the lungs can be detected. An electrocardiogram is useful for assessing the size of the left and right ventricles. If right ventricular hypertrophy is indicated, this may indicate pulmonary hypertension.

Cardiac catheterization may be performed under certain circumstances.

In this procedure, a very thin plastic tube called a catheter is inserted into the skin of the groin, arm or neck (under local anesthesia with minimal pain) and advanced towards the heart under X-ray observation by a cardiologist.
Pressure is measured inside the heart, especially if there has been concern about the degree of pulmonary hypertension and therefore operability in the past. If the lung pressure is very high and does not drop with oxygen, the patient may be inoperable.
If additional abnormalities are possible, a dye study may be performed to visualize the anatomy of the inside of the heart. But an echocardiogram can achieve this goal in most patients.

Treatment of VSDs

In some children with a VSD, the valve closes on its own as the child grows.

Medical treatment

If an enlarged VSD is causing symptoms, your child's doctor may prescribe medication.

Medications prescribed depend on the severity of the symptoms.
The goal of treatment is to reduce the symptoms of congestive heart failure such as poor growth and development, poor weight loss and/or weight gain, excessive sweating and rapid breathing. Older patients usually develop fluid in the lungs, liver, and legs.
Routine use of antibiotics is justified in dental surgery and any invasive procedure if the VSD is still present after closure.

Medications

Vasodilators: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are used to reduce the workload on the left ventricle.
Digoxin increases the strength of the heart muscle to cope with increased blood volume.
Diuretics, such as furosemide or spironolactone, help to remove excess fluid from the body, so the heart does not have to work so hard, and the patient feels much better.

Surgery

Larger VSDs do not close as the child grows. If it does not close, surgical closure of the heart is necessary.

Surgical closure is usually done before the child goes to kindergarten.
Surgery is indicated if medications do not work in the first months or years of life, especially if the child is not growing well even with medication.
Surgery is more urgent if signs of pulmonary hypertension develop.
The most commonly used operation is applying a Gore-Tex patch to the hole. This prevents a shunt (movement of oxygenated blood from the left ventricle to the right ventricle).

Surgery is usually not performed on newborns, as small defects close spontaneously in 20-25% of cases. Surgery is also more risky in the first months of life; The risk of death after surgery is highest during the first 6 months of life.

Researchers are testing devices that close a defect made in a cardiac catheterization lab rather than during open-heart surgery.

Next steps

Regular visits to the doctor and echocardiograms are necessary for the constant re-evaluation of the VSD.
Child's weight and length/height will be checked frequently. Feeding and activity levels should be assessed regularly.
Routine use of antibiotics is warranted for dental surgery and any invasive procedures.

Prevention

There is nothing a woman can do during pregnancy to prevent her baby from developing a VSD.

As the child grows, the defect may shrink and close on its own.

Between 20 and 25% of all VSDs close by age 3 without medical intervention.
Children who do not have symptoms and who are under the supervision of a doctor should not limit their activities. Children with mild to moderate shedding may need to reduce their activity levels.
After troubleshooting, there are no restrictions on activity.

Several other conditions can result from VSDs.

Aortic insufficiency: Blood flows back from the aorta into the left ventricle.
Endocarditis: Infection of the heart valves due to abnormal blood flow. Since endocarditis is always a possibility, health care providers may recommend that children with certain types of VSDs take antibiotics before dental treatment or surgery.
Pulmonary hypertension: Increased pressure in the right side of the heart and in the arteries of the lungs. This is caused by a shunt of blood from the left ventricle to the right ventricle, which increases pressure in the right ventricle.