About the disease
Ventricular septal defect is an inborn heart defect resulting in hole which appears between two opposite ventricles of the heart. Ventricular septal defect is the most frequent congenital heart disease among newborns. Parameters of the hole may vary from 1 or 2 mm to 1 cm. Quite often, ventricular septal defect can be combined with other heart defects. Ventricular septal defect usually forms during the first three or four months of pregnancy. When a child is being in the mother's womb, his blood circulation is carried out by the so-called circle of placenta. However, just right after the birth a newborn develops normal blood flow. If a baby has ventricular septal defect his blood plumps not only from the left ventricle part of the heart into the aorta, but also in the right ventricle, which normally should not be. Thus, baby has an abnormal discharge of blood from left ventricle to the right. This increases the load on the right ventricle of the heart. Also due to abnormal discharge of an additional volume of blood entering the vessels baby develops hypertension resulting in thickened process of the walls of arteries and increased blood pressure.
Usually ventricular septal defect (VSD) is caused by the genetic predisposition of the child. If his relatives had heart disease, it is very likely he can develop it as well. Ventricular septal defect can be acquired during the lifetime, but it happen rarely. A grown-up can develop septal defect if he had a heart attack and hole has formed in the region of the ventricular valve. Ventricular septal defect(VSD) can also be caused by negative environmental factors and by bad habits of pregnant mother, such as alcohol consumption, smoking and harmful dietary habits. It can also develop in combination with other common heart defects, such as valve stenosis. Usually women who already had ventricular septal defect repair and who had it earlier in their lives can get pregnant in case actual size of the opening in the heart was not too big and they were able to develop normally. Risk that their child will also have septal defect is high, however, if size is small, child will not have many complications or he can not have defect at all. If a women has an Eisenmenger syndrome, she is usually not advised to get pregnant, because it can harm baby.
Little defects of ventricular valve do not impose a significant impact on child's development and there are usually no symptoms. If defect is moderate already in the first 5-7 days after the birth there moderate murmur is present. This murmur is usually the only manifestation of muscular ventricular septal defect. In case defect is severe the symptoms of the disease usually occur not immediately after childbirth but 12 months later. Parents begin to have difficulties feeding the child: he has a shortness of breath, he needs to pause and breathe. Sometimes he can not get enough amount of food because of the problems with respiratory system and then he can develop anxiety. That`s why children with septal defect who were born with normal weight can lag behind in their physical development later due to malnutrition and a significant decrease in the large circle of blood circulation. Other symptoms that can appear at that time are:
- Blue coloration of skin
- Rapid breathing
Because of the constant cough child may develop recurrent pneumonia (pneumonia). With age the health and condition of many children improves.
- Electrocardiography (ECG) can not detect small-sized ventricular septal defect, because it has only several mm in its size. If the septal defect is significant, it can be reflected by electrocardiography. Electrocardiogram also reveals signs of increased muscle size of the left ventricle. Cardiac arrhythmias, which are easier to diagnose, occur infrequently, usually among adult patients.
- Phonocardiography can record the noise and murmur of the heart. Echocardiography, which is practically basic diagnostic methods for defects, can detect direct signs of birth defects right after the birth of the baby. It can also ascertain the location, number and size of defects.
- Thorough X-ray of heart and lungs determines pathological changes, which were caused by septal defect. During this subtype of defect lungs can become somewhat enlarged.
- Cardio catheterization measures cavity pressure in main artery and to determine the level of blood oxygen level.
If a patient has a little heart hole, there are usually no signs or symptoms of hypertension and complete failure of the heart. In that case it is possible to refrain from ventricular septal defect surgery.
- Patients need to undergo surgery if they experience fatigue, pneumonia, heart failure and if the parameter of the hole exceeds 1 cm. Operative intervention aims to reduce size of the hole. Operation is performed using a machine which is called heart-lung device. It can make a closure of the hole. Such type of surgery can be performed if an infant is older than 3 years, because this type of surgical incision can be dangerous. Open radical surgery is carried out in two main stages. First a surgeon places a special cuff on the artery, which increases overall resistance of the release of the right ventricle. After that a surgeon reduces size and parameter of the hole.
- Catheter procedure also reduces the size of the hole, but it is overall less invasive than open heart surgery.
- Septal defect repair is usually done during the first three or four years of life. It is very rare that this kind of operation is required after the first three months of baby`s life, because it does not often present a life-threatening complication and it develops slowly. that`s why children with ventricular septal defect vsd are often operated on when they are 5 or 6 years old, so the doctors are sure that their hearts will be able to stand and survive this kind of operation.