| From your Guide Dr.MANI |  | |
Ventricular Septal Defect - VSD | ||
| From your Guide Dr.MANI | | |
Ventricular Septal Defect - VSD | ||
| |
What are the ways to close VSD's ?
Surgical closure by an open heart operation is the "tried and tested" approach for VSD. The
surgeon may close the VSD by opening the right atrium or ventricle, or maybe even only the
pulmonary artery or aorta. Rarely, when multiple VSD's are present - the so-called SWISS
CHEESE VENTRICULAR SEPTUM - an access through the left ventricle is preferred.
In small VSD, simple closure of the hole with sutures made of POLYPROPYLENE or similar
material is enough. When the defect is large, a synthetic "patch" made of a fabric like dacron or
PTFE (Poly tetra-fluoro ethylene) is used. Interestingly, some surgeons have used a kind of "glue"
to simply plug any holes in the ventricular septum, but this technique is still experimental.
This is the era of "minimal access repair". In keeping with this trend, the "catheter-pushers" (or
INTERVENTIONAL CARDIOLOGISTS, if you prefer that term) have developed a way to close
VSD using catheters. Through a narrow plastic tube - called a catheter - threaded into an artery by
a "needle-stick" in the groin or fore-arm, a special device - called a "clam-shell device" - is guided
into the heart. This umbrella-like device is passed across the VSD and opened. The umbrella
closes the VSD, and it is fixed in place. Though elegant, this method is still under evaluation. If
found equally effective, this may be an alternative to surgery in closure of small VSD's.
Is VSD repair absolutely safe ?
Not ABSOLUTELY, but yes, it is reasonably safe. Life isn't perfect after all! Most complications
are not serious. There may be excessive bleeding requiring a blood transfusion. Infection may occur
and be treated by medicines. The mortality risk is very low, and in most hospitals will be below
2%, except in very sick patients with a large VSD and other defects. There is however one
problem that used to be seen often in older times, but which still may happen. This is an arrhythmia
called HEART BLOCK.
What is heart block ? A weak electrical current is normally produced inside the heart, and it
follows a definite pathway as it excites the heart muscle and stimulates it to contract. This path is
marked out by CONDUCTION TISSUE - a special kind of cell designed to "conduct" or carry
current. The conduction tissue of the heart passes very CLOSE to the margins of some VSD's.
When stitches to repair the VSD are applied, they may injure this conduction tissue. As a result,
electric impulses will not be carried normally, and will get "blocked". This is called heart block. In
some cases, it will recover naturally within a short period. But in some it does not, and needs
implantation of an ARTIFICIAL PACEMAKER - a device that delivers an electric current and
sets the "pace" of the heart.
How does the "VSD-repaired" patient do in the long run ?
Fortunately, very well. Most children lead normal lifestyles. Very few restrictions apply. For
instance, if they have had surgery through an incision through the middle of the chest, that has split
the breast-bone, they are limited from playing rough contact sports for fear of fracture. If a
synthetic "patch" has been used to close the VSD, some medicines may need to be taken for the
first few weeks after operation to prevent blood clotting on the patch. Even later on, before other
minor operations or medical tests - like having dental work or a tooth extraction - some medicines
called ANTIBIOTICS may need to be taken for a day or two, to decrease the risk of infection on
the patch. During any illness in the future, don't forget to mention to the doctor that a patient has
had operation for a VSD. Otherwise, VSD-repaired patients have an almost normal life.
If there's anything more you want to read about, or some areas which aren't clear enough, don't
hesitate to write and let me know.
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Copyright 1998, All rights reserved. |
