Ventricular septal defect surgery

The heart is composed of four chambers, two upper atria and two lower ventricles. Deoxygenated blood from the body enters the right atrium and goes into the lungs through the right ventricle. From the lungs, oxygenated blood enters the left atrium and passes into the left ventricle, and then gets pumped to rest of your body. Septum is a tissue that seperates the left and right chambers of the heart. Due to the septum, the oxygen-rich blood does not come in contact with the oxygen-poor blood. 

A VSD is a congenital condition in which the baby is born with a hole in the wall between the right and left ventricles. Due to this hole, the oxygen-rich blood mixes up with the oxygen-poor blood. This can cause increased blood pressure in the lungs, and a lack of oxygen in the body. If the hole is tiny, the blood may not mix, and even the hole may close on its own. Medium and large holes, however, do not close on their own and may need surgery. 

Ventricular septal defect (VSD) surgery is performed to close the hole in the septum between the heart ventricles.

Mostly, VSD surgeries are performed before the child reaches one year of age, but in rare cases, it is performed after this age (usually before two years of age). The surgery may also be performed in adults if the condition is not diagnosed during childhood.

In some children, symptoms of VSD are seen right from birth, whereas in others they may become noticeable as they grow. If the child has a small hole, the doctor can hear a murmuring of the heart with a stethoscope, but there may be no other symptoms. If the hole is large, the symptoms may be as follows:

• Fatigue
• Paleness
• Breathing problems
• Rapid heart rate
• Fast breathing 
• Not able to gain weight
• Getting tired while feeding 
• Enlarged liver
• Recurrent respiratory infections

This surgery is not indicated if a person has:

• Small to medium-sized holes in the septum that may close on their own.
• Fixed pulmonary vascular obstructive disease, which develops gradually due ot septal defect and leads to Irreversible pulmonary arterial hypertension. The surgery is usually done before the condition develops. 

You may need to do the following preoperative preparation:

• Your doctor will perform a physical examination and order the following tests:
  • Blood tests to evaluate kidney and liver function
  • Electrocardiogram to check the heart rhythm 
  • Chest X-ray to observe the size and shape of the lungs and heart
• Inform the doctor about all the medicines your child is taking, including any supplements. The doctor may ask you to discontinue some medications including but not limited to non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, beta-blockers, and antiarrhythmics 
• Speak to your doctor if your child has any illness in the days before the surgery as in such a case, the surgery may be postponed to lower the risk of infection. 
• You will need to sign a form providing your consent for the surgery. 
• Bathe the child with an antiseptic soap on the evening before the surgery.
• The patient should be in a fasting condition from midnight before the surgery.

The surgery is carried out in the following manner:

• The patient will be given general anaesthesia (a sleep-inducing medicine) intravenously (through a vein).
• The surgeon will make a vertical incision on the child's chest and will divide their breastbone to access their heart. 
• A heart-lung machine is used for the surgery. The machine will take over the functioning of both the heart and lungs during the procedure. 
• The surgeon will open one of the heart valves (flaps of tissue in heart that keeps the blood flowing in the right direction) of the child to reach the affected septum.
• He/she will cover the hole with a patch made of synthetic material, or may stitch it closed.
• After this, the surgeon will remove the heart-lung machine, reattach the breastbone using wires, close the child's skin and apply a bandage over it.

After the surgery, the child will be taken to the intensive care unit (ICU) and given pain medications along with sedatives to keep him/her comfortable. A small tube may be attached to the child’s chest to drain the fluid that may accumulate as the wound heals.

The doctor will closely observe your child’s vital signs, including breathing, heart rate, and blood pressure. They may also order tests like an echocardiogram or electrocardiogram to check the functioning of their heart.

Once the doctor thinks the child does not need care in the ICU, they may shift him/her to a ward. The medical staff will continue to monitor the child in the ward.

Your child may get discharged in about four to five days after surgery.

Once you reach home, take the following care:

• Your child may need pain medicines even after discharge.
• The incision site should be kept covered with a dressing for atleast a week and the child should not be bathed. Though make sure to keep the surrounding skin clean and dry.
• When the child starts to bath, make sure that the water does not touch the incision site directly until the site is completely healed. Pat dry the site after bathing your child and avoid using any powder or lotion on the wound. Make sure the incision does not get exposed to direct sunlight.
• If your child has a poor appetite after the surgery, do not push them eat. Instead, start with liquids and light meals. Then slowly add fresh fruits and vegetables to their diet to keep up their nutrient intake. 
• Your child may be at risk of infections for a while after the procedure, make sure to wash your hands before you go near them or touch them and keep them away from crowds.
• Do not lift your child from the arms but rather gently pick them up from the bottom as the breastbone is still healing.  
• All strenuous activities, including riding a bike, jumping, and running should be avoided for six weeks. 
• If the child was on a heart-lung machine, vaccines should not be administered for about six weeks after the surgery. 
• For at least six months after the surgery your child may require antibiotics before undergoing another medical procedure as it may otherwise increase the risk of heart infection.

After the VSD surgery, the child can lead a healthy and active life. Your child will not have any restrictions on activities and will also have normal growth.

When to see the doctor?

If you notice any of these problems, rush to the hospital with your child immediately:

• Breathing problems
• Incessant crying or irritability
• Loss of weight or inability to gain weight
• Diarrhoea or vomiting
• Bluish colour on the lips or tongue
• Reduced activity level, fatigue or increased sleepiness
• Difficulty in feeding or poor appetite
• Increased swelling, tenderness, or pain from the incision site
• Release of pus from the incision site
• Fever

Some possible complications associated with this surgery include:

• Infection 
• Excessive bleeding requiring resurgery
• Blockage in the heart 
• A blood clot leading to stroke 
• Injury to the valves
• Complications due to anaesthesia 
• Abnormal heart rhythm 
• Pulmonary hypertension with poor function of the heart
• Residual ventricular septal defect  
• Need for re-surgery
• Death

Your child will need a follow-up in one to two weeks after discharge, where the doctor will check the incision.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.