Month: June 2018

What is a ventricular septal defect?
A ventricular septal defect (VSD) is a hole in the wall that separates the lower right and left heart pumping chambers (ventricles). It is the most common type of congenital (present from birth) heart condition.

In patients with VSD, oxygen-rich blood passes from the left ventricle and mixes with oxygen-poor blood in the right ventricle. This sends the blood back to the lungs and makes the work of the heart inefficient and harder. The larger the hole, the more symptoms it can cause. If there is significant flow of blood across the hole  some infants may develop difficulty with growth and breathing. Symptoms due to the VSDs may be able to be managed with medication and high calorie feeding regimes. If that is not sufficient, surgical repair to close the hole is recommended. Rarely, a VSD can lead to an infection in the heart, called bacterial endocarditis.

Treatment for babies and children with ventricular septal defects?
Many VSDs are small enough that observation or medical therapy, including higher calorie formula or medications to relieve congested breathing, are all that is needed.  Fro many VSDs the natiral history is for them to become smaller on their own and even close spontaneously over time.

If an infant has significant difficulties with growth or breathing, despite medical therapy, then surgical closure can be performed with excellent results.  In some instances the defect can be amenabke to a catheter or “key-hole” based procedure. The need for surgical or interventional closure is based on the type and size of defect as well as clinical symptoms seen in the baby or child.

What is an atrial septal defect?
An atrial septal defect (ASD) is a hole in the wall that separates the upper right and left heart collecting chambers (atria). “Atrial” is the name we give to the upper chambers of the heart, “septal” is a medical term for wall, and “defect” is a gap. Taken together, it means that there is a gap in the wall of the upper portion of the heart.

ASD is a congenital condition present at birth. The muscle wall dividing the two upper chambers (atria) has multiple building blocks and a deficiency in any of them can lead to a gap in a different portion of this partitioning upper wall.

The ASD allows oxygen-rich (red) blood to pass from the left heart chamber and mix with oxygen-poor (blue) blood in the right chamber.  The effects this communication has on the child’s heart depends on the size of the hole. Some communications are too small to of any significance, the most common type we see is called a PFO (patent foramen ovale). This can be found in up to 1 in 3 adults and is considered a normal variant. If the communication allows a significant amount of blood cross from the left heart to the right heart over time the right heart will increase in size and work harder. Generally this is tolerated quite well initially but if left over time, this can cause the heart and lungs to work harder and put the child at risk for other conditions later in life,  as an adult. These include:

abnormal cardiac rhythms
heart muscle failure
reduced exercise tolerance
pulmonary hypertension

Treatment of ASDs?
As mentioned, the size of the hole can vary from small to large. Some ASDs close on their own over time, typically during the first three years of life. However, if the hole remains significant in size, closure is necessary. The options include non-surgical, catheter based “key-hole” interventions and minimally-invasive surgical techniques. Depending on the size and location of the ASD, non-surgical catheter-based techniques may be able to close the defect, thereby avoiding surgery. Each ASD is assessed individually to ascertain the most appropriate management and closure option.