Ventricular septal defect (VSD) question

[wweir]

I have a question that I thought maybe you all could help me with.

One of the folks who works for me, Greg, advised me tonight that his new born daughter was diagnosed with ventricular septal defect (VSD). It seems that last week at her one month checkup the pediatrician heard a heart murmur so they went to get it checked out.

According to what the doctor told them, they found out that VSD, a congenital disease, is a hole in the heart. The hole, located between the heart's right and left pumping chambers, apparently lets too much blood flow to the lungs. As a result, the heart must work harder to get sufficient blood to the rest of the body. The majority of VSDs are small, and usually close on their own by the time a child is five years old.

Large defects are a different matter (this is what they were told their daughter has). They cause a variety of significant symptoms, usually in the first year of a child's life, and must be closed surgically.

Greg is trying to get a handle on the difference between "small" and "large" since the treatment they were told today was to wait and see if the hole closes on it's own (within a few months) and if not, then probably have to start talking about the surgical procedure.

If anyone has advice or additional information it would help immensely, thanks.

 

[Bryan B]

Walter,

I was born with a VSD. It was diagnosed at 2wk or a month (I forget) and had my first cath at 18mo. Because it was the early 60's (and OHS was a 50/50 proposition) they decided not to do surgery, but I've been told that if I was born today they would have corrected it immediately (so I assume it was large). By the time I was ten it had grown smaller. They did another cath and decided I was doing fine and didn't need surgery. At age 18, the hole had grown even smaller (but never closed) and the suction caused by the "jet" of blood the VSD was now squirting caused my arotic valve to prolapse. This caused AI and regurg, and I had another cath in which they decided to put off surgery because I was relatively symptom free. I lived with that until recently when I developed endocarditis, which further damaged the valve. And since they don't know how I contracted the endocarditis they suspect the VSD played a part in it. When I had my surgery in March they patched my VSD and replaced my aortic valve using the Ross Procedure.

I'm wondering if my Mom could help with recalling some of the details of what they told her when my VSD was first diagnosed. Like I said, it was back in the early 60's so I don't know how much it would help. My educated guess is that if it's a large VSD they are going to want to go in and close it now.

 

[Harpoon]

In fetal development, EVERYONE has a VSD. It's neccesary to allow oxygen to circulate around to everywhere it needs to be. Generally the hole closes within the last few weeks of pregnancy or shortly after a child is born.

Small holes are like that, They're usually expected to close some time after birth and are watched but not messed with. Large holes (I dunno exactly what defines "large" but my guess would be more than 10% of the septum the whole is found in) can make the heart inefficient and will cause problems like failure to thrive, cyanosis, and other developmental issues in infants. They're almost always closed up as soon as possible. I think these days they may not even do it with open heart, just a cath type procedure or some other minimally invasive technique, if they can.


I had a VSD, but mine was INTENTIALLY promoted because of all of the other crap that was going on with my heart. If it wasn't for the VSD and the blood mixing it allowed in my heart, I would have never survived past birth.

The hole allows oxygenated blood from the lungs and oxygen depleted blood from the body to intermix. This makes the circulatory system less efficient so less oxygen is getting to where it needs to go, but it's a slowly developing problem in most cases.


There's a lot more too all of this, but my brain is tired and I can't think straight at the moment. =)

VSD's and ASD's (Atrial septal defects) are the most common heart defect in newborns and are very treatable.


A few medications (asthma meds mostly) can cause septal defects later in life, they also cause valve problems and other heart conditions. Many people live most of their lives without ever knowing they have a septal defect...

 

[Creed3]

My five year old daughter has a very very small congenital atrial septal defect. She also has very mild pulmonary stenosis. Her cardiologist told me that in her case both are very very small/mild and that they will just keep an eye on things. They check her every two years. She is developing just fine. No restrictions at all. The only thing he told me was that at some point, it could be when she is much much older (adult), she may want to consider getting the atrial septal defect closed. He said it may be beneficial to close it before she starts having children of her own, especially if she needed to have a c-section. He said since having a c-section is major abdominal surgery, a small clot could get thrown and caught in the tiny hole. He said the chances are slim that that would happen. He explained to me how they close holes in the heart. It is non-invasive, kind of like a cardiac cath. They would go through a vein on the leg and continue up to the heart where they would patch the hole. The procedure is usually done on an out-patient basis (ambulatory surgery).

Take Care!
Gail

 

[Bryan B]

Not all septal defects can be closed without OHS. As a matter of fact the main reason I had surgery was to close my VSD, and it could only be accessed by sternotomy. I had endocarditis last fall and they (cardio & surgeon) felt that my VSD was a contributing factor, and it needed to be closed to prevent it from recurring with possible fatal results (EC has 25% mortality rate). They thought I might be able to get some more use out of my aortic valve (I had moderate regurg), but since they would have me open for the VSD repair it would make sense to repair or replace the valve. Once the surgeon got in there he found out that my valve was in worse shape than originally thought. He tried to repair the valve, but there were too many perforations in the valve (probably from the EC) so he replaced the valve.

Sorry for rambling on, but having lived with a VSD all of my life it has ALWAYS had an affect on my life. It's hard to say if my life would have been any better if my VSD would have been repaired while I was a young child. I was born a bit of a blue baby and have always had to take prophylactic antibiotics for invasive procedures and dental work, but I've always gotten along pretty well with it until a few years ago when I noticed a marked increase in fatigue. I'm just grateful that I survived the endocarditis, that the VSD is now repaired, and my Ross Procedure was a success. It's given me a new lease on life.

 

[Bryan B]

Gail,

I did some research about ASD's because when I had the bubble echo that detected my endocarditis the results also mentioned that I might have an ASD. The main danger from having an ASD is stroke due to clots. An ASD allows blood to pass through the atrial chambers without being filtered by your lungs. Generally the ASD is a flap that remains closed most of the time, but will open when you do things like cough, strain, etc. The surgeon did not find an ASD while he was under the hood rearranging my parts.

 

[wweir]

Thanks everyone for the input. I shared your stories with Greg and his wife and they are most appreciative.

I also contacted two well known heart surgeons here in Nebraska and asked them for recommendations which they subsequently provided. One advantage of living in a small state is everyone knows everyone.

As you can imagine Greg and his wife are very concerned but optimistic. Heck these surgeons they were able to fix me up.

Thanks again for sharing.

Walter