Treatment for Ventricular Septal Defect in Infants

Most countries face a significant burden of pediatric cardiac conditions, including congenital heart disease (CHD) especially in Africa.

• Congenital heart disease (CHD) is the 7th leading cause of infant deaths in Africa, resulting in 34,000 preventable deaths!
• Nearly, 500,000 children are born with CHD in Africa per year.
• Almost 90% of children who are born with CHD in Africa, lack access to appropriate pediatric heart care.

What is a Ventricular Septal Defect in Infants?

Ventricular septal defect (VSD) is a congenital heart disease in children in which a child is born with a hole in their heart. The hole is in the wall of the muscle that separates the heart’s the left and the right ventricles. The severity of VSD and its treatment, depends on the size of the hole and its location within the septum.

If your baby or child develops any of these symptoms, contact your doctor immediately.

What are the Types of Ventricular Septal Defect? 

There are four types of VSD:

• Membranous VSD: It is a hole in the heart’s wall (ventricular septum) located in the membranous part of the septum, which is near the heart valves, specifically the aortic and tricuspid valves. In most cases treatment of this VSD requires surgery as they do no close spontaneously.
• Muscular VSD: Located in the muscular part of the septum, which is the lower part of the wall. A large number of these muscular VSDs close spontaneously and do not need surgery.
• Atrioventricular Canal VSD: Located underneath the tricuspid and mitral valves. It is associated with atrioventricular canal defect.
• Conal septal VSD: This is a rare VSD which occurs in the ventricular septum just below the pulmonary valve.

What are the Treatment Options for Ventricular Septal Defect? 

Treatment options for VSD depends on your child’s age, symptoms, the size & location of the hole within the septum.

Medication: Medication only helps in treatment of your child’s symptoms such as shortness of breath. It does not make the hole smaller or close it. In most cases a small hole closes naturally on its own and usually does not cause any medical problems. But if the symptoms persist or if the hole is too large to close on its own, surgery is performed.

In some cases, a surgery is performed even if the hole is small because it might be located in a dangerous part of the heart wall.

VSD Closure Surgery: Children born with a larger hole in the heart need surgical repair in the first few months after birth to prevent long-term complications. To treat this a pediatric heart surgeon usually performs an open-heart surgery. But in some cases, minimally invasive surgery is done, as it has low-risk and most children are discharged within 3-5 days after surgery.

This surgery is performed to close the septal opening before the child’s lungs are damaged. Surgery will also help babies who have trouble feeding and gain a normal amount of weight. 

Cardiac Catheterization: Cardiac catheterization is another option used to fix VSD. In this treatment, a tool called a Septal Occluder is used with a Catheter.

• First, the surgeon guides the catheter to the heart through the blood vessels.
• Once the catheter is in the heart, the surgeon closes the hole with the Septal Occluder.

Only certain types of VSDs can be treated with this method. Due to its complexity, it should only be done in centers that have experience in doing Transcatheter VSD Repair.

Frequently Asked Questions:

1. How does the Ventricular Septal Defect affect your child? 

If the defect is a larger hole, the child may breathe faster and harder than normal. The symptoms may not occur until several weeks after birth. This condition may cause higher pressure in the heart or reduced oxygen to the body. In time this will cause permanent damage to the lung blood vessels. 

2. What are the complications of Ventricular Septal Defect? 

• Pulmonary hypertension: Increased blood flow to the lungs due to the VSD will cause high blood pressure in the lung arteries (pulmonary hypertension), which can damage them permanently. This complication will cause reversal of blood flow through the hole (Eisenmenger syndrome).
• Endocarditis: This heart infection is a rare complication
• Abnormal heart rhythms (ventricular arrhythmias)
• Heart valve problems
• Lung problems
• Poor growth and development
• Heart failure

3. How are Ventricular Septal Defects Diagnosed? 

The Medical tests for VSD include: 

• Chest X-ray
• EKG
• Echocardiogram (ECHO) 

4. What are the Causes of Ventricular Septal Defects? 

• Ventricular septal defects in infants are formed when the septum doesn’t completely seal while a baby is developing in the womb.
• The tendency to develop VSD may be genetic and a hole in the heart could occur with genetic problems such as Down syndrome.
• In some cases, the causes of a VSD are severe blunt trauma to the chest.