VSD (a hole in the heart) refers to a congenital heart disease where a hole is formed in the ventricle septum i.e. wall between two lower chambers of the heart. As a result of this, blood from the left portion of the heart (left ventricle) crosses this hole and goes to right-sided heart that results in blood overflow to lungs.
VSD is one of the commonest child heart diseases that is seen at birth, but adults too may suffer from it following an acute heart attack.
What are the causes for Ventricular Septal Defect?
Congenital VSD occurs during heart development of the fetus. The heart develops from a huge tube, dividing into sections that, in turn, will become the chambers, walls and vessels of the heart. If something goes wrong during this process, a hole can develop in the ventricular septum.
Sometimes, VSD may be caused due to genetic and environmental factors. For instance, if you have a family history of genetic conditions like Down syndrome or congenital heart diseases, then your child may be at risk of developing a Ventricular Septal Defect.
Symptoms Indicating VSD-
The signs and symptoms of Ventricular Septal Defect vary depending on the size of the VSD. If the hole is small, child may be asymptotic. Children or young adults with small VSD only show signs of a heart murmur that is detected by their family physician.
A medium or large sized hole is likely to exhibit the following noticeable symptoms in children –
These symptoms indicate that the VSD will most likely not close by itself, and therefore, require urgent intervention. If left untreated, Ventricular Septal Defect may lead to further complications such as pulmonary hypertension, endocarditis, or Eisenmenger like situation.
How is VSD diagnosed?
Usually, VSD is detected within the first few weeks after the birth of the child during a routine check-up. The doctor can tell if your child has a hole in the heart by hearing a heart murmur, as oxygen-rich blood passes between the two ventricles.
Suspecting VSD, your doctor may refer you to a paediatric cardiologist, who will then perform a physical examination on your child, taking his/her medical history in consideration. The following tools are used to confirm the diagnosis –
What is the treatment?
Treatment of VSD depends on the size of the hole, and the age and weight of the child.
A small VSD with no significant symptoms mostly will require only follow-up. The child can do his/her activities without much fear.
Moderately sized VSD children are having poor weight gain and show signs of heart failure but less as compared to large VSD. These VSD needs to be followed up to 9-12 months of age and needs to close. The method of closure of moderate sized VSD depends on its location and size of VSD. Majority of moderate sized VSD can be closed by using a device in cath lab angiographically (VSD device closure non-surgically) or else by doing open heart surgery.
In a case of large VSD: Child shows signs of heart failure or in respiratory distress then first medical therapy in the form of diuretics are prescribed for decreasing the signs of heart failure. Then VSD surgical closure is advised preferably between 3-6 months of age.
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.
Another treatment option is cardiac catheterization.
Cardiac Catheterization (Non-surgical closure of VSD)– The cardiologist inserts a catheter into the blood vessel in child legs that reach up to the heart. 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.
Having your child diagnosed with a heart defect can be scary. However, consulting a paediatric cardiologist at the earliest can be helpful, as he will be familiar with Ventricular Septal Defect, and can tell you the best way to manage the condition.
An Atrial Septal Defect is present at birth (congenital heart disease). The condition refers to a hole in the septum or walls (atrial septum) that separate the heart’s upper chambers – atria.
The heart of the fetus develops during pregnancy. Normally, there are several openings in the septum dividing the atria, which close during pregnancy or soon after birth. However, a hole is formed if one of the openings does not close, leading to atrial septal defect.
Due to a hole in the heart, blood flows from left atrium to the right atrium and extra blood goes to the lungs.
When should you see a doctor?
Majority of atrial septal defect affected children are asymptomatic i.e. not having any symptoms. Only a few babies, especially in the first year of life, can show signs of heart failure if associated with other heart diseases.
It is possible that ASD will remain undetected until adulthood. The most common way to diagnose the condition is to have your doctor listen for a heart murmur while checking up with a stethoscope.
However, if ASD is not treated on time and progresses into adulthood then these problems can occur with time:
Diagnosis and Treatment-
If your doctor suspects your child of having Atrial Septal Defect, he/she will likely perform an X-ray or an ECG.
But for confirming the diagnosis, Pediatric Echocardiogram needs to be done from the chest of the child. This is a non-invasive test.
In bigger children or adolescents, sometimes echocardiogram from the chest is not possible as image quality is not good, in these cases; echocardiogram needs to be done from food pipe (esophagus) known as a transesophageal echocardiogram (TEE).
Treatment for ASD depends on – age of the child, size and location of the hole
There is no role of medications in ASD.
Paediatric cardiologist may recommend the following options –
1. Catheter Closure – Commonly known as ASD device closure (non-surgical closure of ASD by cardiac catheterization). This process involves positioning special devices called a septal occlude into the hole. The device prevents the flow of blood through the abnormal hole in the heart.
Only ostium secundum variety of ASD (OS-ASD) can be closed by this technique if ASD is having good margins around it.
Ideal time for closing the ASD is between 2-4 years of age.
2. Surgery – The surgeon may perform surgery to correct the defect if the hole has not closed by itself. The procedure is done under general anaesthesia. The surgeon sews the abnormal hole directly with a special patch or stitches. This needs to be done from the chest by open heart surgery. Other types of ASD like primum defect, sinus venosus defect closed by surgery.
Ideally, sinus venosus defects should be closed by 5 years of age.
Ostium primum defect if not associated with significant mitral regurgitation then should be closed by 2-4 years of age or else by 1-2 years of age.
All children diagnosed with an Atrial Septal Defect need special care under the guidance of a paediatric cardiologist.