Ventricular septal defect (VSD) is the most common type of congenital cardiac abnormality that affects children. It is also the second most common congenital abnormality in adults, after bicuspid aortic valve defect.
A Ventricular septal defect is a condition in which there is a hole in the septum (wall) that separates the right and left ventricles (lower chambers) of the heart. Usually, the septal wall prevents the blood from two ventricles from mixing. With VSD, the hole in the septum allows the oxygen-rich blood from the left chamber to flow into the right side of the heart. The blood with high oxygen then gets pumped into the lungs, rather than out to the vital organs of the body. This causes the heart and lungs to work harder.
Ventricular septal defects can be classified into different types: membranous, perimembranous, supracristal (infundibular or subpulmonic), and muscular.
- Membranous VSD is known to be the most common type of ventricular septal defect by far. It accounts for almost 80% of all errors. This type of VSD found in the upper section of the ventricle, and It lies just below the aortic valve and tricuspid valve septal leaflet. Membranous VSD can extend into the inlet or muscular septum, which may undergo closure either by tricuspid septal leaflet tissue or prolapse of an aortic cusp. When the defect involves muscular septum, it is also commonly known as perimembranous.
Other VSDs And Their Prevalence –
Also known as infundibular or outlet type VDS. It occurs in the outlet septum of the right ventricle, below the aortic and pulmonary valves (semilunar valves). It is the most uncommon type of VSD and accounts for only 6% of all VSDs. However, within the Asian population, it accounts for approximately 30%. The chances of aortic valve prolapse and regurgitation are more common in this as there is a lack of support of the right and the noncoronary cusps of the aortic valve. Supracristal VSDs defects usually do not close spontaneously.
Inlet Or Atrioventricular VSD:
This septal defect is located near to where the blood enters the ventricles through the tricuspid and mitral valves. It is just below the inlet valves (tricuspid and mitral) in the inlet port of the septum of right ventricular. Inlet VSDs only accounts for 8% of all defects. It is usually seen in patients with Down syndrome.
Also called trabecular VSD. The hole is located in the muscular septum of the heart. The area is usually bordered by muscle in the apical, central, and outlet parts of the interventricular septum. It does not involve the cardiac valve. The defects/holes can be many, having a Swiss cheese-like appearance. They account for up to 20% of VSDs in children. The incidence rate is lower in adults as they tend to close spontaneously.
A Gerbode defect is also a subtype of the ventricular septal defect, although this causes a left ventricular to right atrial shunt.
How Does The VSD Affect A Person?
In children, a large opening in the septal wall can cause difficulties in breathing, and therefore, many children with VSD are recommended for surgery to close the defect.
The infants with large septal openings may have the following symptoms:
- Heavy or fast breathing
- Weight gain is poor
However, large VSDs in adults are not as common, but affected people experience shortness of breath. Mostly, adults have small VSDs that usually do not present symptoms as the heart and lungs are not required to work harder. But even small VSDs can occasionally lead to infection in the center, known as endocarditis. Under physical examination, a loud heart murmur (whooshing sound) can be detected in cases of small VSDs.
A small VSD opening is likely to close on its own and does not need medical intervention. Medium to large VSDs can lead to serious health problems in children, and treatment is required to manage the condition.
Several hospitals in India offer highly effective and successful VSD treatment to children and adults. The country is a medical hub, attracts several patients from all around the world to avail of the country’s high standard medical care facilities. The highly affordable cost of VSD surgery in India brings the hope of a better life for many children and their families.
The methods To Treat A VSD Are Following:
The doctor prescribes medicines to manage the symptoms and not close the opening. These include medicines to:
Lower The Amount Of Fluid In The Lungs And Circulation:
Drugs, called diuretics, such as furosemide (Lasix), are given to reduce the volume of blood that is to be pumped.
Maintain Regular Heartbeat:
Medications such as beta-blockers, including metoprolol (Lopressor), propranolol (Inderal LA), and digoxin (Lanoxin, Lanoxin Pediatric), are used for this.
Surgical Treatment For VSD Treatment:
This involves plugging or patching the opening in the septum between the ventricles. Specialists, including cardiologists, cardiovascular surgeons, and others, perform the procedure. Depending on the size of VSD, symptoms presented, and overall health, the options for surgical treatment of VSD include cardiac catheterization or open-heart surgery.