Treatment of VSD depends on the size of the VSD as well as age and weight of the child.
Small VSD with no symptoms:
This type of VSD generally needs long term follow up only until associated with complications like infective endocarditis, Aortic valve prolapse or aortic regurgitation. Child can perform his/her daily activities without much issues.
Moderately sized VSD:
Children are generally have poor weight gain and may show signs of heart failure but intensity will be less as compared to large VSD.
Moderate sized VSDs generally followed for first few months of life and if not decreasing in size then can be closed either by open heart surgery or if suitable then by angiographic closure by putting an umbrella shaped device across the hole.
Large sized VSD:
Children with large VSD generally shows signs of heart failure or in respiratory distress. This generally occurs in first 1-2 months of life.
For treating large VSD, first we give anti-failure medicines and if heart failure not controlled then early treatment is advised in the form of open heart surgery before 6 months of age. There is no role of angiographic closure in cases of large VSD.
Open Heart Surgery – This involves making an incision in the chest wall and maintaining circulation with the help of a lung-heart machine while closing the hole. The surgeon may either seam the hole or stitch a patch of material over it. The heart tissue will eventually heal over the stitches or patches. In about six months, the tissue will cover the hole completely.
Non-surgical closure of VSD (Angiographic Closure of VSD)
Pediatric cardiologist inserts wire, catheter etc into the blood vessel situated in child thigh. He/she then guides the tube to make measurements of blood pressure, blood flow, and level of oxygen in the chambers of the heart. A special implant known as a device is placed into the septal hole (VSD). The device flattens against the septum on both the sides to permanently heal and close the VSD (VSD device closure).
Medical Follow-up
Regular follow-up is required with VSD whether it is closed or not in view of some issue in the form of heart block or may be pulmonary arterial hypertension if presented and treated in later part of life.
Infective Endocarditis prevention
Unrepaired VSD does not require prophylaxis for VSD. There is mild risk of having infective endocarditis with VSD so child shall receive antibiotics before certain dental procedures for a period of time after VSD repair.
Pregnancy and VSD
Pregnancy after closure of VSD with no pulmonary arterial hypertension is having almost no risk either to mother or to baby.
However pregnancy is contraindicated with Eisenmenger VSDs.
Dr Gaurav Agrawal is a Pediatric Cardiologist (Child and Fetal heart Specialist). Dr Agrawal is a pediatrician who has specialized training in the treatment of various child heart related problems (neonates to 18 years of age). He is also having a vast experience in fetal echocardiography.
He is one of the very few pediatricians in India who practices pediatric cardiology exclusively. Cardiac problems in children are common in children, sometimes life threating and often not diagnosed properly. Early diagnosis and timely treatment is very important. Areas of specific interest include child echocardiography including fetal echocardiography, diagnostic and therapeutic cardiac catheterization (pediatric cardiac holes closure by device, opening of obstructed cardiac valves by balloons etc).