Ventricular Septal Defect

What is Ventricular Septal Defect (VSD)?

VSD is a hole in heart that presents at birth, i.e. child born with a hole in heart. This hole is present between 2 lower chambers of heart, known as right and left ventricles in ventricular septum. This septum separates right and left ventricles.

What are the types of VSDs?

There are different types of defect noted in ventricular septum:
1. Peri-membranous VSD: most common type
2. Muscular VSD
3. Outlet VSD
4. Sub-pulmonic VSD etc

Clinical presentation of VSD?

It depends on size of VSD.

If size of VSD is small, child is generally asymptomatic, and only Systolic murmur will be there on examination by a pediatrician or physician.

If size of VSD is moderate (neither small nor big), child generally have history of poor weight gain, cough and cold etc.

In large sized VSD, child generally presents at 1-2 months of age with complaints of cough, cold, difficulty in breathing, poor weight gain, sweating over forehead.

Diagnosis of VSD?
For diagnosing VSD, Echocardiography of child needs to be done. Echo is a non-invasive test that is without pain. Echo is done from chest. Generally in small child, echo needs to be done when child sleeps.
Timing of closure of VSD?

After confirming the size of VSD and degree of dilatation of left heart chambers on Echocardiography, we can plan further treatment.

If size of VSD is small with no dilatation of left heart chambers then we do follow-up of child at periodic interval. Generally, small VSD closed spontaneously by 4-5 years.

If moderate sized VSD,then it generally associated with left heart dilatation, then we should close the hole between 6 months - 1 year of age.

In large sized VSD: we close between 3-6 months of age.

Can we close VSD by medications?

Medicine is not available for closing the VSD. Medicines are used for controlling symptoms due to heart failure, LRTI etc.

What are the options for closure of VSD?

Either angiographically (without surgery) or by surgery.

Which method is suitable for closing VSD?
It depends on size of VSD, location of VSD as well as on weight of the child. Small sized VSD: If needs closure and is suitable for closure by using a device in cath lab (without surgery), then can be closed in cath lab by using a device. Moderate sized VSD: Closing by method is decided by size & location of VSD and weight of child. Majority can be closed by device method in cath lab by angiography. Large VSD: by open heart surgery only.
Advantages of VSD closure by using adevice (Non-surgical method)?

1. Short hospital stay (2-3 days)
2. No surgical scar on the body
3. Only one tablet once a day for 6 months needs to be taken after the procedure.
4. Can attend school from next day of discharge
5. Can participate in all outdoor activities from very next day
6. Very less risk as compared to surgery, although very safe procedure
7. No requirement of ventilator in most cases

Surgical options?
Only by open heart surgery on bypass machine.
How we should do follow-up after device closure or after surgery?

After Device closure by angiographically: After one month then 3, 6, 12 months after the procedure.

After surgery: after 3 days for wound dressing, then 1,3,6,12 months after surgery.

How are VSDs closed in the cath lab?

By cardiac angiography from thigh blood vessels that are connected with the heart. We close VSDin a beating heart.

This procedure is generally done under conscious sedation. Within six months, device become endothelized and become a part of heart for life long.