While reviewing the adoption medical abstract you may come across a cardiac finding that may require further investigation. It is important to determine if there is any cardiac abnormality which may affect the development of the child. There are some congenital heart conditions (those that you are born with) which can occur for a variety of reasons. Some may be due to maternal infections during the pregnancy, medical conditions like Diabetes or Lupus, or result from maternal drug or alcohol use. There are other conditions which may be hereditary. There are many conditions which require no intervention while others may require further monitoring and perhaps medical or surgical therapy.
The heart is divided into four basic chambers. The septum is a wall that separates the heart's left and right sides. Septal defects are sometimes called a "hole" in the heart. A defect between the heart's two lower chambers (the ventricles) is called a ventricular septal defect (VSD). When there is a large opening between the ventricles, a large amount of oxygen-rich (red) blood from the heart's left side is forced through the defect into the right side. Then it's pumped back to the lungs, even though it's already been refreshed with oxygen. This is inefficient, because already-oxygenated blood displaces blood that needs oxygen. This means the heart, which must pump more blood, may enlarge from the added work. High blood pressure may occur in the lungs' blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls. If the opening between the ventricles is small, it doesn't strain the heart. In that case, the only abnormal finding is a loud murmur.
Surgical closure of small VSD’s 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 VSD restores the blood circulation to normal. The long-term outlook is promising.
Children with this VSD’s should be examined regularly by a pediatric cardiologist. They will make sure that the heart is working normally. Most patients won't need to limit their activity. However, if they develop pulmonary hypertension or the heart doesn't pump as well as it used to, their activity may need to be somewhat limited to ensure their safety.
Most people with uncomplicated ventricular septal defects that have been repaired early in life don't have any significant long-term problems. In some individuals, the heart muscle may be less able to contract. This requires diuretics, agents to help the heart pump better and drugs to control blood pressure. In addition, if pulmonary hypertension develops (it's uncommon), the child may require additional treatment. In children with surgically repaired ventricular septal defects, additional surgical correction is rarely needed unless residual defects are seen afterwards. If this occurs, whether they will require surgery depends upon the size of the residual defects.
The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.
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© Nicholas Rogu, M.D.
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