Ventricular Septal Defect Surgery

A surgical procedure done to repair a ventricular septal defect is known as a ventricular septal defect surgery.
A ventricular septal defect is a hole or defect present in the septum or wall that separates the right and left lower chambers of the heart (ventricles). It is usually congenital (present at birth), however, it can also develop later in life following a heart attack, or as a complication following some heart procedures.

The heart is made up of four chambers, the right and left atria (upper chambers), and the right and left ventricles (lower chambers). Usually, the right side of the heart pumps blood to the lungs, where the blood is oxygenated and pumped to the left side of the heart. From here, the blood goes through the aorta (the main artery of the heart) to the different parts of the body.
In case of a ventricular septal defect, the oxygenated blood mixes with the deoxygenated blood, leading to an increase in the pressure and flow of the blood in the lungs. This increases the workload of both, the heart and the lungs.

Types:
The different types of ventricular septal defects are:

1. Membranous: It is the most commonly seen ventricular septal defect. It occurs in the upper part of the wall or septum between the right ventricle and left ventricle.
2. Muscular: When there are more than one holes present in the septum between the ventricles, the condition is known as a muscular ventricular septal defect.
3. Inlet: When a hole is present just below the mitral valve, which is present in the left ventricle, and the tricuspid valve, which is present in the right ventricle the defect is known as an inlet.
4. Outlet: When a hole is present just before the pulmonary valve, which is a valve through which the pulmonary artery carries blood to the lungs, in the right ventricle and just before the aortic valve, which is a valve through which the aorta carries blood from the heart to the rest of the body, in the left ventricle the defect is known as an outlet.

Causes:
Ventricular septal defect is generally a congenital (present at birth) heart defect.
However, it may also develop later in life due to conditions like a heart attack, or as a complication of a heart-disease treatment.
The exact cause of the ventricular septal defect is not known.
Environmental and genetic factors may play a role in causing a ventricular septal defect.

Risk factors:
Some factors may increase the risk of developing a ventricular septal defect. These factors may include:

• A family history of heart defects
• Genetic disorders, like Down syndrome (a disorder that occurs during the development of the fetus, leading to a developmental and intellectual delay)
• A person of Asian origin
• Drug abuse during pregnancy
• Alcohol consumption during pregnancy
• Smoking during pregnancy

Symptoms

The following symptoms may be associated with a ventricular septal defect:

• Poor appetite

• Failure to thrive (no weight gain or slow weight gain) in children

• Breathlessness or rapid breathing

• Getting tired easily

• Weakness

• Heart murmur (a whooshing sound) heard by the doctor using a stethoscope 

• Arrhythmias (irregular heart rhythm)

• Heart failure (an inability of the heart to pump adequate blood to the rest of the body)

• Pulmonary hypertension (increased blood pressure in the lungs)

• Eisenmenger syndrome (blood flow is reversed through the hole)

• Cyanosis (pale skin or bluish tinge of the lips and skin)
  

Diagnosis

1. Physical examination: The doctor will check the symptoms of the patient and also check with a stethoscope if a heart murmur can be heard. This could indicate a heart defect.

2. Chest x-ray: It helps the doctor in evaluating the condition of the heart and lungs.

3. Echocardiogram: Sound waves are used to obtain the images of the heart in motion. It helps the doctor in evaluating heart-related problems.

4. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and diagnosing heart problems.

5. Pulse oximetry: The amount of oxygen in the blood is measured by placing a small clip on the fingertip.

6. Cardiac catheterization: A catheter, which is a thin, flexible tube, is inserted by the doctor into the groin or arm region and then guides through the blood vessels into the heart region. This test helps in diagnosing congenital heart problems and determining the function of the heart chambers and valves.
   

Treatment

Many cases of ventricular septal defect close on their own in childhood.
Moderate to severe cases of ventricular septal defect may require treatment. The doctor may recommend certain medications to relieve the symptoms of the patient, like diuretics (which prevent the fluid buildup around the heart by removing the extra fluids from the body), and heart failure medicines like digoxin that can help to control the timing and strength of the heartbeats.

The different types of surgical procedures that can be performed to repair a ventricular septal defect include:
1. Surgical repair:

• The most commonly done for the repair of a ventricular septal defect is called open-heart surgery.
• This procedure is done under general anesthesia, that is, the patient is put to sleep during the procedure.
• An incision (cut) is first made by the surgeon in the chest area.
• If the size of the hole between the two ventricles is small, the surgeon will simply stitch (suture) it to close it.
• In case of a moderate or severe defect, the surgeon will either place a patch made up of synthetic material or graft the patient’s own tissue into the area of the defect.
• The heart tissue then starts growing over and around the patch.

2. Transcatheter procedure:

• The surgeon first injects local anesthesia in the groin region to numb that area.
• The doctor then inserts a thin tube, called a catheter, into a blood vessel into the groin region and then guides it towards the heart region.
• A specialized device called an occluder, which is made up of a mesh framework covered in a synthetic material, is placed through the catheter to plug the hole.
• The heart tissue will later grow over and around the mesh.

Risks

The complications associated with a ventricular septal defect are:

• Pulmonary hypertension (increased blood pressure in the lungs)

• Eisenmenger syndrome (blood flow reversal through the hole, causing permanent damage to the lungs)

• Heart failure (the heart fails to pump enough blood to the body)

• Endocarditis (heart infection)

• Bleeding

• Blood clot formation

• Allergy to anesthetic agents

• Arrhythmias (abnormal heart rhythms), requiring a pacemaker placement and life-long medication

• Leakage from the heart valves

• Recurrence of a hole, requiring a repeat surgery

• Death

After Procedure

• It is normal to feel some soreness after the procedure. The doctor may recommend some painkillers to relieve the pain and discomfort after the procedure.

• The doctor may recommend tests like an echocardiogram or ECG after the surgery.

• The patient can normally go home seven days after the surgery.

• Avoid any activities that may cause a blow to the chest.

• It is normal to get tired easily, for a few days after the procedure.

• Most patients can resume their daily activities rapidly after the surgery.

• The doctor will remove the stitches after one or two weeks of the procedure.

If there are any unusual symptoms like bleeding, swelling, fever, or drainage, contact the doctor immediately.
Follow all the diet, wound care, lifestyle, and medication recommendations given by your doctor.
The patient will normally be prescribed antibiotics before any medical or dental procedures to prevent the infection of the heart valves.
Regular follow-ups with the doctor are recommended. 
Most patients can lead a normal life after the surgery, with no restrictions on activity.
Most cases of ventricular septal defect are permanently treated by surgery.