Ventricular Septal Defect (VSD) Treatment

Ventricular Septal Defect (VSD) is one of the most common congenital (present at birth) heart defects that affects the septum characterized by an abnormal opening in the septum, the wall that separates the left and right ventricles (chambers) of the heart allowing blood to pass from the left to the right ventricle, mixing oxygen-rich and oxygen-poor blood.  

Treatment for Ventricular Septal Defect in Cuba is either through minimally invasive catheter-based techniques or traditional surgery based on the size and location of the defect, the presence of symptoms, and the age and overall health of the patient. The benefits of VSD closure are significant, particularly in preventing long-term complications such as: 

• Heart overload and failure 
• Pulmonary hypertension  
• Arrhythmias  
• Endocarditis 
• Growth and development issues in children 
• Progressive heart damage and increased risk of stroke in adults 

Types of Ventricular Septal Defect  

Ventricular Septal Defect can vary in size and location within the septum, leading to different types of VSDs. Typically, VSD is classified as: 

• Perimembranous VSD: This is the most common type of VSD, located in the upper part of the ventricular septum, near the heart valves. This defect involves an opening in the membranous portion of the septum, which can lead to blood flow from the left to the right ventricle. When small, perimembranous VSDs may close spontaneously, larger defects can be associated with aortic valve prolapse, where the aortic valve leaflet protrudes through the VSD. 

• Muscular VSD: This type of VSD can occur anywhere in the muscular part of the septum, which is the lower, thicker part of the ventricular wall and can be single or multiple 

• Inlet (AV Canal) VSD: Also known as AV Canal VSD, this type of VSD is located near the atrioventricular (AV) valves, where blood flows from the upper chambers (atria) to the lower chambers (ventricles) of the heart. This defect is often associated with other congenital heart conditions, such as atrioventricular septal defects (AVSD) or Down syndrome. 

• Outlet VSD: also known as Supracristal, Conal, or Subarterial VSD, this type of VSD is a less common type of heart defect that is located in the upper part of the ventricular septum, just below the pulmonary and aortic valves. Outlet VSD can lead to complications such as aortic valve prolapse and regurgitation, where the aortic valve does not close properly and allows blood to flow backward into the heart.  

• Gerbode VSD: This is a very rare type of heart defect where there is an abnormal opening between the left ventricle and the right atrium, rather than between the left and right ventricles. This defect involves a direct communication that allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right atrium, leading to inefficient circulation.  

Causes 

Ventricular Septal Defect (VSD) can result from a variety of genetic and environmental factors, as well as developmental issues during fetal growth.  

• Genetic predispositions, such as inherited conditions or gene mutation can be a leading factor in developing VSD.  

• Environmental factors, such as maternal infections, diabetes, or exposure to certain medications, drugs, or alcohol during pregnancy, can also be associated with a higher risk for the development of this condition.   

• Disruption in embryonic development can lead to incomplete septal formation. 

Symptoms  

Many individuals with secundum VSD may remain asymptomatic, however, if the defect is large, it can cause symptoms such as: 

• Shortness of Breath 
• Heart Murmur 
• Poor Weight Gain 
• Frequent Respiratory Infections 
• Fatigue:
  This condition can lead to significant hemodynamic consequences, impacting the heart’s efficiency and the patient’s overall health 

Diagnosis 

VSD is often diagnosed during a routine physical exam or when symptoms lead to further medical investigation. Diagnostic tests include: 

• Echocardiogram: This is an essential, non-invasive test that uses ultrasound waves to create in-depth images of the structure and function of the heart chambers and valves. This test can show the size and location of the VSD as well as any potential effects on the heart, like increased blood flow or enlarged heart chambers.  

• Electrocardiogram (ECG): This test records the electrical activity of the heart and can help identify abnormalities. 

• Chest X-ray: Chest X-rays provide a clear picture of the heart and lungs and can reveal complications related to Ventricular Septal Defect 

• Cardiac MRI: Cardiac MRI provides highly detailed images of the heart’s structure, and can accurately determine the size, location, and severity of a VSD. MRI images can also provide comprehensive information about the defect and its impact on the heart and surrounding vessels. It is particularly useful for complex cases or when other imaging methods are inconclusive. 

Treatment Options 

Treatment for VSD varies and is dependent on a number of factors including the defect’s size and location, the presence of symptoms, and the patient’s age and overall health. Small VSDs that do not display symptoms may only require regular monitoring since for some patients, they can close on their own. For larger or symptomatic VSDs, treatment options include minimally invasive catheter-based procedures or traditional open-heart surgery.   

Minimally invasive Closure 

Cardiac catheterization, also known as transcatheter closure, is a non-surgical, minimally invasive method whereby a catheter is inserted into a vein, usually in the groin or arm and then guided to the heart. A specialized closure device is then passed through the catheter and placed over the VSD. Once the device is in position, it expands to seal the defect. With time, heart tissue grows around it, permanently closing the opening. 

Surgical Closure 

Surgical treatment for Ventricular Septal Defect is performed mainly for larger or more complex defects or defects that are not suitable for transcatheter closure. This procedure involves open-heart surgery under general anesthesia whereby the heart is temporarily stopped, and a heart-lung machine takes over the circulation of blood and oxygen. The heart is accessed through an incision in the chest and the defect is repaired by sewing a patch made of synthetic material or from the patient’s own tissue over the hole or by stitching the edges of the defect together. After the repair, the heart is restarted, and the incision is closed. 

Recovery from open heart surgery requires several weeks of hospital stay for recovery and recuperation. While the procedure is more invasive than catheter-based methods, it is highly effective and provides a permanent solution for repairing the defect.