Below article is dedicated for my beloved Aletta (siap2 buat cabut gigi ya Kak…;P)
taken from: http://www.kidshealth.org/parent/medical/heart/vsd.html
Ventricular septal defect, the most common congenital heart defect, is a condition defined by one or two holes in the muscle separating the left and right ventricles of the heart.
About Ventricular Septal Defects
The heart consists of four chambers: The lower chambers are the left and right ventricles, and the upper chambers are the left and right atria. In someone without a heart defect, blood in need of oxygen flows to the right atrium, then to the right ventricle, from where it’s pumped through the pulmonary artery to the lungs to receive oxygen. The oxygenated blood then returns to the left atrium, flows into the left ventricle, and then heads out to the body through the aorta, a large blood vessel that carries blood from the heart to the smaller blood vessels in the body.
A ventricular septal defect, or VSD, leaves an opening in the wall (the septum) between the right ventricle and the left ventricle. As a result, when the heart beats, some of the blood in the left ventricle (which has received oxygen from the lungs already) is able to flow through the hole in the septum into the right ventricle. In the right ventricle, this oxygen-rich blood mixes with the oxygen-poor blood and is directed via the pulmonary artery back to the lungs. The blood flowing through the hole creates a swishing sound, which is what’s called a heart murmur.
Ventricular septal defects are quite common — about 8 out of every 1,000 babies born have heart defects, and about 30% of those babies have VSDs. In about 40% of kids born with VSDs, the hole is small and closes on its own after birth. If a VSD is large and requires surgery to be closed, it will probably be corrected during early childhood. In the remaining cases (kids with VSDs that have not been corrected by surgery and have not closed on their own), the hole is too small to cause health problems.
Causes
Ventricular septal defects occur during a baby’s development and are present at birth. Before birth, the heart develops from a large tube, dividing into sections that will eventually become its walls and chambers. If a problem occurs during this process, a hole in the wall that divides the left ventricle from the right may result.
For most people with a VSD, no one knows exactly why it happens. In some cases, the tendency to develop a VSD may be genetic.
Signs and Symptoms
VSDs are usually found in the first few months of life by a doctor during a routine checkup. The size of the hole and where it’s located in the heart will determine whether the child experiences symptoms of VSD. Most kids with VSD won’t remember having it because it either goes away on its own or is diagnosed so early in childhood that there’s no memory of any surgery or recovery.
Older kids or teens who have small VSDs that haven’t closed usually experience no noticeable physical signs other than the heart murmur that doctors hear. They may need to see a doctor regularly to check on the heart defect and make sure there aren’t any problems.
The very small number of those with moderate and large VSDs that haven’t been treated in childhood may notice some symptoms, however. These include shortness of breath, a feeling of tiredness or weakness (especially during exercise), poor appetite, and trouble gaining weight. Fortunately, though, advancements in medicine during the past few decades mean that most kids with moderate to large VSDs are treated long before the VSD ever causes physical symptoms.
Diagnosis and Treatment
If your child is discovered to have a heart murmur that was not noticed earlier, a doctor may refer you to a pediatric cardiologist, who specializes in diagnosing and treating heart disease in kids and teens.
In addition to doing a physical examination, the pediatric cardiologist will ask about your child’s medical history, including any concerns and symptoms your child has, your child’s past health, your family’s health, any medications the child is taking, any allergies the child may have, and other issues. If a VSD is suspected, the cardiologist may order one or more of the following tests:
- a chest X-ray, which produces a picture of the heart and surrounding organs
- an electrocardiogram (EKG), which records the electrical activity of the heart
- an echocardiogram (echo), which uses sound waves to create a picture of the heart
- a cardiac catheterization, which provides information about the heart structures as well as blood pressure and oxygen levels within the heart chambers
If a VSD is diagnosed, treatment will depend on your child’s age, the size of the hole, and where it’s located in the heart. There’s no concern that a VSD will get any bigger, though: VSDs may become smaller, close completely without treatment, or they may not change, but they don’t get any larger.
A child with a small defect that causes no symptoms may simply need to visit a pediatric cardiologist regularly to make sure that there are no problems. In most children, a small defect will close on its own without surgery. And there’s more good news — if your child has a small VSD, you probably won’t have to restrict sports or extracurricular activities in any way.
For kids with medium to large VSDs, surgery may be necessary to close the defect. In most cases, this surgery takes place in young children — usually before a child’s second birthday — so the only reminder that the child had a VSD is a scar on the chest. A few people have surgery for a ventricular septal defect during adolescence. Until their VSDs are corrected, those with larger VSDs may need to take medication to help the heart pump more efficiently or help the body get rid of extra fluids.
VSD surgery involves making a cut in the chest so a surgeon can stitch the hole closed or sew a patch of manmade surgical material (such as Dacron or Gore-Tex) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, and by 6 months after the surgery, the hole will be completely covered with tissue.
Instead of surgery, some people with VSDs may have a procedure known as cardiac catheterization. A thin, flexible tube called a catheter is inserted into a blood vessel, and a surgeon guides the tube into the heart and inserts a device that helps to close off the VSD permanently. After healing from surgery or having catheterization, kids with VSDs are considered cured and should have no further symptoms or problems.
Anyone with a VSD needs to take antibiotics before having dental work or other surgical procedures. These drugs help to prevent bacterial endocarditis, an infection of the inner surface of the heart that people with some types of heart defects or heart disease are at greater risk for. If your child needs to have dental work or other surgeries, be sure to let the dentist and doctor know about the VSD so they can take precautions.
Also, teens who have a heart defect should avoid getting body piercings. Because piercing increases the possibility that bacteria can get into the body and infect the heart, it puts people with VSDs at risk for bacterial endocarditis.
Kids who have VSDs corrected will take antibiotics to protect against bacterial endocarditis for 6 months following surgery or catheterization closure. Six months to a year after surgery, though, most VSD patients are considered cured and no longer need to worry about bacterial endocarditis.
Home Care
Children who have surgery for larger VSDs usually leave the hospital within 4 to 5 days after surgery if there are no problems. After the VSD has been repaired, a person will have a scar on his or her chest. The scar may be tender and sore, so the doctor may recommend giving your child a pain reliever if there is a lot of pain. It takes about 6 weeks for a chest incision to heal.
The first few days at home after VSD surgery, your child should rest and only engage in quiet activities such as reading, sleeping, and watching TV. Within 2 to 3 weeks, he or she will probably feel better, but should still take it easy until about 6 weeks after the surgery. Everyone heals differently, so a doctor will advise you of when your child can go back to school and return to normal activities.
In most cases, kids who have had VSD surgery recover quickly and without problems. But some signs and symptoms may indicate a problem. If your child has trouble breathing, get medical treatment right away. Also, if your child rarely feels like eating, has lost weight, has a fever, or has increasing pain, tenderness, or pus oozing from the incision, get medical help.
These days, having a VSD is usually nothing to worry about. Most kids who have had a VSD have a normal life expectancy and go on to live healthy, active lives.
Reviewed by: Henry Sondheimer, MD
Date reviewed: September 2003
