Ventricular Septal Defect(VSD)
A small hole allows little amount of blood to go across the hole. A large hole gets a lot more of blood across the hole. This extra amount of blood coming to the right side of the heart immediately gets transmitted to the lungs from where it goes to the left side of the heart. So, it is really the left side if the heart, the left upper and lower chambers which get to see this extra amount of blood!
VSD when large has to be closed by the 3rd to 6th month of life. The decision to close the
VSD has to be made well in time to give family enough time to accommodate to the fact that
heart surgery has to be done on their child and that apart from the emotions of the decision
(how so ever safe it might be, parents will take time to decide and accept), there are
financial (or insurance clearance issues also).
A small hole allows little amount of blood to go across the hole. A large hole gets a lot more of blood across the hole. This extra amount of blood coming to the right side of the heart immediately gets transmitted to the lungs from where it goes to the left side of the heart. So, it is really the left side if the heart, the left upper and lower chambers which get to see this extra amount of blood!
VSD when large has to be closed by the 3rd to 6th month of life. The decision to close the
VSD has to be made well in time to give family enough time to accommodate to the fact that
heart surgery has to be done on their child and that apart from the emotions of the decision
(how so ever safe it might be, parents will take time to decide and accept), there are
financial (or insurance clearance issues also).
- VSD with Coarctation
- VSD, large with a pneumonia
- Large VSD with Severe Malnutrition
What are the ventricles ? What is the Ventricular septum ?
The heart has 2 pumps; pumping blood is the main function of the heart; the 2 pumps are separated by a wall called the ventricular septum. The right pump receives the blue blood which has to go to the lungs for picking up oxygen. This pump has to push blood into its vicinity (heart and lungs being close by within the chest); so the normal pressure in this pump is 30-35 mmHg.
The Left Pump pushes the red blood into the lungs; it has to ensure blood reaches all the parts of the body so the pressure here is equivalent to the blood pressure (upper number of BP i.e. Systolic).
What is a Ventricular septal defect (VSD) ?
A defect in the wall which separates the ventricles is called a VSD. The high pressure in the Left pump as compared to the Right ensures that the blood flows from the left to the right pump (therefore is called a L to R shunt). This implies red (left sided) blood gets into the blue (right sided) blood; this implies that in this condition the patient is not going to be blue.
How common is it?
It is one of the most common defects of the heart. Infact it is the most common defect.
Can it be detected before birth ?
Yes, it can be detected before and at birth. Often, it will detected on an ultrasound. But on fetal echocardiogram there is a better chance of it being picked up. The way this hole is noticed, is by seeing abnormal flow across the septum. But, during fetal life the pressure between the 2 pumps is the same. So, there is not much flow across the hole and that makes it difficult to pick up.
How does a small hole differ from a large hole?
If this blood amount is large, the left side of the heart gets dilated and volume overloaded. This can be seen on an X-ray as enlarged heart. This reverses once the extra blood flow stops.
If the amount of blood is large, there will also be an increase in pressure in the right side of heart and in the lungs. While with the Small VSD the volume will be so small the left heart won’t enlarge. And neither will the pressure in the right heart go up.
Is VSD closure an emergency ?
Usually VSD closure is an elective procedure done in a planned manner, but, ocassioanlly
may turn out to be emergency in some circumstances:
A ventricular septal defect usually is diagnosed after a baby is born.
Doctors may choose to monitor and observe children who have ventricular septal defects (VSDs) but don't have symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on its own or gets smaller.
More than half of VSDs eventually close, usually by the time a child is in preschool. Your child's doctor will let you know how often your child should be checked. Checkups may range from once a month to once every 1 or 2 years.
When treatment for a VSD is required, options include extra nutrition and surgery to close the VSD.
The doctor may recommend surgery if your child's VSD:
Some infants who have VSDs don't grow and develop or gain weight as they should. These infants usually:
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give babies extra nourishment.
In some cases, tube feeding is needed. Food is given through a small tube that's placed through the nose and into the stomach. Tube feeding can add to or take the place of bottle feeding. This treatment usually is temporary because a VSD that causes symptoms will likely need surgery.
Most doctors recommend surgery to close large VSDs that are causing symptoms or haven't closed by the time children are 1 year old. Surgery may be needed earlier if:
Rarely, medium-sized VSDs that are causing enlarged heart chambers are treated with surgery after infancy. However, most VSDs that need surgery are repaired in the first year of life.
Diagnosis
- Shortness of breath,
- Fast or heavy breathing,
- Sweating,
- Tiredness while feeding, or
- Poor weight gain.
- Is large
- Is causing symptoms
- Is medium-sized and is causing enlarged heart chambers
- Affects the aortic valve
Extra Nutrition
- Have large VSDs
- Are born prematurely
- Tire easily during feeding
- The child fails to gain weight
- Medicines are needed to control the symptoms of heart failure
Diagnosis
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