Treatment

The goals of ventricular septal defect (VSD) treatment are to:

• Monitor the defect to see if it closes or gets smaller
• Treat the symptoms of congestive heart failure, if present
• Close or repair the VSD if it does not close on its own

Most small VSDs close without treatment. But treatment is needed if your child's VSD:

• Is large
• Is causing your child to have symptoms
• Is moderate and does not close on its own by the time your child is in preschool
• Affects the aortic valve

Types of Treatment

There are several types of treatment for VSD. They include:

• Monitoring and observation
• Medicines
• Extra nutrition
• Surgery or a procedure using catheters to close the VSD

Your child's doctor will discuss treatment options with you and will consider your family's preferences when making treatment recommendations.

Monitoring and observation

Your baby's doctor may choose to monitor and observe the baby if your child does not have symptoms of congestive heart failure. This means regular checkups and tests to see if the defect closes on it own or gets smaller:

• Weekly for infants with large defects.
• Yearly or even less in older children.
• A VSD diagnosed during infancy usually closes or gets smaller. Even large defects may close.

Medicines

Children with small VSDs and no symptoms may not need any medicines. Children and adults who have moderate or large VSDs and develop symptoms of congestive heart failure may need medicine until the defect can be closed. These medicines include:

• Diuretics to treat fluid buildup
• Digoxin to improve heart function and keep the heartbeat regular

Antibiotics to prevent bacterial endocarditis (an infection of the heart) are usually given for a limited time after surgery or a catheter procedure.

Extra nutrition

Some infants with VSDs do not grow and develop or gain weight as they should. These infants usually include those who:

• Have large VSDs
• Are born prematurely
• Tire easily during feeding

Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk that give the baby extra nourishment. In some cases, tube feeding is needed. Food is given through a small tube that is placed through the nose into the stomach. Tube feeding can add to or take the place of bottle feeding.

Surgery

Today, most doctors recommend surgery to close a large VSD by 1 year of age. Doctors also recommend closing a VSD that does not close on its own by the time a child is in preschool. Surgery may be required earlier if:

• The child fails to gain weight.
• Medicines are required to control the symptoms of congestive heart failure.

The surgical procedure. The surgery to close a VSD is done under general anesthesia so that your child will be asleep and feel no pain. The surgeon makes a cut down the center of the chest to reach the VSD.

• The child is placed on a heart/lung bypass machine during surgery.
• The heart is stopped, and the heart/lung machine takes over for the heart, pumping red blood throughout the body.
• The heart/lung machine also brings oxygen-poor blood back to the machine where it picks up oxygen.
• The surgeon uses a special patch or stitches to close the VSD.
• The surgeon puts the patch over the VSD and sews it into place.
• Once the repair is completed, the heart is restarted.
• The child is taken off the heart/lung bypass machine.
• The surgeon closes the skin incision.

Within 6-8 weeks, heart tissue will grow over the patch so that it will not need to be replaced as the child grows.

After the surgery. After VSD surgery, your child will spend a few days in the intensive care unit or in a regular hospital room. Most children go home about 4 days after the surgery.

While in the hospital, your child will be given medicine to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:

• Limits on activity for your child while he or she recovers
• Avoiding blows to the chest while the incision heals
• Bathing the child
• Followup appointments with your child's doctors
• How to give your child medicine at home

Results. The outcomes from VSD surgery are excellent. Your child should have little pain or discomfort.

Complications from VSD surgery, such as bleeding and infection, are rare and short term. After full recovery from surgery, most children are able to participate in normal activities. Children who ate poorly before surgery often start to eat better and gain weight, and they are more active.

Reference:

National Heart, Lung, and Blood Institute, USA.