Categories: Cardiology

Hole in the Heart or Ventricular Septal Defect

The global prevalence of Congenital Heart Defects (birth defects of the heart) is on the rise. CHDs strike almost 1% of all live births in a year, which makes it an urgent topic of discussion not only among healthcare specialists but also among the general public. Here are some of the relevant information you need to know about one of the most common birth defects of the heart.

What is a Ventricular Septal Defect (VSD) or Hole in the Heart?

A hole in heart or VSD occurs in the wall (septum) that separates the lower chambers of the heart, known as the ventricles.

In a healthy human heart, oxygen-rich blood flows from the left atrium (upper heart chamber) to the left ventricle, from where it circulates into the body organs. The oxygen-deficient blood pours into the right atrium and passes through the right ventricle towards the lungs for oxygenation.

A ventricular septal defect bypasses this system and causes the oxygen-loaded blood to flow abnormally from the left to the right ventricle, in turn, pumping too much blood into the lungs.

Who is most affected by VSD: Infants or Adults?

  • VSD in Adults:

VSD cases are relatively rare in adults, more serious and potentially fatal. The most common cause is damage to the heart muscle causing a hole after a serious heart attack. The other reasons being heart surgeries and trauma to the heart. This sort of defect usually needs corrective surgery.

  • VSD in Infants:

A VSD in infants is a congenital abnormality (one that the baby is born with) and occurs due to abnormal organ development during pregnancy. There are different types and sizes of VSD with no to minimal consequences to being potentially fatal. Babies who are born with a VSD and have other associated heart conditions are much more serious and require corrective surgery. Babies born with either a small VSD and as an isolated finding usually have a better outcome. Many of them can go on to live normal lives without even realizing there is a problem and the VSD is usually picked up by a doctor when visited for something unrelated.

Symptoms for Hole in Heart:

Most children with smaller VSDs do not have any symptoms. However larger anomalies and those with other associated heart problems tend to have symptoms much earlier. The baby may exhibit the following alarming indications:

  • Breathing distress: shortness of breath, rapid breathing
  • Pale skin and appearance of bluish colour near the lips and fingernails
  • Recurrent respiratory infections
  • Weight gain difficulties
  • Copious sweating while eating
  • Fast heart rate
  • Unable to feed continuously
  • Failure to gain weight/thrive
  • Blue baby
  • Excessive crying

Causes for Hole in Heart:

It is considered that a ventricular septal defect develops during the early stages of fetal development. There is no definite cause of VSD. During the initial developmental stage of the heart, there is no septum between the chambers. As the fetus grows, a muscular wall starts forming, separating the atria from the ventricles.

A hole in heart occurs when this wall fails to form fully between the two ventricles, resulting in these chambers abnormally interacting with each other. Consequently, this hole in the heart causes oxygenated blood to mix with deoxygenated blood, forcing the blood to the lungs and in turn increasing the pressure in the lungs and other associated problems. There can also be similar defects in the atrial septum which gives rise to the Atrial Septal Defect (ASD).

Warning Signs to Consult a Doctor:

How do you know if it’s time to consult a doctor?

  • In Infants:
  1. Becomes breathless or breathes rapidly while eating, playing or crying
  2. Gets quickly tired while playing
  3. Faces difficulty in weight gain
  4. Gets recurrent respiratory infections
  • In Adults:
  1. Lack of breath after physical activities and when you lie down
  2. Excessive fatigue
  3. Irregular and rapid heartbeat

Understanding the risks and complications of VSD:

Patients with VSDs can face mild to fatal complications as a side-effect of this congenital anomaly like:

With a large hole in the heart, the organ faces excessive pressure to pump sufficient blood to the body. As a result, it has to work faster and harder causing its muscles to weaken over time. Lack of an early heart hole closure (either by operation or device) can lead to cardiac failure.

  • Pulmonary Hypertension:

The pulmonary artery carries blood from the heart to the lungs for oxygenation. Hole in the heart makes this artery carry an increased amount of blood that results in high blood pressure leading to pulmonary hypertension. This extreme stress can also permanently damage the pulmonary artery.

  • Endocarditis:

Patients with smaller VSDs may face an uncommon complexity of heart infection called “Endocarditis”. This happens when micro-organisms from other parts of the body spread through the bloodstream and get attached to the damaged cardiac tissues.

Hole in Heart Treatment: Is Surgery Necessary for VSD?

Not every patient with VSD needs surgery. The majority of smaller VSDs close naturally within 18 months or they do not allow the excessive mixing of blood between ventricles.

A heart hole (VSD) treatment is possible without major cardiac surgery through a minimally invasive procedure with the use of a device (VSD Device Closure) to close the heart. However, this procedure does not apply to all patients and the Cardiologist/Surgeon will decide which patient is suitable to undergo this less invasive procedure.

VSD Treatment: Any Complications?

Any heart procedure or operation can be potentially associated with complications. Some of them might be minor and some may be major. Your doctor will discuss the pros and cons of the proposed treatment and what might apply to you. Ultimately it will be a risk-benefit ratio that will determine the success and acceptance of any treatment.

Prevention and Precautions

Being a birth deformity, VSD is impossible to prevent in the first place. A healthy pregnancy and opting for early prenatal care can prove to be crucial precautionary steps. The current state of the art radiology imaging facility (Ultrasound) during pregnancy is well equipped to detect some of the larger and serious birth defects of the heart. The family and the doctor will be in a much better position to determine the level and type of care the pregnant woman needs. It is of utmost importance to be under the care of the specialist cardiologist to look after these patients as there are potentially life-changing consequences that need to be managed appropriately. The treatment has to be individualized and long term care and planning are crucial for a safer, better, and healthy life.

Dr. Praveen Phaneendranath Sadarmin, Consultant – Cardiology (Adult), St. Martha’s Heart Centre, Sampangi Rama Nagar, Bangalore

Narayana Health

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