Why is there a hole in your child’s heart?
Some people are born with a hole in their heart. While in some cases, this is as serious as it sounds, in others, it isn’t. Some individuals don’t even know that they have an issue until they’re an adult. How do you know if you have one? Why did it happen? How is it treated?
Ventricular septal defect (VSD) is when there is a hole in the muscular heart wall (septum) that separates the heart’s two lower chambers (ventricles). This allows oxygenated blood from the left ventricle to mix with deoxygenated blood in the right ventricle, which means that your heart must work harder to provide enough oxygen to the rest of the body. It arises from issues during the heart’s development while in utero. There isn’t a clear cause, but thought to be a result of genetics and environmental factors. The holes can vary in size and happen in several locations with in the wall. Sometimes, there can be more than one hole. Also, VSD can occur by themselves or with other congenital heart defects. Typically, they are something that someone is born with, but it is possible to develop them later in life, like after a heart attack or as a complication to various heart procedures. For some individuals who are born with a VSD, they don’t know that they have one until they’re an adult.
Symptoms for infants are poor eating, fast breathing, breathlessness and easily tires. If you notice that your child is not gaining weight, has rapid breathing, tires easily when playing/eating or is breathless when eating/crying, then call their doctor. For adults, symptoms are shortness of breath or a heart murmur (usually heard by a doctor when they listen to your heart). If you develop shortness of breath upon exertion or lying down, rapid/irregular heartbeat or fatigue/weakness, call your doctor. Certain things can increase your risk of developing a VSD, such as a family history or having other genetic problems (ex. Down syndrome). Small VSDs don’t usually cause any noticeable problems, but medium or large ones can result in a wide variety of complications, especially if it isn’t treated. Some of these complications include heart failure, pulmonary hypertension (increased blood pressure within your lungs—it can result in the reversal of blood flow through the whole, which is called Eisenmenger syndrome), endocarditis (uncommon), abnormal heart rhythms and heart valve problems.
Sometimes, an ultrasound during pregnancy can detect a ventricular septal defect or your child’s pediatrician might hear a murmur shortly after they’re born. In either case, the treatment is the same, but is different depending on the size of the VSD. Small ones don’t usually require any intervention and will often close on its own, but your child’s doctor will continue to monitor them to make sure that they don’t develop any complications. If they do develop complications or if your child has a medium-large VSD, they’ll need to have surgery to close the hole by plugging or patching it.
Surgery is done within the first year of their life. The most common procedure is open-heart surgery to place a patch or stitch close the hole. This requires a heart-lung machine to be used during the procedure. The catheter technique doesn’t require opening the chest or using the heart-lung machine. Instead, it means a thin tube (catheter) is inserted via a small incision into a blood vessel of the groin. The catheter is then guided to the heart and a special mesh device is placed to cover the hole. A hybrid procedure combines the two together. While the heart-lung machine isn’t required, a small incision is made in the chest to access the heart and a device is used to close the hole via a catheter placed in the incision. Regardless of the type procedure, your child’s doctor will continue to monitor them for a period of time for after to ensure that it worked and make sure that they don’t acquire complications.
Occasionally, you or your child might need to take medications to treat complications. These can include medication to decrease the volume of fluid in the circulatory system/lungs if you/they have heart failure. If you/they have an irregular heartbeat, medication can correct this as well. It’s also important to prevent endocarditis, which is an infection of the heart tissue. In some cases, this means you or your child might need to take antibiotics before having dental work done. It’s also key to practice good oral hygiene and have regular dental checkups. Children who have small defects or who have had a repair usually have few or no restrictions when it comes to activity or exercise. Just be sure to follow your child’s doctor’s recommendations. It can also be helpful to join a support group in order to talk with others who are going through similar situations.
If you have a VSD, make sure you talk to your doctor before becoming pregnant, especially if you’re taking any medications. If you’ve had a defect repaired without complications or a small defect, then your risk level isn’t higher than if you’d never had one. If you have Eisenmenger syndrome, then you shouldn’t become pregnant because it could be life-threatening.
In order to prevent a ventricular septal defect in your child, there are several things that you can do. It’s vital to have a healthy pregnancy by getting early prenatal care. Another essential thing is to eat a well-balanced diet and take a vitamin supplement that includes folic acid. Limit caffeine and don’t use alcohol, tobacco or drugs while pregnant. Before becoming pregnant, make sure that your vaccinations are up to date to prevent infections while you are and to protect your baby after they’re born. It’s vital to exercise regularly, but check with your doctor as far as what routine is best for you. If you have diabetes, keep in well control before and during pregnancy. If you have a family history of heart defects or other genetic disorders, it can be good to talk to a genetic counselor before becoming pregnant to understand the risk to your future children.
Ventricular septal defects can be mild or life-threatening. Either way, there are treatments available, which will allow you or your child to have a healthy life. If you have any questions or concerns about VSD, please talk to your doctor. If you would like more information, please visit the American Heart Association’s VSD page at https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/ventricular-septal-defect-vsd