Treatment of ventricular septal defect abroad
Ventricular septal defect (VSD) is the most common type of congenital heart defect. It is characterized by one or more holes located between the left and right ventricles.
VSD as it is commonly known, is the most frequent congenital heart disease, constituting 30-35% of the total number of cases.
Causes of Ventricular septal defect
Ventricular septal defect is formed during a child’s fetal development. The direct cause is not known. Some risk factors are established:
- Heredity (about 3% of patients with VSD have relatives with history of the disease in the family)
- Prematurity (term infants have with a frequency of 2-3 cases per 1,000 live births, and preterm - 5-6 cases in every 1000 births)
- Some diseases of the mother (diabetes, alcoholism, systemic pathologies of the connective tissue)
- Viral infections during the pregnancy
- First pregnancy after 38 years old
- Drug usage during the first trimester (ibuprofen, indomethacin, some antihypertensives)
Ventricular septal defect - Symptoms
Severity of the symptoms depends on the kind of ventricular septal defect. Depending on the location the ventricular septal defect can be:
- Perimembranous (80% of cases)
Due to the size a restrictive,less than the diameter of aorta, and non-restrictive septal defect, equal or bigger than the diameter of aorta, are distinguished.
If VSD is small in size, there are almost no symptoms. The systolic noise is possible at the apex. Children don’t lag behind in development, heart borders are not beyond the age norms.
Severe VSD symptoms for the newborns:
- Shortness of breath. First seen while breast feeding or anxiety, and then in a state of rest.
- The lag in physical development is observed among 70% of patients. Moreover, in 30% of cases second degree malnutrition is observed.
- Heart hump is formed in the early months of life and located in the centre of the chest.
- Ripple is determined and visually observed at the site of the gastric projection.
- Heart boundaries expanded upward and to the side.
- While auscultation systolic noise is heard.
- Tachycardia (increased heart rate beyond age norms).
Children with VSD over the age of 1 year have gradually decreasing symptoms. There is a phase of compensation when tachycardia and shortness of breath go away and children develop according to the age norms.
Clinical signs of VSD for older children:
- 60-65% observed having heart hump
- Apical impulse may be strengthened
- Heart borders expanded
When listening to the heart auscultation a number of symptoms can be identified (Graham-Still noise, Flint’s noise, systolic noise in the third intercostal space left to the sternum).
Ventricular septal defect - Diagnostics
The main methods of diagnosing VSD are an electrocardiogram (ECG) and echocardiography (echocardiography is an ultrasound of the heart).
ECG enables a doctor to suspect a child ventricular septal defect based on the detection of signs of hypertrophy (increase) of the left ventricle. With long-term course of the disease, right ventricle hypertrophy can also occur. With low ventricular septal defect ECG might not detect any change.
Echocardiography. Ultrasonic Doppler sonography can visualize the VSD and identify its location, moreover it can also define the pressure in the left and right ventricles. With the help of an ultrasound the doctor is able to detect other heart defects that can develop simultaneously with ventricular septal defect.
MRI is a lookup method. It is used when there is a suspicion of the VSD, but this disease cannot be detected by using echocardiography.
Chest X-ray is a helper method as it reveals indirect signs of VSD: cardiomegaly (enlarged heart), and increased pulmonary pattern.
Treatment of Ventricular septal defect abroad
Surgery is the main treatment for VSD. Treatment tactics for the patients with VSD are as follows:
- For children with pulmonary hypertension (pulmonary artery pressure greater than 50% from the systemic) and symptoms of congestive heart failure, that are not amenable to drug therapy, surgery is performed in a short time before the age of 3 months.
- For children with symptoms of heart failure and pulmonary hypertension, that can be improved by the use of the medical treatment, the surgery is performed later at around the age of 6 months.
- For children with a small VSD (pulmonary artery pressure less than 50% from the systemic) who are experiencing congestive heart failure symptoms the conservative treatment of up to 5 years is used. Then, if the hole is not closed by itself (this occurs in 30-50% of cases), the operation is performed.
- For children with a small VSD without symptoms of chronic heart failure the conservative treatment is not appointed, but at the age of 5 years the operation has to be performed to eliminate the defect.
Conservative therapy (diuretics, cardiac glycosides) is assigned for the symptomatic treatment of heart failure prior to surgery, or chronic treatment if the surgery is contraindicated.
Children who fall behind in physical development in the first year of life have to be given a high-calorie nutrient mixture that will allow them to gain weight steadily.
Surgery is done in different ways, choice of which is made on the basis of the VSD size and location and clinic’s possibilities.
- Plastic reconstruction of the ventricular septal defect is carried out using a heart-lung machine and the small defects are sutured. To close the medium and large defects, patches of synthetic materials or own pericardium is used.
- Transcatheter VSD plastic is an endovascular surgery held without artificial cardiopulmonary bypass. The occluder that will close the defect is introduced using a catheter through the blood vessel trunk.
Ventricular septal defect - Prognosis
Prognosis depends on the size and location of VSD. Small defects often close by themselves during the first year of life. But even if this does not happen, people can live quite long and active life even without surgical intervention.
With a significant VSD there is a poor prognosis as the child may die in the first months of life because of the increasing risk of heart failure.
The consequence of untreated defect can lead to other complications for older children or adults:
- Bacterial septal endocarditis
- Stenosis of the pulmonary artery
- Recurring respiratory tract infections
- Congestive heart failure
Life expectancy without treatment with a small VSD is about 60 years, medium size defect is about 20-30 years.
Large defect leads to the death of 2/3 of the patients under the age of 1 year of age, if the surgery has not been performed in time.
Women who have VSD are advised to not fall pregnant, as it can be life threatening.
If the surgical treatment of VSD is performed there is a favourable prognosis. The length and quality of life are the same as for a healthy person.