Human heart is composed of four chambers(two atria and two ventricles) which are separated by walls between them. The presence of a defect in the wall dividing the two ventricles results in the ventricular septal defect. Although VSD is the most common congenital heart disease accounting for the 20 – 25%, it can also be due to injury to heart such as due to myocardial infarction (heart attack) or a cardiac surgery. It may occur as an isolated defect or in combination with other cardiac defects. Here blood in the left chamber of heart is shunted into the right side. It is seen uncommonly in adults, as most of them close spontaneously by 3 years of age.
Ventricular Septal Defect is usually symptomless at birth. It usually manifests a few weeks after birth. Small VSD can be asymptomatic, but larger ones can result in heart failure, pulmonary hypertension or growth restriction with recurrent respiratory infections like pneumonia. Other features may be poor weight gain, breathlessness on breast feeding and increased heart rate. If not intervened, it can develop into Eisenmenger Syndrome, which has a very bad outcome.
Electrocardiography and echocardiography are the investigations commonly employed. Auscultation of a murmur, produced by the flow of blood through the defect, can be a useful guide for the doctor.
Treatment is either conservative or surgical. Smaller congenital VSDs often close on their own, as the heart grows, and in such cases may be treated conservatively. Conservative approach includes treating the chest infection promptly, iron supplementation to treat anaemia, and regular follow up. Complications such as cardiac failure should be treated promptly. Surgical treatment can be done either by an elaborate procedure done under anaesthesia, where the defect is closed by a patch of tissue from other parts of body. These procedures are now being replaced by interventional cardiac catheterization. Here a small flexible tube is introduced into the heart chamber through a blood vessel in thigh and the defect is closed by using devices such as Amplazter.
