VENTRICULAR SEPTAL DEFECT
Dr Ira Shah
Editor - Pediatric Oncall
What is ventricular septal defect?
The heart consists of 4 chambers, right atrium that receives oxygen poor blood from the body, right ventricle that receives blood from right atrium and pumps it through the pulmonary artery to the lungs to get oxygen; left atrium that receives oxygen rich blood from the lungs and left ventricle that receives blood from left atrium and then pumps it through the aorta to the rest of the body. In ventricular septal defect, there is a hole between the two ventricles that lets blood pass from the left ventricle to the right ventricle. Thus, less amount of blood flows into the aorta and into the body. Extra amount of blood goes into the lungs and heart has to pump extra to accommodate that extra blood that comes to the left atrium and to maintain regular blood supply to rest of the body.
What are the symptoms of ventricular septal defect (VSD)?
In VSD, since more blood goes into the lungs, lungs have to work more and thus child may have breathlessness. Since more blood comes into left atrium and then left ventricle, the left atrium and ventricle enlarge. Also since right ventricle also receives more blood, right ventricle also enlarges. The child will have an enlarged heart which may not work well. On exertion, breathlessness increases. The body tries to compensate by increasing the pressure in the pulmonary artery (pulmonary hypertension) to decrease the amount of blood entering into the lungs. If the pulmonary pressures become too high, then the blood would flow from right side of the heart to the left with mixing of oxygen poor blood with oxygen rich blood and causing bluish discoloration of the skin. This is known as Eisenmenger’s complex.
Do all children with VSD develop Eisenmenger’s complex?
No, all children with VSD do not develop Eisenmenger’s complex. It is only those in whom pulmonary pressures are high which is commonly seen with large holes.
What is the treatment of VSD?
If the hole is small, it may not strain the heart and often it may close spontaneously so no treatment may be required. If the hole is larger, then surgery to close the hole is required to prevent heart failure and Eisenmenger’s complex. Till surgery is done, drugs that improve function of the heart such as furosemide, captopril or enalapril may be prescribed by your doctor. The most common operation done is placing a patch over the hole.
Why are children with VSD more prone to pneumonia?
In patients with VSD, since blood supply to the lungs is more, thus there is more fluid in lungs. This fluid becomes a source for the germs in the air that we breathe in, a good breeding ground to grow and infect the lungs and thus pneumonia.
After surgery, how do patients with VSD do?
The long term outlook is good. However long term follow up with cardiologist is advocated.
created on 1-08-2010
updated on 1-08-2010