A commonly known heart problem caused due to hole between the ventricles is a ventricular septal defect. According to the US centre for disease control and prevention, ventricular septal defect affects 42 out of every 10,000 babies.
Ventricular septal defect surgery is a heart operation that is a procedure to close a hole that is present between the ventricles. In 2018, as per the thoracic surgeon society, around 7500 VSD surgeries were performed.
In normal development, the walls of heart chambers connect. However, sometimes, a hole between the ventricles is present. In VSD, the extra blood flows into the pulmonary ventricles. Lungs can be obstructed and can be permanently damaged. If the hole is not too large, the surgery is necessary within a few years of the birth of a child. If the hole is large enough, the operation becomes necessary within a few months of the nascency of a child.
The left side of the heart provides oxygenated blood to the body. The right side of the heart supplies deoxygenated blood to the lungs. In the lungs, the oxygenation of blood occurs. In a healthy heart, pure and impure blood does not mix. In a person with a ventricular septal defect, blood moves from the left ventricle to the right ventricle. In defected person, blood flows out into the lung arteries. The large VSD increases the blood flow in the lungs, which further leads to an increasing flow of blood pressure in the vessels of the lungs. The enhancement of blood pressure in the ventricles of the lungs causes pulmonary arterial hypertension (blood pressure in arteries of the lungs more than usual)
The symptoms of heart defect often appear during the first few days or months of childbirth.
If the problem is not huge, you and your doctor may not observe the signs of VSD. Symptoms of the disease depend upon the size of the hole. The doctor can feel the defect in a baby during regular checkups while listening to the heartbeat with a stethoscope. Sometimes, the determination of VSD is possible before the birth of a child during the ultrasound.
Call your doctor whenever your baby does not gain weight, breathe rapidly, or become breathless while feeding or crying. The growth of a baby is the most important sign. If the baby gains weight well in the first few months of life, the ventricular defect will not lead to significant heart failure. Sometimes babies with ventricular septal defects grow well due to their ability to feed and remain unaffected. A baby may have other signs of congestive heart failure like short and rapid breathing.
If the doctor advises a VSD surgery in India, the patient or family can have a deep discussion with the healthcare members and the specialist surgeon. The cardiac surgeon explains the procedures of Ventricular Septal Defect surgery and the situation the patient is in for a clear understanding and trust.
It is a must for the patient or family to share all the previous medical details and medications with the assigned surgeon. They can also make themselves comfortable asking any queries about the method or health of the patient. In case of an individual takes an anticoagulant, they must inform the doctor and refrain from taking these medicines. Such medicines cause excessive blood flow in and after the surgery, so the doctor will ask to restrain them before the scheduled operation.
Before beginning the procedure, in Ventricular Septal Defect surgery, the doctor prescribes a few medicines to suppress the symptoms till the surgery. The patient goes through a few tests to determine the capability and health quotient to experience the surgical procedure.
The tests are:
The echocardiogram is a test using sound waves to picture the flow of blood and the current structure of the heart.
The individual going for Ventricular Septal Defect surgery has to admit themself to the hospital and take light or liquid food a day prior to the surgical appointment. It is a must for the patient to abide by all instructions given by the pediatric doctor.
Types of Treatment in Ventricular Septal Surgery
Depending on the size, age and area of the opening specialist doctor advise the treatment to the patient. A patient or child with a tiny defect shows no symptoms and can pay timely visits to the cardio surgeon to get a clear view and understanding of any other problems. Treatments of VSD are of two types apart from medicines, they are:
Medications for the ventricular septal defect depend upon the severity of the disorder. The amount of fluid in circulation decreases in the medication process.
This surgical treatment of VSD is done in the few first weeks or months of childbirth to save the infant. The cardiac surgeon creates a cut/incision in the chest and stitches the heart hole to close it or hem a patch of artificial surgical material over it. The heart and lungs machine will maintain blood circulation during the procedure. The tissue of the heart heals and finally covers the synthetic patch or stitches made on it. For surgical treatment, the average hospital stay is 7 to 10 days. Usually, in a span of six months, the tissues completely cover the hole. This surgery of VSD is known as PA banding. The PA banding reduces the blood flow to the lungs and protects against damage to lung arteries. With time, when the baby grows up, another surgery is necessary to remove the PA band and close the defect with open-heart surgery.
Cardiac catheterization is done in rare cases and is the other option for VSD treatment. The heart surgeon covers a few Ventricular septal defect types with the cardiac tubulation method. The catheterization does not require an opening of the chest. The surgeon installs a flexible, thin catheter in the blood vessel of a child’s leg or adult’s leg leading towards the heart. A tube helps to know the flow of blood, the pressure in the heart cavity and the oxygen levels. A specific channel tube with the shape of two disks forms a flexible mesh of wires placed in the hole of the septum. The device has a built-in pattern with the septum walls on either side permanently sealing the VSD. Once you complete your treatment, a complete evaluation is necessary for better results.
If the problem occurs in the patch of VSD, continuous endocarditis prevention medicine is necessary.
The health care team helps the patient get through the pre-procedures of the Ventricular Septal Defect Surgery in India and guides them conveniently to the operating room. A specialized cardiac surgeon will brief them about the procedure, wherein they clear any remaining doubts.
A patient is under anaesthesia by the specialist before beginning the procedure of surgery. Anaesthesia is necessary for the patient to remain unconscious and numb their senses while undergoing surgery for VSD. Then the patient is shifted to the operation theatre to begin the surgery.
The operating room will be ready for the scheduled patient with the Head surgeon, assistants, anesthesiologist, technicians and qualified nurses. The patient under anaesthesia will be unconscious, sleeping throughout the Ventricular Septal Defect surgery. The surgeon in charge makes a cut/incision in the centre of the chest, reaching the heart through the breastbone. Meanwhile, the patient is in connection with the heart & lungs machine pumping blood and working as the lung-heart of the patient throughout the VSD surgery. The cardiac surgeon will locate the wall going through the heart valves. On detecting the opening in the ventricle, the doctor firmly stitches an artificial patch. Once the patch is firm, the heart begins to function normally. The surgeon, upon completion of the process, removes the heart and lungs pumping machine. Then the breastbone is set back in its original place through surgical wires, closing the chest muscles and securing the skin with a bandage.
When the treatment surgery for VSD is complete, the patient is taken to the ICU to closely monitor the blood pressure, heart rate, breathing and level of oxygen post the surgery. Pain killers and other medicines are in prescriptions as per the condition of the patient and recommendations by the doctor. The patient is later in the recovery room, depending on the improvement. But, the duration a patient stays in the hospital is on several factors. Determining factors of the hospital stay are the defect type, level of defect, infections or complications in the surgical procedure and the complete rate of recovery. The patient will undergo a few tests, such as an echocardiogram or electrocardiogram for checkups. In many cases, the patient is stable to move around and get a hospital discharge around after a week of VSD surgery.
Usually, the patients undergoing Ventricular septal defect surgery tend to recuperate smoothly and without any severe complications. The surgeon in charge can monitor them closely to detect any symptoms or signs indicating problems. The doctor will ask the patient to regularly visit the hospital for some time to get routine checkups done.
In case of breathing issues, consult the doctor immediately or take the patient to the ER. The signs needing immediate care post-surgery are
Growing pain, being tender or oozing pus from the place of surgery.
The Support and Coping Period
The patient post VSD surgery needs to follow and take good care throughout an individual life. They should go for checkups frequently so the doctor can monitor the condition and check any complication signs. It is essential for pregnant ladies to consider a safe pregnancy and to experience pregnancy healthily and securely.
After the treatment of VSD, the patient and family can join support groups with people having heart ailments or defects. These groups are helpful in finding answers and connecting to other different families. They can initiate sharing their concerns and hopes with the other people going through a similar challenge.
A patient should maintain frequent dental follow-ups and oral hygiene to restrain endocarditic.
To follow exercises that can keep the patient healthy, safe and active.
Complications when the patient does not go for VSD Surgery:
It is a heart muscle disarray creating difficulty for the organ heart in pumping blood to the body. It can further lead to the failure of the heart. The prime cardiomyopathy types include hypertrophic, dilated, and restrictive cardiomyopathy. It has various treatments like medicines, healing tools and heart surgery.
This ailment in the heart causes the thickening of muscles in the heart. As the muscles are fat, it is tough for the heart continuously pump blood to the body and lungs. It arises from genetic mutation of cardiac protein sarcomere. HCM is a commonly caused disorder resulting in unexpected expiry at a young age.
The noticeable VSD increases high blood outflow in the pulmonary arteries to cause excessive blood coercion in the lungs is pulmonary hypertension. Such actions bore to create irreversible damages. They can also cause Eisenmenger syndrome- reverse blood flow from the hole.
It is a common heart infection that is also a complication.
Types of Ventricular septal defect
There is a possibility of more than one hole in the case of an infant. Moreover, the location may differ(not specified) in the septum.
In membranous VSD, an opening in the upper section of the ventricular septum is present (also called the membranous septum). Membranous VSD is the most commonly operated type of VSD.
A hole in the muscular section is present. In muscular VSD, an opening exists in the lower part of the ventricular septum. In muscular VSD, there is no need for surgery, and the hole closes spontaneously.
In atrioventricular VSD, the hole develops underneath the tricuspid and mitral valve. The VSD correlated to atrioventricular canal defect.
The type of VSDs occurs in the ventricular septum below the pulmonary valve.
The percentage of the ventricular septal defect is half of all congenital heart disease cases.
VSD Size And Effects
The ventricular septal defects range from small to large size. The size plays a prime role in the effects the ventricular septal defect may cause.
VSDs of large size are requisite for a transplant having a width of 06-10mm. The VSD of larger size should be repaired even before 02 years of age to shield from it may cause to the lung and heart. If the hole is unrepaired for 02 years from birth, it may cause permanent damage and eventually result in heart failure.
Moderate VSDs are incapable of complex complications or symptoms in the lungs or heart. The doctor advises a few surgeries or delays as the hole will naturally close over the years.
In many small VSD cases, they remain symptom-free. At around 08 of 10 occurrences in this size, types close naturally till a child reaches the age of 06. Surgery for this type is rare and has a width of or less than 03mm.
If a large or moderate VSD is left unrepaired, it results in persistent impairment of the pulmonary vessels and is a heart disease called Eisenmenger syndrome. In this, the less oxygenated blood also gets pumped into the body, causing an oxygen shortage in the organs.
Diagnosis of a ventricular septal defect
A VSD comes into the picture after the birth of a child. After the childbirth, the doctor hears the heart murmur during the physical examination. The heart murmur indicates the VSD. If the hole is small, the baby does not show any symptoms, and it will close on its own. If the hole is large, the baby shows these signs shortness of breath, poor weight gain, rapid breathing, sweating, and tiredness.
During the physical examination, the doctor hears a sound called a heart murmur. In case; the pediatric doctor observes the problem in heartbeat sound, suggests and asks for required tests. The most common test to diagnose the VSD is an echocardiogram, an ultrasound of the heart. An echocardiogram shows the size of a hole and how much blood flows through the opening. If the hole is small, it may go undetected. Physical examination is the most common way to diagnose VSD.
The best way of detecting chromosomal abnormalities is first-trimester screening which identifies the risks of the cardiac defect.
Tests to diagnose the ventricular septal defect
The doctor can diagnose the VSD during pregnancy using regular ultrasound or echocardiogram. The tests produce sound waves in the body through a device affixed to the chest skin. These wave signals help create an internal and external picture of the heart. The tests do not take long, give results accurately and are painless.
VSD can also detect after birth when the doctor hears a heart murmur using a stethoscope. The doctor can require one or more tests to confirm the presence of VSD. For the detection of the VSD, the tests are the following:
In the echocardiogram, sound waves produce the image of the in-motion heart pictures. A TEE determines the ventricular septal defect and shows the size and location of the hole. An echocardiogram is also called an ultrasound of the heart. The radiologist technician helps the patient glide the transducer. An electrical device is an ultrasonogram tool that is a flexible, thin tube passing through the mouth in a downward direction toward the oesophagus to actual images.
An ECG or electrocardiogram test diagnoses heart defects and rate problems through electrical activity of the heart. The test records the VSD through electrodes attached to the skin and provides a graph or digital print for diagnosing the heart defect. The doctor studies the test and reviews the condition. If the shape of the heart changes, the electrical graph will also change. In many cases, the EKG will be usual if the structure has not changed and the hole is small.
If the hole in the heart is broad, that will transpose the shape and change the functions of the organ heart. Doctors use chest X-rays to see if the heart becomes enlarged and the lungs have extra fluid. a few cases require injecting a chemical substance in the bloodstream for better visibility on heart x-ray.
In CT scans computer is used to provide 3D images of the shape and internal view of the heart. They are helpful to get a good detailing with X-rays.
In cardiac catheterization, doctors insert a catheter into the blood vessels in the arm or upper thigh by following the blood vessels into the heart. The cardiac catheterization determines the function of the heart valve and chambers. This device helps the doctor know the VSD size, place and other things that can hinder the work of the heart. It is advisable if the doctor is dubious of damage to the blood vessels in the lungs.
This medical examination is like sonography and compass by a special ultrasonographer. The doctor of fetal-congenital specialist of heart diseases studies the tests through the images. Determining a fetal heart is feasible in obstetric scans.
The Doppler technique earmarks the determination of the direction and velocity of blood flow by using the doppler effect. This procedure gives an overall inspection of the heart.
It is an echocardiography test under stress. This test determines the work of the heart during stress. The stress test can be medicinal as dobutamine or exercise on the treadmill. Dobutamine stress test or DSE is for individuals who cannot work out.
In pulse oximetry, the small clip on the fingertip measures the quantity of oxygen in the blood.
Therapies for Ventricular Septal Defect
If a patient has VSD, some therapies can help them to provide the normal functioning of the heart and proper control. These therapies are temporary for VSDs the permanent solution is to undergo a Ventricular Septal Defect surgery.
The treatments to balance the heart rhythm are
An ICD is a tiny cell-based tool installed beneath the skin of the chest. It is to fix and terminate the asymmetrical heartbeat. It also displays the heart rate digitally and with helping in restoring a normal rhythm.
The AICD or ICD is a tool wherein a wire inserts the heart through the respiratory tube and right ventricular chamber monitoring the heartbeat. The wire inside the heart works similar to a pacemaker. Placing itself in the upper area of the chest has access to the venous vein by the subclavian veins. ICD transmits shocks by converting the rhythm of the sinus from ventricular fibrillation, saving a life.
A patient with VSD wears a waistcoat to control the heart rate is WCD. It has a defibrillator fitted to it. This gadget helps to restock the opening in critical and irregular heart rates. It can also check the graph and heart rate of the patient. Upon detecting a severe or increasing heart rate, the built-in mechanism sends an electric shock to the heart to maintain the heartbeat and rate.
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|Procedure||Cost in USD||Stay in Hospital||Stay in India||Total Days|
India comes among the leading developing nations in the South-East Asian countries. The country is playing a substantial role in providing health treatments, also a competitive and prominent hub for healthcare. The Ventricular septal defect surgery treatment cost in India with the other facilities is below.
The treatment and the approximate cost for Ventricular septal defect surgery in India can be around $6000 or INR 468,657. It is necessary for the patient to stay for about a week or more at the hospital to monitor the patient closely. They provide excellent quality and advanced medical treatments along with the availability of the lowest rates. The cost includes the structure of medical treatments, with many other facilities for free.
The hospital has good infrastructure, services like money exchange, also a 24/7 availability of translators and helplines. India is among the top countries providing excellent treatments at the most affordable prices for Ventricular septal defect VSD Surgery.
The VSD size has a chief outcome on the survival rate in adults and children.
In small VSDs, the impact is dubious on an individual life. Around 96% of people having unrepaired tiny VSD tend to stay alive above twenty-five years from the diagnosis period.
The effect of moderate and unrepaired VSDs on survival rate is slightly low, and around 86% of people survive for twenty-five years at least from diagnosis.
The large size and unrepaired VSDs have a low survival rate, with 61% of people still living after twenty-five years from diagnosis.
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