What're the treatments for ventricular septal defect?
Treatment of ventricular septal defect is either surgical (open or percutaneous endovascular) or conservative. Smaller congenital ventricular septal defects often close on their own (as the heart grows) and are thus treated conservatively. Open surgical procedures require a heart-lung machine and are done with a median sternotomy. Percutaneous endovascular
procedures are less invasive and can be done on a beating heart, but are only suitable for certain patients. Repair of ventricular septal defects are complicated by the fact that the conducting system of the heart is in the immediate vicinity.
Closing small ventricular septal defects may not be needed. They often close on their own in childhood or adolescence. But if the opening is large, even in patients with few symptoms, closing the hole in the first two years of life is recommended to prevent serious problems later. Usually the defect is closed with a patch. Over time the normal heart lining tissue covers the patch, so it becomes a permanent part of the heart. Some defects can be sewn closed without a patch. Repairing a ventricular septal defect restores the blood circulation to normal. The long-term outlook is good.
Babies who have shown some signs of congestive heart failure will typically be placed on medication, usually a diuretic to help get rid of extra fluid in the lungs. Sometimes digoxin will be added to help increase the squeeze. Sometimes a medication to lower the blood pressure will also be added to relieve the workload of the heart. In babies who are failing to thrive because it is too difficult for them to eat, a high calorie formula or fortified breastmilk will be added to help the baby grow. Sometimes babies get so worn out with feeding that a nasogastric feeding tube is necessary to deliver the food. The goal is to control the signs of heart failure to allow the baby time to grow. In the meantime, the ventricular septal defect can get smaller and cause fewer problems, in which case the infant will not require surgery and will eventually come off medications. When the symptoms of a ventricular septal defect are hard to control with medicines or there is persistent evidence that the heart is doing extra work, surgical closure of the defect is often recommended. Surgical closure of isolated ventricular septal defects is uncomplicated in 99 percent or more of cases. |
