Device closure of a large ventricular septal defect (VSD) in a small baby | Dr Debasree Gangopadhyay

Overview

Congenital heart defects can occur in babies during fetal development, leading to serious health issues if not treated properly. Ventricular septal defect (VDS) is one condition with a hole between the heart’s two lower chambers. Sometimes, the hole can be small and may not require any treatment. However, in other cases, the hole can be large. It may cause symptoms such as difficulty breathing, poor growth, and an increased risk of infections.

Case Study

GS, a small baby weighing only 4.5 kg at 13 months, was brought to the RTIICS OPD to assess poor weight gain. After auscultation, her paediatrician suspected a heart disease. An echocardiogram confirmed a large 10 mm mid-muscular ventricular septal defect (VDS), causing a significant blood flow from the left to right heart chambers and through her lungs. As a result, her lungs were wet and susceptible to frequent infections, as confirmed by her parents, who reported that she suffered from frequent cough and cold episodes.

After a detailed discussion with the parents about the device closure procedure for the ventricular septal defect, consent was obtained for the closure. The procedure posed several challenges due to the size of the defect and the baby’s small weight. However, after carefully considering the anatomy, a 12 mm muscular ventricular septal defect closure device was chosen and placed across the defect to seal the hole through the neck vein.

Following recovery from the procedure and return to normal, the mother noticed an immediate improvement in her baby’s breathing pattern, and she began to eat better. After only two days of observation in the hospital, she was discharged home. Seven days later, when the parents returned for a follow-up check, they were delighted to see their baby girl’s significant improvement beyond their expectations. She was more playful, less out of breath, and asked to be fed.

Device closure of holes in the heart is a well-established and safe procedure in expert hands. In addition, this procedure provides a lifelong cure for the hole without leaving scar marks on the chest.

Dr Debasree Gangopadhyaya is one of the leading and eminent practising pediatric cardiologists with more than ten years of experience in Pediatric Cardiology. She holds immense experience in fetal echocardiography, pediatric echocardiography, adult congenital heart disease, and pediatric cardiac interventions. She has performed a lot of complicated procedures and helped patients recover. Some of these procedures are-

• • Device closure of holes in the heart
  • Balloon dilatation of valves
  • Fetal echocardiography
  • Stenting of arteries
  • Pediatric echocardiography

Symptoms of a large ventricular septal defect in a small baby

• • Common symptoms of a large ventricular septal defect include difficulty breathing, fast or difficult breathing, rapid heartbeat, sweating, fatigue, and poor feeding.
  • These symptoms can affect a baby’s overall health and development, leading to failure to thrive and developmental delays.
  • If left untreated, ventricular septal defects can lead to complications such as pulmonary hypertension, congestive heart failure, and infections.

Causes of a large ventricular septal defect in a small baby

A ventricular septal defect (VDS) is a congenital heart defect that occurs when there is a hole in the wall (septum) between the two lower chambers (ventricles) of the heart.

• • The exact cause of the ventricular septal defect is unknown. Still, it is thought to be due to genetic and environmental factors.
  • The ventricular septal defect can also occur as part of other genetic syndromes such as Down or DiGeorge.
  • Ventricular septal defects can range from small to large, with larger defects causing more significant symptoms and complications.
  • Larger ventricular septal defects can cause increased blood flow to the lungs, leading to pulmonary hypertension and an increased risk of developing infections.
  • Babies with large ventricular septal defects may experience fatigue, rapid breathing, sweating, poor feeding, and failure to thrive.
  • In some cases, ventricular septal defects may close on their own as the baby grows, but larger defects may require medical intervention to prevent complications and improve quality of life, causes

Treatment Options for a large ventricular septal defect in a small baby

Several treatment options are available for babies with large ventricular septal defects. The decision on the best course of action will depend on various factors, such as the size and location of the defect, the severity of symptoms, and the baby’s overall health.

• • Watchful Waiting: Doctors may recommend a wait-and-see approach for small ventricular septal defects that are not causing significant symptoms. In these cases, the ventricular septal defect may close as the baby grows, and surgery or other interventions may not be necessary.
  • Medications: In some cases, medications such as heart failure or pulmonary hypertension may be prescribed to manage symptoms associated with a large ventricular septal defect.
  • Surgery: Traditional open-heart surgery may be recommended for larger ventricular septal defects or those causing significant symptoms. During surgery, the ventricular septal defect is repaired by suturing the hole closed, usually with a patch or tissue from another part of the heart or the body.
  • Device Closure: Device closure is a less invasive procedure commonly used to treat ventricular septal defects. During the procedure, a catheter is inserted into the heart through a small puncture in the groin, and the device is placed across the hole to close it.

Pros and Cons of Each Treatment Option for a large ventricular septal defect:

Watchful Waiting:

• • Pros: No need for surgery or intervention if the ventricular septal defect closes independently.
  • Cons: There is a risk that the ventricular septal defect may not close and may require surgery later.

Medications:

• • Pros: Can help manage symptoms associated with a large ventricular septal defect.
  • Cons: Medications may have side effects and do not address the underlying problem.

Surgery:

• • Pros: Can repair the ventricular septal defect completely and eliminate the risk of complications associated with the defect.
  • Cons: Surgery is a major procedure with a risk of complications, such as bleeding, infection, and reaction to anaesthesia.

Device Closure:

• • Pros: Less invasive than traditional open-heart surgery and can be performed under sedation rather than general anaesthesia.
  • Cons: There is a risk of complications, such as bleeding or infection.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

• • Best Cardiologists in Delhi
  • Top Cardiologists in Ahmedabad
  • Best Cardiologists in Bangalore
  • Top Cardiologists in Jaipur
  • Best Cardiologists in Kolkata

How to Decide on the Best Treatment?

The decision on the best treatment for a baby with a large ventricular septal defect will depend on several factors, such as the size and location of the defect, the severity of symptoms, and the overall health of the baby. Parents should discuss all available options with their child’s doctor and consider the pros and cons of each treatment option before making a decision.

The treatment plan may need to be adjusted over time as the baby grows and develops. Regular follow-up appointments with a pediatric cardiologist will help ensure that the baby’s heart is functioning correctly and that any necessary adjustments to the treatment plan are made.

FAQs

Q: How is a large ventricular septal defect detected?
A: A large ventricular septal defect can be detected through an echocardiogram, a type of ultrasound that uses sound waves to create heart images.

Q: Is device closure the only treatment option for a large ventricular septal defect in a small baby?
A: Other treatment options are available, including medication and surgery. Your pediatric cardiologist can help you choose the best treatment for your baby.

Q: How can I prepare my baby for a device closure procedure?
A: Your pediatric cardiologist will provide detailed instructions on preparing your baby for the procedure. This may include fasting for a particular duration before the procedure and avoiding certain medications.

Reference

• https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/ventricular-septal-defect-vsd
• https://www.stanfordchildrens.org/en/topic/default?id=ventricular-septal-defect-vsd-90-P01829
• https://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html

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