Ventricular septal defects
Overview
A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes. The membranous portion, which is close to the atrioventricular node, is most commonly affected in adults and older children
Symptoms
* Heart murmur * Breathlessness * Cough * Slow growth and development of baby/child * Blue colouration of lips and tongue * Clubbing of fingers * Asymptomatic * Murmur * Failure to thrive (in children) * Shortness of breath * Heart failure * Respiratory distress * Elevated jugular venous pressure * Tachycardia * Diaphoresis * Tachypnoea * Heart murmur * Cyanosis * Fatigue * Breathing difficulty during activity * Breathing difficulty during feeding * Poor infant feeding * Cold extremities * Grayish extremities * Rapid breathing * Shallow breathing * Enlarged heart * Hole in the heart * Heart murmur * Abnormal electrocardiogram * Rapid breathing * Wheezing * Tachycardia * Enlarged liver * Failure to thrive * High pulmonary artery blood pressure * Lung damage
Causes
Although doctors know that heart defects that are present at birth (congenital) arise from errors early in the heart's development, there's often no clear cause. Genetics and environmental factors probably play a role. A ventricular septal defect occurs when the septum, the muscular wall separating the heart into left and right sides, fails to form fully between the lower chambers of the heart (ventricles) during fetal development. This leaves an opening that allows mixing of new (oxygenated) and used (deoxygenated) blood. As a result, blood overfills the lungs and overworks the heart. If not treated, the blood pressure in the lungs goes up (pulmonary hypertension) and the ventricles enlarge and no longer work efficiently. Ultimately, this can lead to irreversible damage to the lung arteries and to congestive heart failure.
Prevention
In most cases, you can't do anything to prevent having a baby with a ventricular septal defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics: * Get early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control - these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you're taking. * Eat a balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine. * Exercise regularly. Work with your doctor to develop an exercise plan that's right for you. * Avoid risks. These include harmful substances such as alcohol, cigarettes and illicit drugs. Also, avoid X-rays, hot tubs and saunas. * Avoid infections. Be sure you're up-to-date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus. * Keep diabetes under control. If you have diabetes, work with your doctor to be sure it's well controlled before getting pregnant.
Diagnosis
A VSD can be detected by cardiac auscultation. Classically, a VSD causes a pathognomonic holo- or pansystolic murmur. Auscultation is generally considered sufficient for detecting a significant VSD. The murmur depends on the abnormal flow of blood from the left ventricle, through the VSD, to the right ventricle. If there is not much difference in pressure between the left and right ventricles, then the flow of blood through the VSD will not be very great and the VSD may be silent. This situation occurs a) in the fetus (when the right and left ventricular pressures are essentially equal), b) for a short time after birth (before the right ventricular pressure has decreased), and c) as a late complication of unrepaired VSD. Confirmation of cardiac auscultation can be obtained by non-invasive cardiac ultrasound (echocardiography). To more accurately measure ventricular pressures, cardiac catheterization, can be performed.
Treatment
* Surgical repair of septal defect * Drugs * Surgical closure * Device closure