Ventricular Septal Defect

Types of Ventricular Septal Defect

Ventricular Septal Defect is a congenital heart condition that results in a hole in the heart wall between the lower chambers. The hole can form during pregnancy if the septum wall is not fully developed. It can occur in isolation or be associated with other congenital heart defects. The cause of this condition is still unknown, but certain conditions during pregnancy may increase the risk of VSD. Treatment depends on the size of the hole and the consequences of the extra blood flow to the lungs and the heart.

There are four types of VSD depending on their location: Perimembranous VSD, Inlet VSD, Muscular VSD, and Conoventricular VSD. Small, medium, or large categorizes VSDs based on their size.

Causes of Ventricular Septal Defect

The cause of VSD, a congenital heart condition, is currently unknown. Nonetheless, it may appear in combination with other heart conditions, genetic disorders or heart defects. The risk of developing VSD may increase if the mother consumes anti-seizure medications or engages in habits such as smoking and alcohol consumption during pregnancy. Maternal infections during pregnancy or uncontrolled diabetes can also be contributing factors. However, further research is required to confirm if these factors are definitive causes.

Ventricular Septal Defect Symptoms

The heart has four chambers, with the ventricles responsible for pumping blood. Blood low in oxygen returns to the right side of the heart and is pumped into the lungs for oxygenation. The oxygen-rich blood then returns to the left ventricle and is pumped to the whole body. The ventricular septum separates the right from the left side of the heart, but a VSD allows oxygen-rich blood to cross over to the right side, leading to extra blood in the lungs and additional stress on the heart. Symptoms depend on the size and type of VSD, with smaller defects often not causing any symptoms until childhood. Moderate to severe VSDs may cause sweating during feeding, slow weight gain, frequent respiratory infections, shortness of breath, and fatigue. Larger defects usually present within a few weeks of birth.

Diagnosis of Ventricular Septal Defect

A small ventricular septal defect (VSD) may close on its own, and infants may not exhibit any symptoms. Diagnosis of VSD begins with a physical exam, during which the doctor listens for a heart murmur with a stethoscope. Further tests may be required to confirm the diagnosis, including a chest x-ray to detect increased blood flow, pulse oximetry to measure oxygen levels, an electrocardiogram to diagnose heart rhythm problems, and an echocardiogram to produce images and determine the location, size, and severity of the defect. In some cases, cardiac catheterization is necessary to identify congenital heart defects and assess the severity of the condition, and cardiac MRI is emerging as a useful diagnostic tool.

Ventricular Septal Defect Treatment

For infants born with small ventricular septal defects (VSD), surgical intervention is generally not necessary. Instead, doctors may monitor the infant and manage symptoms while waiting to see if the defect resolves on its own. In contrast, larger VSDs may require medication to manage symptoms, promote weight gain, and prevent congestive heart failure. Medications may include angiotensin-converting enzyme inhibitors and Digoxin. If medications fail to control symptoms, surgery to close the defect may be necessary.

Surgical closure with a patch is the preferred method for closing VSDs. However, for patients with multiple VSDs or contraindications for surgery, pulmonary artery banding may be considered. Muscular VSDs may be closed non-surgically using a catheter-based device. The prognosis for patients who undergo VSD closure is generally excellent, but it is recommended to take prophylactic antibiotics for six months after the procedure to prevent infective endocarditis. Good oral and dental hygiene is also important for all patients following the six-month period.

Complication of Ventricular Septal Defect

Small ventricular septal defects (VSD) typically do not cause significant issues, but larger ones may lead to life-threatening complications if left untreated. These complications include heart failure, endocarditis, high lung pressures, irregular heart rhythms, lung problems, and poor growth and development.

Outlook

The prognosis for ventricular septal defect is generally favorable. Infants with small, asymptomatic defects may undergo a period of observation to see if the hole closes on its own, and symptom management may be provided. Surgical intervention has a high success rate and good long-term outcomes, with recovery time varying based on the size and type of the defect.