From your
Guide
Dr.MANI 		Heart Disease Online Guide Photo - DR.MANI explains Congenital heart disease, Heart valve disease, Coronary artery disease, Heart failure, Angina, Heart attack, Bypass surgery, CABG, Angioplasty, PTCA, MIDCAB, Health, Fitness, High Cholesterol, Arrhythmia, www.dencats.org, www.dencats.org/heart, Webcasts, Resources, Links, Heart disease books,Cardiac surgery, Cardiothoracic surgery, Cath, ECG, EKG, Xray, Angiogram, Echo, Echocardiogram, Catheterisation and much more

Ventricular Septal Defect - VSD

Heart Disease Best of the Net - Ventricular Septal Defect, VSD, vsd, Congenital heart disease,heart birth defects

home

|

disease

|

webcast

|

latest

|

links

news

|

archive

|

contact

|

books

|

disclaimer

Ad Banner

Should a VSD be repaired ?

There is not much doubt about the need for closure in a large VSD where the patient usually has severe symptoms due to heart failure. But the decision is not always easy.
There is another special thing about VSD. Some of them close even without any treatment ! There is no way to definitely and reliably predict which VSD will close and which will not. The best chance for closure is in the first six months of life. After this, spontaneous closure becomes less frequent. If by the tenth year of life the VSD has not closed by itself, it probably needs to be repaired.
There is one exception to this rule - the SMALL VSD. There is still much controversy about this problem. While surgeons advise that small VSD's be repaired, cardiologists sometimes recommend "no treatment". The arguments against repair are the small risk and discomfort involved with surgery, and the absence of any symptoms in most patients. The surgeons however claim that

  • repair is safe and has very few complications
  • all chances of future effects, particularly infective endocarditis, are avoided
  • the child and parent are freed of the "psychologic" stigma of heart disease
  • life and health insurance issues arise in some countries

The decision to repair these small defects would perhaps depend on the hospital, and the philosophies of the parent and the doctor.

When should a VSD be repaired ?

This is another area where decision making is very complex. Factors to be considered are the age of the patient, size and location of the VSD, severity of lung vessel blood pressure and the degree of symptoms of heart disease.
In very small babies with severe heart failure and large VSD, IMMEDIATE repair usually cannot be avoided. If there is no heart failure, however, surgery can be postponed until SIX MONTHS of age. The reason for this is that a certain number of VSD will close spontaneously by this age. Beyond six months, the decision to close a VSD is based on measurement of PULMONARY VASCULAR RESISTANCE - that is, the degree of damage to lung blood vessels. If the damage is not too severe, closure is strongly recommended. If the damage is severe, repair of the VSD may actually be HARMFUL. These patients have crossed the boundary of "operability".
With medium-sized VSD's, a longer waiting period is possible. If even after five to ten years the VSD has not closed, repair is justified. A special group is the VSD's that are just below the aortic valve. Because of the risk of the valve becoming "leaky" in these patients, earlier repair - before five years - is better.

NOTE: A lot of controversy still surrounds issues related to closure of VSD. The facts I have mentioned above are only currently "accepted guidelines". The decision about which treatment option is best for a particular case is best made by the physician who analyzes all the factors.

What are the ways to close VSD's ?. Read on ....
Back Next

 

 

Conceived, created and designed by Dr.S.Sivasubramanian.
Copyright 1998, All rights reserved.