Posts Tagged ‘ventricular septal defect’

Ventricular Septal Defect

Tuesday, March 9th, 2010

Ventricular septal defect (VSD) is a hole in the wall (called the septum) that separates the right and left ventricles.

When the left ventricle contracts, in addition to sending blood out the aorta, it sends oxygenated blood through the defect to the right ventricle. In the right ventricle, this oxygenated blood mixes with the normal unoxygenated blood coming back from the body and then it is all pumped to the lungs. The result is more blood than normal is pumped to the lungs and, in turn, more blood than normal returns from the lungs to the left atrium and left ventricle. If the hole is more than small, then this increase in blood returning to the left atrium and left ventricle causes these chambers to enlarge and work harder than normal. If the enlargement is significant, then the left ventricle may not function efficiently and blood can back up into the lungs. This may lead to signs of congestive heart failure. In addition, large ventricular septal defects can lead to increased blood pressure in the arteries in the lungs (called pulmonary hypertension) and may eventually lead to damage in the small arteries in the lungs.

What are the warning signs and symptoms of ventricular septal defect?
There are often no obvious signs or symptoms of a ventricular septal defect in a newborn infant. After several days or weeks, the following may appear and suggest the presence of a VSD:

  • Abnormal heart murmur
  • Labored breathing
  • Poor feeding
  • Poor growth

How is ventricular septal defect detected?
Often the first sign of a ventricular septal defect is the presence of an abnormal heart murmur. This often leads to the performance of an echocardiogram, which generally will show the precise anatomy of the defect as well as its size and effect on the heart function.

What are the treatment options for ventricular septal defect?
Ventricular septal defects are small and most of these will get even smaller or close by themselves. A medium-sized ventricular septal defect may need to be closed surgically but it is often possible to wait several years to see if the VSD will get smaller on its own. Small VSDs often never need treatment. If the VSD, however, is large enough to cause the left ventricle to be enlarged and there are no signs that the hole is getting any smaller, surgery is generally recommended. Large ventricular septal defects will require surgical closure, the timing of which depends on the degree of symptoms. Symptoms often can be improved by giving the infant medication such as:

  • Diuretics, which decrease the amount of fluid retention in the body by increasing urine output
  • Digoxin, which helps the heart pump more efficiently
  • After-load reducing medicines, which improve the forward flow of blood from the left ventricle to the aorta

If, in spite of medication, the infant is still symptomatic, then surgery will be necessary. If the symptoms are improved but the hole is large, then a short period of observation is possible to see if there are any signs that the hole is getting smaller. Recently, some ventricular septal defects have been closed in the cardiac catheterization laboratory with devices that are undergoing research.  The vast majority still require surgical closure, however.

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Tetralogy of Fallot

Tuesday, March 9th, 2010

Tetralogy of fallot is a name given to a complex of four cardiac malformations when they appear together.

The above mentioned cardiac malformations are: ventricular septal defect, pulmonary stenosis, right ventricular hypertophy, and overriding aorta. For practical purposes, however, the signs and symptoms of tetralogy of fallot depend on the ventricular septal defect and the degree of pulmonary stenosis. The VSD is a large hole in the wall between the ventricles. Pulmonary stenosis is a narrowing in the outlet from the right ventricle to the pulmonary artery. With more severe degrees of pulmonary stenosis, the right ventricle delivers less and less blood to the arteries to the lungs for oxygenation. With increasing degrees of pulmonary stenosis, more and more of this blue blood (lacking oxygen) is directed away from the lungs, through the ventricle septal defect, and back to the left ventricle and out to the body. Thus, as the pulmonary stenosis becomes increasingly narrowed, the patient becomes more blue.

What are the warning signs and symptoms of tetralogy of fallot?
The most common warning signs and symptoms of tetralogy appear in a newborn or young infant and include bluish coloring around the mouth, lips, tongue, and fingertips (called cyanosis) and presence of a heart murmur.

Occasionally, early on, the degree of pulmonary stenosis will be very mild and the symptoms will be that of a ventricular septal defect, including labored breathing, poor feeding, and poor weight gain.

How is tetralogy of fallot detected?
Usually tetralogy patients are initially referred for evaluation because of a heart murmur or cyanosis. This leads to performing an echocardiogram and the diagnosis of tetralogy is documented. Occasionally, a cardiac catheterization with angiography is needed prior to surgery to obtain more detailed anatomical information.

What are the treatment options for tetralogy of fallot?
Patients with tetralogy of fallot generally undergo surgery in infancy. Most often a complete repair is performed with patch closure of the ventricular septal defect and widening of the outflow from the right ventricle to the pulmonary artery. Occasionally, it is too dangerous to perform open-heart surgery on a particular infant and a temporizing surgery is performed called a shunt, which allows more blood to flow to the lungs. The open-heart repair is then deferred until the patient gets bigger. Sometimes, infants will have periods of inconsolable crying accompanied by a severe increase in cyanosis (called “Tet Spells”) requiring immediate notification to the child’s physician.

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