Ventricular Septal Defect and its Treatments
What is a Ventricular Septal Defect?
Ventricular Septal Defect (VSD) is one of the most common congenital heart diseases which has a prevalence of 4 per 1000 live births. The interventricular septum consists of three primary anatomical parts, and VSDs can happen anywhere along any of the three parts. They are the septum of the atrioventricular (AV) canal, the muscular septum, the parietal band or the distal conal septum. The majority of clinically relevant VSDs are membrane-based.
A VSD can also develop over time as an acquired condition as a side effect of acute myocardial infarction, after aortic valve replacement surgery or through a catheter, after septal myectomy for hypertrophic cardiomyopathy, or as a result of erosion from a mitral valve bioprosthesis strut.
Clinical Context of VSD
The size of the defect determines the clinical appearance and natural history of isolated VSDs in children. Small VSDs are most frequently discovered when a murmur is heard, usually during a routine medical visit. The murmur, which can be either holosystolic or a blown high-pitched systolic murmur of varied length, is most audible near the mid to lower left sternal boundary. Small VSDs rarely exhibit symptoms and frequently close on their own.
Due to left atrial and ventricular volume overload, moderate VSDs with low pulmonary vascular resistance (PVR) typically appear with heart failure and poor development in infancy. Moderate defects shrink over time and occasionally close on their own. Patients may experience heart failure signs and symptoms in the meantime, which may necessitate medical attention.
Heart failure, feeding issues, and poor weight gain are early signs of large nonrestrictive VSDs with increased PVR. Examination results are comparable to those of newborns with mild abnormalities. Large defects may shrink in size, but they seldom close entirely.
Echocardiography, which may help pinpoint the defect’s location and gauge the shunt’s size, is used to confirm the diagnosis of VSD. The flow of colour Doppler is incredibly useful for identifying more subtle muscular defects. Just below the aortic valve, in the parasternal long axis echocardiographic image, are membrane abnormalities. Endocarditis, aortic regurgitation, subaortic stenosis, right ventricular obstruction, and left ventricular-to-right atrial shunting are complications that may develop in people with isolated VSDs
Treatments for VSD
The size of the defect, level of shunting, and likelihood of spontaneous closure all play major roles in VSD management. Usually, patients with moderate to significant abnormalities experience symptoms. Medical treatment for these people focuses on minimising the heart failure symptoms and effects. Throughout the first year of life, there should be frequent follow-ups. The intensity of the symptoms determines how frequently you will need to return.
Most patients who need VSD closure have primary patch surgical closure, which is linked to superior outcomes, whether compared to surgical to transcatheter closure (ie, low surgical mortality, low complication rates, and low reoperation rates). Patients with abnormalities that cannot be repaired surgically are typically the only ones who can have transcatheter closure (eg, multiple muscular defects that may be difficult to visualise at the time of surgery). Transcatheter VSD closure is a technically demanding procedure that should only be carried out in facilities with extensive experience and expertise in interventional catheterization procedures, as well as with surgical support2. Dr Ankur Phatarpekar and Dr Haresh Mehta are renowned interventional Cardiologists in Mumbai who are capable of doing these procedures. For more details please check the link to The Valve Clinic
When we consider all the facts mentioned above, we can conclude that there are several treatment modalities available for VSD depending on the severity and they have been successful up to now. New treatment methods are also introduced through the continuous improvement of knowledge about congenital heart disease.
- Isolated ventricular septal defects (VSDs) in infants and children: Anatomy, clinical features, and diagnosis – UpToDate. Accessed August 5, 2022. https://www.uptodate.com/contents/isolated-ventricular-septal-defects-vsds-in-infants-and-children-anatomy-clinical-features-and-diagnosis
- Management of isolated ventricular septal defects (VSDs) in infants and children – UpToDate. Accessed August 5, 2022. https://www.uptodate.com/contents/management-of-isolated-ventricular-septal-defects-vsds-in-infants-and-children