VSD Closure: Understanding the Procedure to Repair a Ventricular Septal Defect

VSD is the commonest type of congenital heart defect (VSD), which is the abnormal opening or hole in the wall (septum) separating the lower chambers(ventricles) of the heart.

Early diagnosis is critical for timely interventions and preventions of life-long complications like pulmonary hypertension and heat failures.
Depending on certain symptoms, such as a blue tint to the skin or lips, a faster heartbeat, and quick breathing, VSD can be identified during pregnancy using specialized ultrasound called fetal echocardiography or just after birth.
Some of the diagnostic tests that are conducted are:

- An echocardiogram shows the rotation of blood through the heart
- Palpitation oximetry records the quantum of oxygen in the blood.
- A comprehensive image of the heart is created using cardiac magnetic resonance imaging (MRI) and computed tomography (CT) scans.

What Causes a VSD?

VSD does not have any currently known causes. Usually, genetics and environmental factors may play a role. It can be associated with other genetic disorders like Down Syndrome. Anti-seizure specifics (valproic acid and phenytoin) or drinking potables containing alcohol during gestation may increase the threat of a VSD in the fetus.

Why Closure is Needed

The gap in the septum that divides the heart's two bottom chambers is known as a ventricular septal defect.. Without treatment, complications can arise that can seriously affect one's health. It is often advised to close the VSD to prevent these complications and protect heart function.

Why Are VSDs Closed?

To Prevent Heart Failure: A large defect can keep the heart working much harder, and over time, this can lead to heart failure.
To Avoid the Risk of Endocarditis: This condition increases the chances of infection on the inner lining of the heart, which can be fatal.
To Defend against Arrhythmias: Abnormal blood flow may interfere with normal heart rhythm, causing abnormal heartbeats.
Protect Lung Health: If a defect is left open, increased blood flow into the lungs may cause pulmonary hypertension, leading to Eisenmenger syndrome, in which the lung blood vessels get stiffened with irreversible lung damage.
Improve Oxygen Delivery: A proper closure causes the heart to function well, with the maximum delivery of oxygen-rich blood to the body.
Finally, VSD closure reestablishes an even rate of blood flow, lowering the workload on both the heart and lungs, all of which is good for the long-term health and quality of life.

Types of VSD Closure

Surgeries and procedures to repair a VSD include:

Open-heart Surgery: The most popular method for fixing a VSD involves the surgeon sewing a patch over the hole. This procedure requires a chest opening and a heart-lung machine.
Catheter-based Procedure (non-surgical): This procedure uses thin flexible tubes (catheters), usually inserted through the groin, to guide a small device next to the walls to the ventricles in the heart. The device is released to plug up the hole in the wall, and the catheter is retracted.

How is VSD Closure Done?

Open-heart Surgery:

The subject will be anaesthetized through an IV line before the surgery starts. It will be a painless operation.
Throughout the procedure, this machine will take over the subject's heart and lungs.
The heart-lung machine will be removed after completion of the procedure.
The breastbone will be put back together with cables. The muscle and the skin will be stitched, and a girth will be applied.

Post Procedure Steps:

The subject will be observed for several hours in a recovery room or in the intensive care unit.
Vital parameters like the heart rate, blood pressure, oxygen levels, and breathing will be closely monitored.
Pain medicine might be administered if needed.
Follow-up tests, like an electrocardiogram or an echocardiogram, might be conducted.
By the second day, the subject should be mobile as much as possible.
The subject will get discharged about a week after surgery.

At Home After the Procedure:

The subject might take certain medicines after the surgery. Pain medicines can be given as needed.
Most subjects can get back to their normal activities when they get home. But they may feel exhausted easily. The subject should avoid activities that might result in blows to the chest.
Follow- up movables should be rigorously stuck.The healthcare provider should be notified if the subject shows an increase in swelling, increased bleeding or drainage, a fever, or severe symptoms. A little drainage from the point is normal.
Instructions from the healthcare provider about medicine, exercise, diet, and wound care should be followed.
Antibiotics might be prescribed before certain medical and dental procedures to prevent any potential infection of the heart valves.

For a short time after the procedure, the subject will need regular checkups by a cardiologist.

Catheter-based procedure (non-surgical):

The subject will be anesthetized through an IV line before the surgery starts. It will be a painless procedure.
It will take roughly two hours to complete the process.
A flexible tube( catheter) is fitted into the blood vessels in the groin, supplemented with a small device inside it
The catheter is carefully manoeuvred through the blood vessel to the ventricular septum.
To determine the precise location of the catheter, X-ray imaging and echocardiography will be performed concurrently. A transoesophageal echocardiography may occasionally be used by the surgeon to visualise the catheter. The ultrasonography camera is placed on the subject's neck for this purpose.
It is deployed from the tube and plugs the hole in between the wall of the ventricles. The surgeon fastens the device in place.
The catheter will be removed through the blood vessel after confirming the position of the device.

Post procedure steps:

The subject will be kept in a recovery room.
Vital signs( heart rate, blood pressure, oxygen saturation, and breathing) will be nearly covered.
The subject will also have to lie flat for a few hours after the procedure, and canâ€™t bend their legs, to help prevent bleeding.
You will receive medication to aid with blood clots.
Pain medicine will be administered if needed. It may be necessary to perform follow-up testing, such as an echocardiography or electrocardiogram.
The patient needs to be hospitalised for at least a day.

At home after the procedure:

Subjects might be prescribed antibiotics or medicines for a short time to prevent blood clots. Pain medicines can be taken as needed. Strenuous activities should be avoided.
Follow-up movements need to be stuck to remove the aches.
Healthcare provider should be contacted if swelling, more bleeding or drainage, a fever, or severe symptoms is observed. Minor drainage from the site is normal.
Instructions on medicine, exercise, diet, and wound care should be followed. In order to avoid heart valve infections, antibiotics will be recommended for a period of time prior to specific medical and dental operations.

Following the procedure, a cardiologist should be consulted on a regular basis. Subjects can resume their regular life after recovery with no limitations on their activities.

Recovery and Aftercare

Children: In infants most children recover well after a VSD surgery but complications may sometimes develop. The specific threat factors depend upon the age, the extent of the disfigurement and also other medical problems. Late complications are rare. This can be heart faucets issues. occasionally, the patch used to seal the defect can detach, requiring additional surgery.

Grown-ups : Grown-ups with VSD surgery bear a regular follow- up with a cardiologist endured with grown-ups with natural heart blights. Preventive treatment for endocarditis is generally specified during the six- month mending period post surgery. Specifics are infrequently demanded and only in cases of heart failure( which is veritably uncommon) or pulmonary hypertension. Non-invasive tests like electrocardiograms, Holter monitors, exercise stress tests and echocardiograms might be performed if demanded.

Activity limitations: The majority of patients are able to resume their regular activities. However, depending on the patient's level of endurance, activity may be limited if there is pulmonary hypertension or ineffective cardiac pumping. If effort restriction is required, the cardiologist will assist in making that determination.

Risks and Success Rates

All procedures are associated with some risks. Some of the possible risks include:

Excess bleeding
Infection
Blood clots that may eventually result in a stroke
An irregular heartbeat, which infrequently results in death
Accumulation of blood (hematoma) in the groin
Device migrating to the heart or vessels (embolization)
Problems with the heart valves
Complications from anaesthesia

Success Rates The success rates of repair procedures for VSD are generally high both in children and adults.

Children: Surgical closure of VSD has been reported to be 100% successful while 97.7% success rate was reported for transcatheter procedures.
Adults: A study published by AHA reported 97% eventâ€free survival at 1 year after either VSD diagnosis (patients with unrepaired defect) or VSD closure (patients with surgically closed defect). Eventâ€free survival was reported to be 93% at 40 years of followâ€up.

VSD Closure in India

The average cost of a VSD closure surgery in India is approximately between USD 4500 to USD 5500, depending on a number of criteria. These include the patient's condition, treatment approach, geographical location, hospital infrastructure, medication and diagnostic procedures and duration of the treatment. India has several hospitals with state of art facilities for advanced diagnostic imaging, intraoperative echocardiography, for carrying out the VSD closure procedures. Some of the hospitals which offer VSD closure surgery are:

Frequently Asked Questions (FAQs)

Q. Is Surgery Safe for Infants?

A. Yes, VSD surgery is typically safe for infants. Most of them recover quite well, but there are risks involved with the surgery that will have to be discussed with the cardiologist.

Q. Duration of Hospital Stay After VSD Closure?
A. It varies according to procedure - open-heart surgery may need about a week, while catheter-based closure may require just 1-2 days.

Q. Is it Possible For the Child to have a Normal Life After VSD Closure?
A. Yes, after adequate healing and follow-up, most children can lead healthy, active lives.

Q. What is the Cost of VSD Closure in India?
A. Conditions of the patient, facilities provided by the hospital, type of procedure, medicines, and duration of care are all elements determining charges.

Q. Is VSD Closure Always Required?
A. Not always. Small VSDs may close spontaneously. Larger defects indicate the need for closure or symptomatic cases.

Q. Does the Child Require Medications Post-surgery?
A. Yes, some may need medications for a limited time to aid healing and prevent complications in children.

Q. Can Adults Undergo VSD Closure?
A. Yes, in adults, if it is an undiagnosed or untreated VSD, it could also be closed depending on the general health condition of the adult.

Q. What are the Risks of VSD Closure Surgery?
A. Risks include bleeding, infection, arrhythmias, or reaction to anesthesia. Serious complications are very few.

Q. How Long is the Recovery?
A. Most children recover within 4-6 weeks, but the healing period is variable with the person and procedure.

Q. Will There be a Need for Regular Visits to the Hospital After VSD Closure?
A. Yes, regular follow-up with a cardiologist is very important to monitor heart function and ensure healthy development.