Ventricular septal defect (VSD) is the most common congenital heart defect, representing abnormal communication between the right and left ventricles. While many small VSDs close spontaneously, larger defects cause significant left-to-right shunting requiring surgical or catheter-based closure. Livasa Hospital provides comprehensive VSD management from diagnostic evaluation through definitive closure with excellent outcomes.

Understanding Ventricular Septal Defects

The ventricular septum is the wall separating the right and left ventricles. VSDs are classified by location:

• Membranous VSD – Most common (70% of cases); below the aortic valve

• Muscular VSD – Within the muscular septum; more likely to close spontaneously

• Outlet (conal) VSD – Beneath the pulmonary and aortic valves

• Inlet VSD – Associated with inlet septum abnormalities

Haemodynamic Effects

The size of the VSD determines haemodynamic significance:

Small VSDs ("restrictive"):

• Minimal left-to-right shunting

• Normal cardiac size and function

• Low risk of complications

• Often close spontaneously

Large VSDs ("non-restrictive"):

• Significant left-to-right shunting

• Left ventricular and atrial dilatation

• Progressive pulmonary hypertension risk

• Require closure before complications develop

Clinical Presentation

Symptoms depend on VSD size and age:

Small VSDs:

• Often asymptomatic (detected by murmur)

• Normal growth and development

Large VSDs:

• Poor feeding and failure to thrive

• Recurrent respiratory infections

• Breathlessness with exertion

• Progressive fatigue

• Heart failure symptoms (in severe cases)

Diagnostic Evaluation

Diagnosis and assessment includes:

• Clinical examination – Characteristic murmur heard at left sternal border

• Chest X-ray – Cardiomegaly and pulmonary congestion in large defects

• ECG – Ventricular hypertrophy patterns

• Echocardiography – Gold-standard; demonstrates defect, size, location and shunt magnitude

• Cardiac catheterization – Occasionally needed for pulmonary vascular disease assessment

Management Approach

Conservative Management:

• Small VSDs followed expectantly

• Natural closure occurs in 30–50% of muscular VSDs within 2 years

• Regular follow-up echocardiography

Medical Therapy:

• Diuretics for heart failure symptoms

• ACE inhibitors to reduce afterload

• Antibiotics to prevent endocarditis

Interventional Closure:

• Catheter-based closure for selected secundum-type VSDs

• Minimally invasive with excellent results

Surgical Repair:

• Indicated for large VSDs causing heart failure

• Risk of progressive pulmonary hypertension

• Failure of medical therapy

The VSD Repair Procedure

Surgical repair involves:

1. Median sternotomy and cardiopulmonary bypass

2. Right atrial or ventricular access to identify the defect

3. Direct closure using primary suturing or patch placement

4. Careful attention to nearby valves and conduction pathways

5. Verification of complete closure

6. Bypass weaning and closure

Post-Operative Management

• ICU monitoring for 24–48 hours

• Gradual weaning from mechanical ventilation

• Progressive activity escalation

• Hospital discharge on postoperative day 5–7

Long-Term Follow-Up

• Periodic echocardiographic surveillance

• Assessment of valve function

• Detection of complications

• Endocarditis prophylaxis guidance

Outcomes

• Operative mortality <1% for isolated VSD repair

• Excellent long-term functional outcomes

• Normal exercise capacity achievable

• Life expectancy equal to general population

Why Choose Livasa Hospital?

• Experienced congenital cardiac surgeons

• Specialised paediatric cardiac anaesthesia

• Dedicated paediatric cardiac ICU

• Access to catheter-based closure when appropriate

• Comprehensive long-term follow-up

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

Call +91-80788 80788 to arrange evaluation for VSD at Livasa Hospital.