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VSD Closure / Repair (Adult): Symptoms, Classification, Diagnosis & Recovery

A ventricular septal defect, or VSD, is a condition where there is a hole in the wall between the two lower chambers of the heart, present from birth. It's the most common congenital heart defect and can occur alongside other heart issues. A small hole usually causes minor or no symptoms, but a larger one may require repair to prevent lasting damage and complications.

Ventricular septal defects (VSD) occur in around one-third of 1% of newborns, but it's less likely for adults to be diagnosed since the defect often closes naturally during childhood in 90% of cases. VSDs linked to heart attacks are exceptionally rare nowadays, with less than 1% of all heart attacks being associated with them, thanks to modern treatment methods.

The exact cause of ventricular septal defects (VSD) at birth remains unknown. However, it can be associated with other heart defects, heart conditions, or genetic disorders. The use of specific anti-seizure medications (sodium valproate and phenytoin) or alcohol consumption during pregnancy may potentially elevate the risk of a child developing VSD, although further research is needed to establish these as definite causes.

A rare known cause of VSD is its occurrence as a side effect of a heart attack.

Ventricular septal defects (VSD) come in four main types, each differing in location and hole structure:
  • Membranous: This is the most common, constituting about 80% of cases. It occurs in the upper part of the ventricular wall.
  • Muscular: Found in approximately 20% of VSD cases in infants, this type often involves multiple holes in the heart wall.
  • Inlet: Positioned just below the tricuspid valve in the right ventricle and the mitral valve in the left ventricle, blood passing through the ventricles must navigate this type of VSD.
  • Outlet (conoventricular): Creating a hole just before the pulmonary valve in the right ventricle and before the aortic valve in the left ventricle, this type connects the two chambers, requiring blood to pass through the VSD on its way through both valves.

In babies, a moderate to large ventricular septal defect (VSD) can show symptoms resembling heart failure, such as:

  • Breathing Issues: Shortness of breath, fast breathing, or difficulty breathing.
  • Fatigue During Feeding: Sweating or tiredness while eating.
  • Slow Weight Gain: Difficulty thriving and gaining weight.

Diagnosing a ventricular septal defect (VSD), especially when it's moderate or large, involves a physician considering symptoms, conducting a physical exam, and using imaging tests. Small VSDs may go unnoticed due to their minimal impact on health.

A common method for detecting VSD is a physical exam, as a significant VSD creates a heart murmur that a doctor can hear through a stethoscope. The size of the defect can even be estimated based on the sound of the murmur. Imaging tests play a crucial role in diagnosis, including:

  1. Echocardiogram: This painless test uses sound waves to create images of the heart, making VSDs visible based on size and location.
  2. Electrocardiogram (ECG or EKG): By assessing the heart's electrical activity, changes in structure due to VSD can be detected over time.
  3. Chest or Heart X-ray: Visible changes in the heart structure caused by a large VSD can be observed through certain X-rays.
  4. Computed Tomography (CT) Scan: This three-dimensional imaging test provides a detailed view of the heart's interior.
  5. Cardiac Catheterization: A catheter device inserted into a blood vessel near the thigh helps visualize the heart's interior, particularly useful when blood vessel damage in the lungs is suspected.

Most ventricular septal defects (VSDs) are too small to pose significant issues, often closing on their own by age 6. In such cases, healthcare providers typically recommend monitoring for symptoms rather than immediate surgery. For moderate to larger-sized VSDs, repair is usually advised. The two primary methods are:

  1. Surgery: A cardiac surgeon surgically patches or closes the hole, which can involve stitching it shut or using a synthetic material or tissue graft, depending on the size and location of the defect.
  2. Transcatheter Procedures: These catheter-based procedures access the heart through a major artery. A specialized device called an occluder is placed at the defect site to plug the hole. The occluder is typically a mesh framework covered in a synthetic material.

In both cases, the heart tissue eventually grows around the patch or occluder, incorporating it into the heart wall between the ventricles.

The recovery period after repairing a ventricular septal defect (VSD) varies depending on the chosen method. Transcatheter procedures generally result in shorter recovery times, measured in days or weeks. In contrast, surgical interventions require longer recovery periods, measured in weeks or months. Following either procedure, symptoms of a VSD typically decrease or vanish, contributing to improved post-treatment well-being.

Antibiotics will be administered to prevent infections like endocarditis. Regular checkups will follow for a while to ensure that the hole gets closed properly. To prevent blood clots the patient may be given aspirin. Apart from all these, for the first few months, activities will be kept limited till he or she is fit enough to exert more with physical activities.

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