Indications for surgery in infancy include symptoms unresponsive to medication, elevated blood pressure in the lungs, and significant dilation of the heart due to excess blood flow. Usually the need for surgery in infancy becomes clear by months of age, and often much earlier. Less common indications for surgery are infection of heart tissue due to the VSD, or damage to the aortic valve secondary to the VSD. The first successful surgery to close a VSD was performed in by C.
Walton Lillehei and associates at the University of Minnesota. Since that time, surgical techniques and progress have improved tremendously. In this day and age, surgical closure of a VSD is generally considered a safe operation.
Because the hole created by a VSD is inside the heart, the heart must be drained of blood prior to any operation or manipulation. This requires the use of cardiopulmonary bypass. Cardiopulmonary bypass refers to the technique by which blood is diverted from the heart and lungs by a machine that subsequently removes carbon dioxide and supplies oxygen. This is especially important if you're taking medications. It's also important to see both an obstetrician and a cardiologist during pregnancy.
Having a repaired VSD without complications or having a small defect doesn't pose a large additional pregnancy risk. However, having an unrepaired, larger defect; heart failure; pulmonary hypertension; abnormal heart rhythms; or other heart defects poses a high risk to both mother and fetus. Doctors strongly advise women with Eisenmenger syndrome not to become pregnant because of the high risk of complications. Prevent endocarditis. You or your child usually won't need to take antibiotics before certain dental procedures to prevent an infection of the heart's inner lining endocarditis.
However, your doctor may recommend antibiotics if you've had prior endocarditis, a heart valve replacement, if you have had a recent VSD repair with artificial material, if you still have leaks through the VSD , if the repaired VSD is next to a defect that's been repaired with artificial material, or if you have a large ventricular septal defect that's causing low oxygen levels.
For most people with a ventricular septal defect, good oral hygiene and regular dental checkups can prevent endocarditis. Follow exercise recommendations. Your doctor can advise you about which activities are safe for you or your child. If some activities pose special dangers, encourage your child to engage in other, safer activities. Keep in mind that many children with VSDs can lead healthy, fully active, productive lives.
Children with small defects or a repaired hole in the heart will usually have few or no restrictions on activity or exercise. Children whose hearts don't pump as normally will need to follow some limits. A child with irreversible pulmonary hypertension Eisenmenger syndrome has the greatest number of restrictions.
Consider joining a support group for families of children born with heart defects. Support groups can help parents, families and caregivers find answers, connect with other families, and share their hopes and concerns with others facing similar challenges.
If you or your child develops signs and symptoms common to ventricular septal defect, call your doctor. After an initial examination, it's likely that the doctor will refer you or your child to a doctor who specializes in the diagnosis and treatment of heart conditions cardiologist.
When signs and symptoms do occur, heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat. Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they're harmless or signs of heart problems.
Over time, if a large ASD isn't repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This doesn't occur until adulthood. Signs and symptoms of heart failure include:. A heart murmur usually is present in ventricular septal defect VSD , and it may be the first and only sign of this defect.
Heart murmurs often are present right after birth in many infants. However, the murmurs may not be heard until the babies are 6 to 8 weeks old. Most newborns who have VSDs don't have heart-related symptoms.
However, babies who have medium or large VSDs can develop heart failure. Signs and symptoms of heart failure usually occur during the baby's first 2 months of life. The signs and symptoms of heart failure from VSD are similar to those listed above for ASD, but they occur in infancy. A major sign of heart failure in infancy is difficulty feeding and poor growth. VSD signs and symptoms are rare after infancy because the defect either decreases in size on its own or is repaired.
Doctors usually diagnose holes in the heart based on results from a physical exam and tests and procedures.
The exam findings for an atrial septal defect ASD often aren't obvious, so the diagnosis sometimes isn't made until later childhood or even adulthood. Ventricular septal defects VSDs have a very distinct heart murmur , so a diagnosis usually is made in infancy. Doctors who specialize in diagnosing and treating heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Cardiac surgeons repair heart defects using surgery.
During a physical exam, your child's doctor will listen to your child's heart and lungs with a stethoscope.
The doctor also will look for signs of a heart defect, such as a heart murmur or signs of heart failure. These tests also will help the doctor determine the location and size of the defect. Echocardiography echo is a painless test that uses sound waves to create a moving picture of the heart.
During the test, the sound waves called ultrasound bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen. Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echo is an important test for both diagnosing a hole in the heart and following the problem over time. Echo can show problems with the heart's structure and how the heart is reacting to the problems. Echo will help your child's cardiologist decide whether and when treatment is needed.
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm steady or irregular. It also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can detect whether one of the heart's chambers is enlarged, which can help diagnose a heart problem. A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs.
This test can show whether the heart is enlarged or whether the lungs have extra blood flow or extra fluid, a sign of heart failure. Pulse oximetry shows how much oxygen is in the blood. For this test, a small sensor is attached to a finger or toe like an adhesive bandage. The sensor gives an estimate of how much oxygen is in the blood. During cardiac catheterization KATH-e-ter-i-ZA-shun , a thin, flexible tube called a catheter is put into a vein in the arm, groin upper thigh , or neck and threaded to the heart.
Special dye is injected through the catheter into a blood vessel or a chamber of the heart. The dye allows the doctor to see the flow of blood through the heart and blood vessels on an x-ray image.
The doctor also can use cardiac catheterization to measure the pressure inside the heart chambers and blood vessels. This can help the doctor determine whether blood is mixing between the two sides of the heart. Cardiac catheterization also is used to repair some heart defects. Many holes in the heart don't need treatment, but some do.
Most holes in the heart that need treatment are repaired in infancy or early childhood. Sometimes, adults are treated for holes in the heart if problems develop. The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health. Periodic checkups are done to see whether an atrial septal defect ASD closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life.
Your child's doctor will let you know how often your child should have checkups. For an ASD, frequent checkups aren't needed. When treatment of an ASD is required, it involves catheter or surgical procedures to close the hole. Doctors often decide to close an ASD in children who still have medium to large holes by the time they're 2 to 5 years old.
The higher pressure can lead to decreased oxygen levels in the body. It can prevent long-term damage to the lungs. Healthcare providers often do the surgery in infants or children. Sometimes adults also need this type of repair if their VSD was not found during childhood.
Surgery is still the standard of care. But a minimally invasive procedure using cardiac catheterization may be an option to fix the VSD for some children. This approach uses a long, flexible tube catheter inserted through a blood vessel in the groin instead of open heart surgery. This is a newer method that may have a higher rate of complication.
But it may also lead to faster recovery times than surgery. Most children do well with VSD surgery. But complications do sometimes occur. Specific risk factors may vary based on age, the size of the defect, and other health problems. Possible risks include:. Late complications are also possible. But they are rare. These might include problems with the heart valves. Very rarely, the patch used to fix the defect might become loose.
Then another surgery will be needed. Have your child follow any directions for not eating or drinking before the surgery. Your child may also need to stop taking any medicine beforehand. These might include:. In general:. Your child will be given anesthesia before the surgery starts.
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