Cardiac heart surgery in Thailand
Treatment of Septal Defect in Thailand
Heart and It's function
How is a VSD diagnosed?
The diagnosis of a VSD is usually suspected clinically by the doctor by hearing a characteristic heart murmur. A abnormally turbulent flow of blood through the heart generates this murmur sound. Blood is shunted through the VSD from the higher-pressure left ventricle into the lower-pressure right ventricle which generates this sound. If your doctor notices a heart murmur that was not noticed earlier, you may be referred to a pediatric cardiologist( a doctor who specializes in diagnosing and treating heart disease in kids and teens.) In addition to a physical examination the doctor will also note the medical history of the patient like past health, family health, any medications you are taking, any allergies you may have, and other issues. If the cardiologist thinks a person might have a VSD, he or she may order one or more of the following tests to confirm it like ..
If a doctor diagnoses someone with a VSD, treatment will depend on age, the size of the hole, and where it's located in the heart.
What are the Treatments for Ventricular septal defect(VSD)?
If the VSD is small
If the defects are small say less than 0.5 square cm which is quiet common, there is no reasons to worry. This is because, as there is minimal shunting of blood and the pressure in the right ventricle remains normal. There will be no damage to the lung arterioles, since the right ventricular pressure is normal. The heart functions normally, but a prominent murmur is heard through a stethoscope. This murmur is generally noticed during the first week of life.
One-third to one-half of all small VSDs close on its own as the child grows. This occurs most often before the child is 1 year old to almost 4 years old, generally 75% of child with small VSDs are cured by 2 years of age. Even if a small VSD does not close on its own, surgical repair is gererally not recommended. However, long-term follow-up is adviced.
If the VSD is large
If the VSD is large generally greater than 1 sqaure cm, then there is a reason to worry. This is because there is a significant shunting of blood from the left ventricle into the right ventricle. The right ventricle is strained by the extra blood volume and thus the lungs suffers with an increase in the blood pressure called "pulmonary hypertension." The symptoms in the child are labored breathing, difficulty feeding, grow poorly, and have pallor.
The patient with a large VSD will need surgery to "patch the hole" in the ventricular septum. The timing of the surgery is an personal decision depending upon many factors. Like
A) The duration and the extent of increased pulmonary artery pressure. Chronic pulmonary arteriolar pressure may become irreversible and put a strain on the right ventricle. However, such side effects can be treated with medications until surgery is appropriate.
B) A child with a large VSD often suffers from poor growth. The increased metabolic demands requires additional calories as compared to children without such a cardiac defect. High-calorie dense supplements are added to formula. Nighttime continuous feedings is required for some infants. This is done by using a tube that is passed through the nose to the stomach known as nasogastic tube to maximize growth. However this is very rare case, so as to restrict fluid volumes in these children.
C) Infants with iron-deficiency anemia are given iron supplements to maximize the oxygen carrying capacity of their blood. Blood transfusions to solve such a case are rare.
What are the Types of surgery are available to cure a VSD?
Surgery is indicated if medications do not work in the first few months or years of life. However, there are two types of surgery available to cure a VSD. They are
1. The intra-cardiac technique
2. The trans-catheter technique.
Which surgical technique will be selected is a very personal decision based upon the condition of the VSD and the added side effects on the patient's heart and lungs. However, the intra-cardiac approach is the most common technique. It is an open-heart operation. It is done keeping the patient is under a "heart-lung machine". This is the procedure selected for most children and at most pediatric surgical centers. The other technique uses surgical instruments which are passed through catheters placed in the patient's large blood vessels into the heart. This technique that is the "trans-catheter approach" is generally more difficult and should only be operated on select patients and at pediatric centers that have specialist in this very procedure.
Surgery is not usually performed in newborns because small defects will close on its own in 20-25%. The surgery also is more risky in the first few months of life. It is to be noted that the risk of death from the operation is higher in the first 6 months of life than later.
What is the result after a successful VSD surgery?
After a successful surgical VSD repair, the two ventricles are entirely separate from each other and there is a normal circulation of the blood within the heart. The heart will return toward its normal size if it was enlarged. The high pressure in the pulmonary artery should also begin to resolve. The growth rate in the child will increase and the child generally catches up within a year or two. Long-term follow-up like regular doctor's office visits, echocardiograms and regular check of child's weight and length/height are required. Feeding and activity levels should be assessed routinely.VSD (repaired or not) needs to take antibiotics before dental procedures, including cleaning and other dental care, and before surgical procedures on the mouth or throat.
What are complications of VSD surgery?
There are very rare complications with intra-cardiac VSD surgery. Studies reveals that currently, if the VSD is the only defect present in the patients heart, then in most centers the operative mortality rate is less than 1%. Major complications are rare that is 1%-2%, which include heart rhythm problems and incomplete closure of the VSD. In very rare cases, a pacemaker insertion or a second procedure to resolve the defect are needed. However, some cases with multiple VSDs ("Swiss cheese" defects) are also harder to treat.
VSD generally has an excellent long-term outlook
For other heart surgery and treatment options visit:-
Heart Valve Surgery