Ventricular Septal Defect

Treatment

Some ventricular septal defects (VSDs) may close themselves over time, particularly muscular and perimembranous ones. Cardiologists may wait to see if this happens on its own. However, surgery is often necessary if too much blood passes through the hole(s) or increases aortic valve leakage. Some VSDs can be successfully closed in the hospital’s catheterization lab using special devices, thus avoiding open-heart surgery.

Medications

If the VSD doesn’t close on its own, the cardiologist may recommend anti-congestive heart failure medications. These may include:

• Diuretics – The most commonly prescribed diuretics are furosemide (Lasix) and thiazides (Diuril and Hydrodiuril). Diuretics act to cause the child to pass more urine, leading to a smaller blood volume—and a smaller burden on the heart to pump. Another commonly used diuretic is spironolactone (Aldactone). It has a weak diuretic effect and is mainly used because it helps the kidneys retain potassium since other diuretics tend to waste potassium excessively.
• Inotropes – These medications, which include digoxin, help the heart pump more efficiently, i.e., stronger while using less energy.
• Afterload-reducing agents – These drugs, including captopril, are sometimes used to treat VSDs. However, they help blood flow to the body and perhaps less to the lungs. This leads to less blood crossing the VSD and a reduction in congestive heart failure.

In patients with pulmonary hypertension or Eisenmenger syndrome, medications that lower pulmonary arterial resistance, such as phosphodiesterase 5 inhibitors (e.g., sildenafil or tadalafil), endothelin receptor antagonists (e.g., bosentan) or prostacyclins may be prescribed.

Surgical closure

Open-heart surgery may be recommended if the VSD is too large if medications aren’t helping, if the function of the valves is affected, or if the child is beyond an age when the VSD may close by itself. The surgeon opens the heart and closes the defect using a patch or sutures during surgery. The child who undergoes surgery may stay in the hospital on average between three to five days.

Occasionally, surgery may be recommended if the VSD isn’t large but is causing damage to the nearby aortic valve. This valve is responsible for keeping blood flowing out in one direction from the heart’s left ventricle to the blood vessel that carries blood from the heart to the rest of the body (aorta). This may cause the valve to leak due to distortion of the valve leaflets.