Ventricular Septal Defect: Information & Specialists in Ventricular Septal Defects

Explanation of the term: The medical term “ventricle” refers to the two chambers of the heart. “Septum” refers to the wall separating the ventricles. The term “defect” indicates a flaw, in this case, a hole in the wall separating the ventricles.

Depending on the anatomical location, three types of defects are distinguished:

• Membranous ventricular septal defect: The most common type of defect in the ventricular septum. The hole is located in the membranous upper portion of the septum.
• Perimembranous ventricular septal defect: The hole is located in both the membranous and muscular portions of the septum.
• Muscular ventricular septal defect: A defect in the muscular portion of the septum. It often involves multiple holes.

The heart’s main function is to pump oxygen-poor blood from the body through the lungs. The blood then returns to the heart enriched with oxygen. From the left ventricle, it is pumped back into the systemic circulation.

The pressure in the left ventricle is higher than the pressure in the right ventricle, which is responsible for the pulmonary circulation.

A ventricular septal defect means that there is a connection between the two ventricles. As a result, oxygen-rich blood flows back from the left ventricle into the right ventricle. This blood is then pumped into the pulmonary circulation together with the oxygen-poor blood from the systemic circulation.

This reversal of blood flow is also known by the medical term “Eisenmenger reaction.” The process places a heavy strain on the pulmonary vascular system, the ventricles, and the entire heart.

The extent of the strain depends on the size of the defect in the heart’s septum. If the hole is very small, it usually does not cause any symptoms.

In cases of a larger defect, infants suffer from shortness of breath and rapid breathing. Children find drinking difficult due to the additional physical strain, and they break into a sweat while doing so. In addition, newborns lag behind in their overall development. This is primarily evident in their lack of weight gain.

Furthermore, there is an increased susceptibility to infectious diseases, particularly of the respiratory tract. If left untreated, the chronic lack of oxygen causes

• blue discoloration of the fingertips and toes, as well as
• a bluish discoloration of the tongue

in children.

This congenital heart defect is usually due to a genetic defect. A malformation during embryonic development causes the heart chambers to grow abnormally.

This may be caused by an infection during pregnancy, such as

• rubella or
• herpes viruses.

Other possible causes include harmful substances consumed during pregnancy, such as

• medications or
• alcohol.

In most cases, however, no specific causes can be identified.

Pediatricians and pediatric cardiologists have various methods at their disposal for diagnosis:

• Auscultation: Using a stethoscope, changes in heart sounds can be detected even in infants
• Ultrasound examination: A specialized form of ultrasound, known as echocardiography, visualizes blood flow within the heart
• ECG: The ECG is used to record the heart’s electrical activity and assess the heart’s workload
• X-ray: Chest X-rays allow for the assessment of the heart’s size and position

If these diagnostic methods cannot detect the holes with sufficient accuracy, further, even more precise examinations are necessary. These include magnetic resonance imaging (MRI) and cardiac catheterization.

To monitor how much oxygen is entering the blood, it is also necessary to monitor oxygen saturation.

Smaller ventricular septal defects often close on their own during the first few years of life. If the defect is moderate to large in size, surgery is unavoidable. The procedure should then be performed as early as possible.

The child should not be subjected to any significant physical exertion until the surgery. Until then, the doctor may also prescribe medication. This helps the heart work more efficiently and alleviates the child’s symptoms.

The surgery cannot be performed on a beating heart. The heart must be stopped for the procedure. Therefore, the patient is connected to a heart-lung machine. This machine takes over the heart’s function for the duration of the surgery. It oxygenates the blood and pumps it throughout the body.

First, the surgeon opens the chest and the right atrium. Then, through the heart valve, the surgeon treats the hole in the septum between the right atrium and the right ventricle.

The hole is either sutured or patched with a plastic patch. For smaller defects, the hole can be closed using a catheter with a small umbrella-like device. The device is guided through the femoral vein to the appropriate location in the heart.

After the surgery, the patient is monitored in an intensive care unit.

Thanks to advanced medical technology, complications are now rare. The child begins to feel better just a few days after the surgery. They can breathe normally again and quickly make up for any weight loss. For older children, light physical activity—in consultation with the doctor—can be beneficial for the recovery process.

The child will not face any physical limitations for the rest of their life. The surgery enables a normal

• quality of life,
• career choice, or
• pregnancy.

The child’s life expectancy is no different from that of people with healthy hearts. Nevertheless, lifelong follow-up examinations of heart function—particularly of the heart chambers—are necessary.