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Ventricular Septal Defect

Pediatric Patent Ductus Arteriosus Surgery India, Pediatric PDA Surgery, Atrial Septal Defect Repair

Ventricular septal defect (VSD) is a hole (defect) in the wall that separates the lower chambers of the heart. The lower chambers of the heart are called the ventricles. The wall between them is called the ventricular septum. In the normal heart, the septum prevents blood from flowing directly from one ventricle to the other. In a heart with a VSD, blood can flow directly between the two ventricles.

Types of VSD :

Doctors classify VSDs based on the:

Size of the defect.

Location of the defect.

Number of defects.

Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. It is harmless and can help a VSD close on its own. VSDs range in size from small to large.

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VSDs range in size from small to large.

Small VSDs usually allow only a small amount of blood flow between the ventricles. Because of this, they are sometimes called restrictive. Most small VSDs:

          o Do not cause symptoms in infants and children
          o Close on their own, often by school age
          o Rarely need surgery or other procedures to close the defect

Moderate (or medium-sized) VSDs are less likely than small defects to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.

Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle and are sometimes called nonrestrictive. A large VSD is less likely to close completely on its own, but it may get smaller. A large VSD can cause more symptoms in infants and children, and surgery is usually needed to close it.

VSDs are found in different parts of the septum.

Membranous VSDs are located near the heart valves. They can close at any time if a ventricular septal aneurysm is present.

Muscular VSDs are found in the lower part of the septum. They are surrounded by muscle, and most close on their own during early childhood.

Inlet VSDs are located close to where blood enters the heart. They are less common than membranous and muscular VSDs.

Outlet VSDs are found in the part of the ventricle where the blood leaves the heart. This is the rarest type of VSD.

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Symptoms :

The major signs and symptoms of ventricular septal defect (VSD) are:

Heart murmur
The signs and symptoms of congestive heart failure
Slowed growth

Most newborns with VSD do not have heart-related symptoms.

Heart Murmur :

A heart murmur is an extra or unusual sound heard during your heartbeat. It is usually present in VSD and may be the first and only sign found by your doctor. The heart murmur is often present right after birth in many infants, but it may not appear until the baby is 6 to 8 weeks old. Sometimes the heart murmur is not found until the child is older or much later in life as an adult.

Congestive Heart Failure :

A baby with a moderate or large VSD can develop congestive heart failure. These symptoms usually appear during the baby's first 2 months of life. Some older children and adults with VSD also may develop symptoms of congestive heart failure, which include:

Fatigue or tiring easily
Shortness of breath
Fast breathing
Slow growth and poor weight gain

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Diagnosis :

Ventricular septal defect (VSD) is diagnosed using a medical history, a physical exam, and tests. Your baby's doctor may see symptoms of VSD during a routine checkup. Some parents also notice signs, such as poor feeding, and bring the baby to the doctor.

Most cases are diagnosed in infancy and childhood. Babies born with a large VSD may have symptoms of congestive heart failure by the time they are 1 - 2 months old. They are usually diagnosed at that time. Some cases are not diagnosed until adulthood.

Tests :

Echocardiogram :

This test is harmless and painless. It uses sound waves to create a moving picture of your baby's heart. During an echocardiogram, reflected sound waves outline the heart's structure completely. The test allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. An echocardiogram is the most important test available to your baby's cardiologist to both diagnose a heart problem and follow the problem over time. With VSD, the echocardiogram shows exactly where the hole is located in the wall between the two lower heart chambers, how big the hole is, and whether the heart is overworking because of the defect. An echocardiogram also is used for a baby with VSD to make sure there are no other problems with the heart's structure.

Chest x ray :

This test takes a picture of the heart and lungs. It can show if the heart is enlarged or if there is fluid in the lungs.

EKG (electrocardiogram) :

This test measures the rate and regularity of your child's heartbeat. It provides an estimate of enlargement of the heart chambers and shows abnormal heart rhythms (arrhythmia).

Cardiac catheterization :

A thin, flexible tube (catheter) is passed through a blood vessel (artery or vein) to the heart. With the assistance of x rays, the doctor can see the child's blood vessels and heart. During the procedure, the doctor can measure blood pressure in the heart and arteries connected to the heart, and see how much blood is mixing between the two sides of the heart. Cardiac catheterization is rarely used for diagnosis unless the echocardiogram does not provide enough information or if other defects or problems are suspected.

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