The ventricular septal defect ( VSD ) refers to a hole in the septum of the heart. Around a third of all congenital heart defects are ventricular septal defects. This makes the VSD the most common congenital heart defect.
What is a ventricular septal defect?
The ventricular septal defect is a congenital (innate) heart malformation. The VSD is therefore one of the cardiac defects. The septum between the two chambers of the heart has a hole that connects the left and right chambers of the heart. The symptoms depend on the size of the defect. Minor defects often close by themselves within the first two years of life. Surgery may be required for larger defects. For all you need to know about hirsuties papillaris penis, please visit phonecations.com.
The causes of ventricular septal defect are not known. There is a defect in the heart septum (ventricular septum). The defect can be in different places. It is most commonly found just below the aortic valve. Muscular or perimembranous defects are less common. The blood from the left heart is pumped into the systemic circulation, the blood from the right heart goes into the lungs.
Since the blood pressure in the pulmonary circulation is much lower than in the other body vessels, the left heart has to pump with a higher pressure. This means that the pressure in the left ventricle is higher than in the right ventricle. Oxygen-rich blood flows from the left to the right ventricle via the ventricular septal defect. There is a so-called left-right shunt. Therefore, the VSD is also one of the shunt defects.
Symptoms, Ailments & Signs
The consequences of this shunt depend on the size of the VSD. A small defect shows hardly any symptoms. Many of these defects are only discovered by accident. However, in medium and large ventricular septal defects, much of the arterial blood flows back into the right heart. This then pumps the blood back into the lungs.
The additional amounts of blood increase the blood pressure in the vessels of the lungs. Pulmonary hypertension develops. The right heart has to pump against this increased blood pressure and therefore enlarges. This enlargement is called right ventricular hypertrophy. The vessels in the lungs cannot cope with the great pressure, so they harden over time. However, these hardenings only make the situation worse.
The blood pressure in the lungs continues to rise and the right heart enlarges. Eventually the right heart pumps so hard that the shunt reverses. From now on, the blood through the ventricular septal defect no longer flows from the left to the right ventricle, but from the right to the left ventricle. The blood from the right ventricle comes from the systemic circulation and is low in oxygen.
The body is therefore supplied with oxygen-poor blood. This gives the patient’s skin a slight blue discoloration. The accumulation of blood in the lungs can also lead to pulmonary edema. In pulmonary edema, fluid collects in the alveoli. The consequences are shortness of breath and coughing. Children with a VSD often show increased breathing. They don’t drink well and grow poorly. Children with a VSD are often very thin.
Diagnosis & course of disease
On auscultation of the heart, a thud may be heard over the third to fourth intercostal space. However, as the size of the ventricular septal defect increases, this murmur becomes quieter. If the defect is large, a diastolic flow murmur may occur as a result of the increase in blood pressure in the pulmonary circulation. The second heart sound is then split. The ECG is usually unremarkable with small defects.
In the case of a larger ventricular septal defect, signs of left-sided or right-sided heart hypertrophy become visible. X-rays of the chest are negative for small defects. Otherwise there are signs of pulmonary edema. The diagnosis is confirmed using echocardiography. A heart catheter examination is also carried out in older patients in order to clarify the resistance conditions within the lungs.
Since the ventricular septal defect is a heart defect, it primarily has a very negative effect on the life expectancy of those affected and can reduce it. However, this usually only occurs if the disease is not treated. Those affected primarily suffer from very high blood pressure, which can lead to a heart attack.
Permanent tiredness or exhaustion can also occur and have a very negative effect on the quality of life of those affected. A ventricular septal defect does not heal itself and the symptoms worsen over time. Since the body does not receive the usual oxygen supply, those affected cannot do any sports or strenuous activities.
This can lead to delayed or very limited development, especially in children. Many patients also suffer from severe shortness of breath or coughing. This condition is treated with medication and surgery. In most cases, this can alleviate the symptoms. However, those affected are dependent on regular examinations by the doctor throughout their lives so that further complications do not arise.
When should you go to the doctor?
In the case of a ventricular septal defect, the patient is dependent on treatment by a doctor. Since this is a serious heart condition, a doctor should be consulted as soon as the first symptoms and signs of the disease appear, so that there are no further complications or, in the worst case, death of the person concerned. As a rule, a doctor should be consulted for a ventricular septal defect if the heart beats very strongly even with little exertion. With great effort or sporting activities, those affected usually notice the high pulse and thus also the high heartbeat.
Many patients also suffer from shortness of breath or a strong cough. If these symptoms occur over a longer period of time and do not go away on their own, an examination and treatment by a doctor is definitely necessary. The disease can be evaluated and treated by a cardiologist. Since this is a hereditary disease, genetic counseling should be carried out if you wish to have children in order to prevent the disease from recurring. It cannot be universally predicted whether this will lead to a reduced life expectancy.
Treatment & Therapy
In a third of all infants with a VSD, the defect closes on its own within the first two years of life. In 20 percent of all babies, it at least gets smaller. Larger defects are fatal in a tenth of affected children within the first year of life. The children die from recurring infections of the bronchi and lungs or from acute insufficiency of the left heart.
Because patients with larger ventricular septal defects often suffer from failure to thrive, they often require surgery in infancy. Otherwise, it is actually only a matter of waiting to see whether the defect does not close itself. The VSD can be operated on in three different ways:
- With the transatrial method, access is through the right atrium of the heart.
- Transventricular access is through the right ventricle
- and with the transarterial method, the access route is chosen through the pulmonary artery or the main artery (aorta).
The defect is then closed with either sutures or a patch. Normally, a suture is avoided, since the resulting scar can later lead to cardiac arrhythmias. During the operation, patients are connected to the heart-lung machine. One percent of children die from an uncomplicated ventricular septal defect.
Mortality is significantly higher in infants with heart failure . Complications occur in three to five percent of cases. The most serious complication is a conduction disorder. The electrical excitation, which is responsible for the contraction of the heart muscle, is not transmitted from the atrium to the ventricle.
A ventricular septal defect is difficult to prevent. However, alcohol and smoking are major risk factors for maldevelopment in the unborn child and should therefore be avoided at all costs.
If the ventricular septal defect has been surgically closed, follow-up treatment is required. This initially takes place in the intensive care unit of the hospital. The patient is carefully observed. Because there is a catheter on one leg, it must not be moved independently at first. Intense physical exertion should also be avoided in the first week after the operation.
During the patient’s stay in the hospital and before the patient is discharged, the position of the closure system is checked, which is usually done as part of a transesophageal echocardiography (TEE). This procedure makes it possible to determine whether the attached occluder is properly seated and whether the defect has also been correctly closed.
Some patients are at risk of blood clots forming on the occluder. These can be identified using the TEE examination. If there is a clot, it is usually dissolved successfully by administering appropriate medication.
To prevent another blood clot from forming, the patient takes drugs such as clopidogrel and aspirin for three to six months. Another check-up takes place after three to six months. Usually no other medicines to prevent a blood clot need to be given.
The patient receives antibiotics as additional medication during the follow-up treatment of the ventricular septal defect. They have the task of preventing heart and vascular inflammation. If there are any abnormalities, a doctor must be informed immediately.
You can do that yourself
A small ventricular septal defect may close spontaneously after birth. The most important self-help measure for parents is to carefully monitor the child and work closely with a cardiologist.
Larger defects must be surgically closed. After an operation, the child needs bed rest and rest. Parents must consult with the pediatrician and comply with their instructions. In most cases, an adjustment to the child’s diet is also necessary. The weight loss must be compensated by giving high-fiber beverages. The child may need special supplements. In general, the child should be supplied with sufficient liquid. Children with a ventricular septal defect should not exert themselves. Rest is particularly important in the first few days and weeks after heart surgery. After consultation with the doctor, gentle movement is allowed.
The measures to be taken for a ventricular septal defect depend on the size of the defect and the treatment method. The pediatrician names suitable measures and supports the child’s parents during treatment and aftercare. Endocarditis prophylaxis usually has to be maintained for twelve to 16 months.