Ventricular Septal Defect Surgery

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What is Ventricular Septal Defect?

Ventricular Septal defect is a hole (defect) in the wall that separates the lower chambers of the heart. The lower chambers of the heart are called the ventricles. The wall between them is called the ventricular septum. In the normal heart, the septum prevents blood from flowing directly from one ventricle to the other. In a heart with a VSD, blood can flow directly between the two ventricles. VSD is a congenital (present at birth) heart defect. As the fetus is growing, something occurs to affect heart development during the first 8 weeks of pregnancy, resulting in a VSD.

Some terms to remember re: Congenital Heart Diseases

Atrioventricular Septal Defect (AVSD) - This includes an Atrial Septal Defect,Ventricular Septal Defect and abnormal development of the atrioventricular valves (tricuspid and mitral). This causes blood to flow abnormally inside the heart. An AVSD is also known as an atrioventricular canal defect.

Atrial Septal Defect (ASD) - This is a hole in the wall that separates the upper chambers (atria) of the heart. This causes blood to leak from one atrium to the other.

Patent Ductus Arteriosus (PDA) - In this condition there is a persistent connection between the aorta and the pulmonary artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours to days after birth. In some children, this vessel fails to close.

• Problems with the Heart Valves

  1. o Aortic Valve Stenosis is a defect of the aortic valve in the heart that often causes it to open incompletely. This reduces blood flow to the body.

  2. o Pulmonary Valve Atresia is a defect where a solid sheet of tissue forms instead of the pulmonary valve. This prevents oxygen-poor blood in the right side of the heart from traveling normally to the lungs to pick up oxygen.

  3. o Pulmonary Valve Stenosis is a narrowing of the pulmonary valve. This slows the flow of blood from the right side of the heart to the lungs. The heart must pump harder to push blood through the smaller opening to the lungs where the blood picks up oxygen.

  4. o Tricuspid Atresia is a defect where a solid sheet of tissue forms instead of the tricuspid valve. The tricuspid valve is between the right atrium and right ventricle of the heart. Without the tricuspid valve, oxygen-poor or blue blood entering the right atrium cannot travel normally to the lungs to pick up oxygen.

  5. o Ebstein's Anomaly is a defect where the tricuspid valve is both displaced and abnormally formed. The valve is leaky and allows blue blood to flow back into the right atrium instead of to the lungs to pick up oxygen.

• Transposition of the Great Vessels - This is a defect where the location of the aorta and pulmonary artery coming off the heart is switched. The aorta comes off the right ventricle instead of the left ventricle. The pulmonary artery arises from the left ventricle instead of the right ventricle. Therefore, blood without oxygen is continually pumped to the body, instead of blood with oxygen.

• Tetrology of Fallot - is a combination of four defects:

  1. o Pulmonary valve stenosis (narrowing)

  2. o Ventricular Septal Defect

  3. o Overriding of aorta where the aorta is positioned between the left and right ventricles, over the Ventricular Septal Defect.

  4. o Right ventricular hypertrophy is the thickening of the right ventricle.

• Truncus Arteriosus - This is a defect of the aorta and pulmonary artery. The aorta and pulmonary artery do not form as separate arteries. Instead, a large artery, called the truncus, comes from the heart. As the truncus leaves the heart, it may branch into arteries that carry blood to the body and to the lungs.

• Coarctation of the Aorta - In this condition there is a narrowing of the aorta. It slows or blocks the flow of blood from the heart to the body.

What are the types of Ventricular Septal Defects?

Ventricular Septal Defect can be divided in to 3 types:

• Size of the Ventricular Septal Defect

  1. o Small Ventricular Septal Defect

  2. o Moderate (or medium-sized) Ventricular Septal Defect

  3. o Large Ventricular Septal Defect

• Location of the Ventricular Septal Defect

  1. o Membranous Ventricular Septal Defect are located near the heart valves.

  2. o Muscular Ventricular Septal Defect are found in the lower part of the septum

  3. o Inlet Ventricular Septal Defect are located close to where blood enters the heart.

  4. o Outlet Ventricular Septal Defect are found in the part of the ventricle where the blood leaves the heart

• Number of defects

• Presence or absence of a ventricular septal aneurysm

What Cause Ventricular Septal Defect?

Heredity may play a role. Parents who have congenital heart defects are more likely to have a child with VSD than parents who do not have congenital heart defects. In some cases, VSD may be due to a defect in one or more genes or to chromosomal abnormalities.

What are the Symptoms of Ventricular Septal Defect?

The following are the most common symptoms of VSD. However, each patient may experience symptoms differently. Symptoms may include:

  • fatigue
  • sweating
  • rapid breathing
  • heavy breathing
  • congested breathing
  • disinterest in feeding, or tiring while feeding
  • poor weight gain

The symptoms of VSD may resemble other medical conditions or heart problems.

How is Ventricular Septal Defect Surgery Performed?

The surgery to close a Ventricular septal defect is done under general anesthesia so that your child will be asleep and feel no pain. The surgeon makes a cut down the center of the chest to reach the VSD.

  1. • The child is placed on a heart/lung bypass machine during surgery.
  2. • The heart is stopped, and the heart/lung machine takes over for the heart, pumping red blood throughout the body.
  3. • The heart/lung machine also brings oxygen-poor blood back to the machine where it picks up oxygen.
  4. • The surgeon uses a special patch or stitches to close the VSD.
  5. • The surgeon puts the patch over the VSD and sews it into place.
  6. • Once the repair is completed, the heart is restarted.
  7. • The child is taken off the heart/lung bypass machine.
  8. • The surgeon closes the skin incision.
What is the outcome of surgery for Ventricular Septal Defect?

In 99% of cases, there are successful results with no complications following surgical closure of Ventricular Septal Defect in children as they have a remarkable ability to heal and recover quickly. There is usually no residual leakage. After the Open Heart Surgery to repair Ventricular Septal Defect, there might be some pain and discomfort which will soon subside. Your child will be able to participate in all the normal activities pretty soon leaving all the memories of pain and discomfort behind.

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