Treatment for ventricular septal defect
Specific treatment for VSD will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of the disease
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Small ventricular septal defects may close spontaneously as your child grows. A larger VSD usually requires surgical repair. Regardless of the type, once a ventricular septal defect is diagnosed, your child's cardiologist will evaluate your child periodically to see whether it is closing on its own. A VSD will be repaired if it has not closed on its own to prevent lung problems that will develop from long-time exposure to extra blood flow. Treatment may include:
Medical management. Some children have no symptoms, and require no medication. However, some children may need to take medications to help the heart work better, since the right side may be under strain from the extra blood passing through the VSD. Medications that may be prescribed include the following:
Digoxin. A medication that helps strengthen the heart muscle, enabling it to pump more efficiently.
Diuretics. The body's water balance can be affected when the heart is not working as well as it could. These medications help the kidneys remove excess fluid from the body.
ACE inhibitors. Medications that lower the blood pressure in the body, making it easier for the blood to be pumped from the left ventricle into the body (because of its lowered blood pressure) rather than that blood being pumped from the left ventricle across the VSD into the right ventricle then into the lungs.
Adequate nutrition. Infants with a larger VSD may become tired when feeding, and are not able to eat enough to gain weight. Options that can be used to ensure your baby will have adequate nutrition include the following:
High-calorie formula or breast milk. Special nutritional supplements may be added to formula or pumped breast milk that increase the number of calories in each ounce, thereby allowing your baby to drink less and still consume enough calories to grow properly.
Supplemental tube feedings. Feedings given through a small, flexible tube that passes through the nose, down the esophagus, and into the stomach, can either supplement or take the place of bottle feedings. Infants who can drink part of their bottle, but not all, may be fed the remainder through the feeding tube. Infants who are too tired to bottle feed may receive their formula or breast milk through the feeding tube alone.
Surgical repair. The goal is to repair the septal opening before the lungs become diseased from too much blood flow and pressure. Your child's cardiologist will recommend when the repair should be performed based on echocardiogram and (less commonly) cardiac catheterization results.
The operation is performed under general anesthesia. Depending on the size of the heart defect and your doctor's recommendations, the ventricular septal defect will be closed with stitches or a special patch. Consult your child's cardiologist for more information.
Interventional cardiac catheterization. In certain circumstances, your child's VSD may be repaired by a cardiac catheterization procedure. One method currently being used to close some small muscular VSDs is the use of a device called a septal occluder. During this procedure, the child is sedated and a small, thin flexible tube is inserted into a blood vessel in the groin and guided into the heart. Once the catheter is in the heart, the cardiologist will pass the septal occluder across the VSD. The septal occluder closes the ventricular septal defect providing a permanent seal.
Postoperative care for your child
In most cases, children will spend time in the intensive care unit (ICU) after a VSD repair. During the first several hours after surgery, your child will most likely be drowsy from the anesthesia that was used during the operation, and from medications given to relax him or her and to help with pain. As time goes by, your child will become more alert.
While your child is in the ICU, special equipment will be used to help him or her recover, and may include the following:
Ventilator. A machine that helps your child breathe while he or she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he or she is too sleepy to breathe effectively on his or her own. Many children have the ventilator tube removed right after surgery, but some other children will benefit from remaining on the ventilator for a few hours afterwards so they can rest.
Intravenous (IV) catheters. Small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medications that help your child recover from the operation.
Arterial line. A specialized IV placed in the wrist, or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU.
Nasogastric (NG) tube. A small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery.
Urinary catheter. A small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys remove excess fluids from the body.
Chest tube. A drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours, or even a few days after surgery.
Heart monitor. A machine that constantly displays a picture of your child's heart rhythm, and monitors heart rate, arterial blood pressure, and other values.
Your child may need other equipment not mentioned here to provide support while in the ICU, or afterwards. The hospital staff will explain all of the necessary equipment to you.
Your child will be kept as comfortable as possible with several different medications; some of which relieve pain, and some of which relieve anxiety. The staff may also ask for your input as to how best to soothe and comfort your child.
After discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while, and these will be explained to you. The staff will give you written instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged.
Care for your child at home following VSD repair
Most infants and older children feel fairly comfortable when they go home. Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable. Your child's doctor will discuss pain control before your child is discharged from the hospital.
Often, infants who fed poorly prior to surgery have more energy after the recuperation period, and begin to eat better and gain weight faster.
After surgery, older children usually have a fair tolerance for activity. For a short period of time, your child may become tired quicker than before surgery, but usually will be allowed to play with supervision, while avoiding blows to the chest that might cause injury to the incision or breastbone. Within a few weeks, your child should be fully recovered and able to participate in normal activity.
You may receive additional instructions from your child's doctors and the hospital staff.
Long-term outlook after VSD repair
Most children who have had a ventricular septal defect repair will live normal, healthy lives. Activity levels, appetite, and growth will return to normal in most children. Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis for a specific time period after discharge from the hospital.
Outcomes also depend on the type of VSD, as well as how early in life the VSD was diagnosed and whether or not it was repaired. With early diagnosis and repair of a VSD, the outcome is generally excellent, and minimal follow-up is necessary. When a VSD is diagnosed later in life, if complications occur after surgical closure, or the VSD is never repaired, the outlook may be poor. There is a risk for developing irreversible pulmonary hypertension (high blood pressure in the blood vessels of the lungs) or Eisenmenger’s syndrome. These individuals should receive follow-up care at a center that specializes in congenital heart disease.
Consult your child's doctor regarding the specific outlook for your child.