Septal Defect Repair


What is a ventricular septal defect (VSD)?
A ventricular septal defect (VSD) is an abnormal opening between the left and right lower heart chambers (ventricles). The opening is in the wall (septum) between the two ventricles. With each heart contraction, the higher blood pressure in the left ventricle allows blood to flow from the left ventricle to the right ventricle where it must be repumped through the lungs. Septal defects vary in size and in the symptoms they produce.

How does it occur?
A VSD is the most common heart defect present at birth. It often occurs as a single defect with no known cause, but is also found in children with multiple problems.

About one in three children with a heart abnormality discovered at birth has a VSD. VSDs account for one in five heart abnormalities found during childhood and for one in 10 found in adults.

A VSD may occur when a heart attack weakens the muscle of the septum. Blood pressure in the left ventricle breaks open the weakened septum, pushing blood into the right ventricle through the new opening. Rarely, trauma to the heart may cause a VSD.

What are the symptoms?
A small VSD usually causes no problems. A large VSD in small children can lead to severe heart failure, a condition in which the heart cannot do its proper job as a pump.

If the opening is small, it does not stress the heart. The only symptom is a heart murmur, a sound your doctor can hear through a stethoscope.

Even if the defect is large, symptoms often do not occur for several weeks after birth. Some babies with a large VSD do not grow normally and may become undernourished. Other symptoms include sweating, increased breathing rate, and frequent lung infections.

A VSD that results from a heart attack is very serious. The heart muscle, weakened by the heart attack, must now also repump blood through the lungs. Sudden congestive heart failure often results in death. Shortness of breath, fluid in the lungs and other body tissues, and low blood pressure are common symptoms.

How is it diagnosed?
Your doctor is usually able to hear the heart murmur of a VSD through a stethoscope. A chest x-ray may show that the heart is slightly larger than normal and that there is more blood flow through the lungs.

A test called an echocardiogram uses sound waves to make pictures of the heart. Doppler ultrasound, a special type of echocardiogram, outlines flowing blood, shows the location of the VSD, and can help your doctor determine the size of the VSD. The echocardiogram also indicates whether there is increased blood pressure in the lungs.

A test called cardiac catheterization may be used to confirm the diagnosis and to be sure there are no other heart problems.

How is it treated?
Small VSDs may close on their own during the first years of childhood. The smaller the defect, the more likely it is to close on its own. But no one can predict which defects will close and which will not. A small VSD usually does not cause any problems and seldom requires treatment. People with a small VSD may lead normal lives.

However, a small VSD may serve as a location for bacterial endocarditis, an infection of the heart tissue that lines the defect. Bacterial endocarditis is a serious problem that can be prevented by taking antibiotics before any medical or dental work (even teeth-cleaning) that might cause germs to enter the bloodstream. Be sure to tell the dentist if you have a VSD.

Medium and large ventricular septal defects may need to be fixed with surgery. The VSD is closed by sewing a patch of a special material (Dacron) over the defect. The surgery helps prevent problems later in life. These problems include heart failure and high blood pressure in the lung arteries. Children who have surgery to repair a VSD before they are 2 years old usually do well. Older children and young adults who have surgical repair may still have some problems with their heart function. These problems, which include abnormal heart rhythms and a slightly reduced pumping ability of the heart, are usually not serious and may be treated with medications. Some VSDs may be closed with a patch that is positioned through a catheter, without surgery.

In the rare case that an infant with a VSD is very ill and has several other defects, an operation may be done to relieve the severe symptoms and to prevent high blood pressure from developing in the lungs. In this procedure, called a pulmonary artery band, the pulmonary artery is narrowed to reduce the amount of blood flow into the lungs. This will allow the child to grow. When the child is older, doctors will remove the band and repair the VSD.

A heart attack can make the septal muscle so weak that it cannot hold the stitches that would patch the defect. This makes the surgery quite risky. If other kinds of treatment can control heart failure for about 2 weeks, the septum recovers enough to hold the stitches, and successful surgery is more likely. Without surgery, people who develop a VSD after a heart attack have a high risk of death.

What are the results of treatment for ventricular septal defect?

When surgical repair of a VSD is not an emergency, the operation carries very little risk. Most people with repaired VSDs live normal lives and have a normal ability to exercise. The results are not as good if the VSD is due to a heart attack.


What is an atrial septal defect?
There are four chambers in the human heart. The upper two are called atria. The atrial septum separates the atria into right and left chambers. The right atrium receives blood from the veins of the body, and the left atrium receives blood from the lungs. Before birth, there is normally an opening in the atrial septum that allows blood to bypass the lungs. The opening is supposed to close at about the time of birth, but remains open in about 1 out of 1,000 babies.The size of the defect can be very small or more than an inch in diameter. The higher blood pressure in the left atrium pushes blood into the right atrium, adding to the normal supply coming from the body to the heart. This added volume increases both the workload of the right ventricle (the pumping chamber to the lungs) and the flow of blood in the lungs.

How does it occur?
As you may imagine, a baby’s development from a tiny egg requires very complex changes. Just what goes wrong is unknown. A gene defect or other influences may prevent the heart tissues from developing properly. An atrial septal defect usually does not otherwise prevent the heart or the baby from developing normally, and the defect does not appear to be inherited.
What are the symptoms?
Unless the defect is very large or associated with some other cardiac defect, most babies and children have few or no symptoms. In fact, many people may live their entire lives with small atrial septal defects and are unaware of it. Some people will not develop symptoms but may need surgery when they are middle-aged. Larger defects may cause symptoms including shortness of breath, sweating a lot with activity, increased breathing rate, or decreased growth. The extra blood flow through the lungs may cause an increase in blood pressure in the lungs. Congestive heart failure may develop, with cough and swelling of the legs or ankles. Occasionally, the added strain on the heart results in irregular heart rhythms.
How is it diagnosed?
If the defect is small, diagnosis is difficult and a heart echocardiogram may be the only clue to its presence. A heart echocardiogram bounces sound waves off the heart to create a detailed picture of the heart and its structures. This is a painless procedure that can be done in your doctor’s office.

Increased blood pressure in the lungs can also be detected by the heart echocardiogram. Increased blood pressure in the lungs is sometimes measured by placing a small tube in the lung arteries.
In larger defects there is an increased flow of blood through the heart that creates a heart murmur, which can be heard with a stethoscope. The increased blood flow may also cause heart enlargement noted on a chest x-ray or on an electrocardiogram. An electrocardiogram is a test that measures the electrical activity of your heart.
How is it treated?
Not all septal defects need treatment. Some are so small they never cause problems. Children who develop symptoms as a result of the defect should have surgery to close the hole. This helps prevent the development of high blood pressure in the lungs.
The surgeon may patch the defect using a small piece of tissue from the sac surrounding the heart (the pericardium). If the hole is small enough, the surgeon may sew it shut. Sometimes the defect can be fixed by pushing a flexible plastic “umbrella” through a leg vein and attaching it over the hole. This form of treatment does not require chest surgery.
For adults, the situation is not quite so clear. In most reports, adults with symptoms who were treated with surgery did better than those not treated. However, those with high blood pressure in the lungs are not good candidates for surgery because of the poor results. Adults with mild symptoms may do as well with nonsurgical treatment as with surgery. Your doctor will make a recommendation based on the extent of the disease and your symptoms.
When should I call the doctor?
If you have a known atrial septal defect and no symptoms, try to live as normally as possible. Call your doctor if you notice a sudden increase in shortness of breath, you awake at night short of breath, or you become aware of an irregular heartbeat. Regular checkups are recommended.


What is a patent ductus arteriosus (PDA)?
A patent ductus arteriosus (PDA) is a heart defect in which a channel that exists between two major blood vessels before birth fails to close as it is supposed to shortly after birth.
Every baby is born with an open connection between the two major blood vessels emerging from the heart, the pulmonary artery and the aorta. The channel is called the ductus arteriosus. The pulmonary artery carries blood from the right pumping chamber of the heart (the right ventricle) to the lungs. The aorta carries blood from the left side of the heart (the left ventricle) to the rest of the body.
Normally, the channel closes within 3 days after birth. When this fails to happen, some of the blood that should have gone through the aorta and on to the rest of the body is returned through the PDA to the lungs. Failure of this channel to close is quite common in premature infants but is fairly rare in full-term babies. Less commonly, it may not be detected until later in life.
How does it occur?
In premature infants, particularly if their lungs are not mature, the PDA often does not close normally. In full-term infants, the cause is unknown.
What are the symptoms?
Babies who have a small open channel often will have no symptoms except a heart murmur. If the PDA is large, the babies may have difficulty gaining weight and become short of breath and sweat when they exert themselves (such as when they cry). Older children may not be able to exercise as much as normal and may have frequent lung infections.
How is it diagnosed?
Most babies with this defect will have a heart murmur, which the health care provider will hear with a stethoscope. Some PDAs are silent, however. An echocardiogram, a special test that uses sound waves to create a picture of the heart, will reveal a PDA. A chest x-ray of a child with a PDA will often show an increased amount of blood in the lungs.
How is it treated?
In premature babies, a PDA often closes by itself within weeks or months. In full-term infants or in premature infants whose PDA fails to close, surgery is needed.
There are three common ways to close a PDA surgically. In the first, the surgeon makes a small cut under the armpit. The ribs will be spread (not broken) and the PDA exposed. The surgeon will then tie off the PDA.
In the second method, two or three small tubes will be inserted in the baby’s side. Small instruments are used to tie off the PDA through these small tubes. This is called thoracoscopic surgery.
The third way of closing the PDA uses tubes that are inserted in a leg artery and pushed through to the PDA. Special coils are then inserted into the PDA that keep blood from flowing into it. This procedure uses a technique known as cardiac catheterization.
Discuss the options with your health care provider before making a treatment decision.
How long do the effects last?
Surgery involves little risk, corrects the problem, and enables the child to grow and develop normally.