Ventricular septal defect is the most commonly treated congenital heart defect and can be referred to as a “hole” in the heart along with atrial septal defect. There is a consensus that larger holes in the heart should be treated promptly, but with improved medical care, many very small holes are being detected by physicians. Small ventricular septal defects usually have no heart murmur and are often detected by cardiac ultrasound, but ventricular septal defects are different and usually have a distinct murmur, so small ventricular septal defects are often heard by doctors and in some cases even by the patient’s family.
Here we explain a misunderstanding, some parents complain why the ventricular septal defect was not detected by the doctor during routine postnatal visits, but was detected by other doctors after a few months or a period of time, this is not a problem of the doctor’s level, but the disease itself has this characteristic, the newborn has a normal physiological period of pulmonary hypertension, only after this period the murmur of the ventricular septal defect becomes obvious. Small ventricular septal defects usually do not cause serious damage, even if there are recurrent lung infections or other discomfort that cannot be explained by this hole.
However, once detected, it always brings a lot of psychological baggage to the parents or the patient. At this point its faced with two choices, one to treat or not to treat.
Treatment, although small ventricular septal defects, often perimembranous type, can generally be minimally invasive methods, such as percutaneous interventional blocking, or small incisional blocking, the former commonly speaking is a needle in the thigh can be treated, will not leave a body scar, the latter will only leave a small surgical scar in the chest. Because these two methods are not very traumatic and the risk of surgery is not particularly high, many parents do not even understand why surgery is necessary, but take it for granted that a hole in the heart is a big deal and must be treated.
Why does a disease need to be treated?
This sounds like a very unanswerable question. Of course a disease needs to be treated! But in reality, it is not that simple. The goal of treatment is to live a long, good life. And does a small ventricular septal defect shorten life expectancy? There is no very clear answer to this question.
A septal defect is a hole between the left and right ventricles of the heart, and because the pressure in the left ventricle is greater than in the right ventricle, this hole causes some of the blood from the left ventricle to flow through it into the right ventricle, and it is usually thought that this abnormal shunt is too large to cause adverse consequences.
These consequences include.
1. Excessive pulmonary artery blood flow, which may lead to recurrent lung infections and, after prolonged action, to pulmonary hypertension and even Eisenmenger’s syndrome.
2. Excessive load on the left side of the heart, leading to enlargement of the left ventricle and resulting in left-sided heart failure.
3, Infective endocarditis.
If compared with atrial septal defect, it seems that these kinds of adverse consequences are less, but the actual incidence and severity are much higher, i.e. the problem of ventricular septal defect is much more serious than atrial septal defect.
The anatomy of the ventricular septum is much more complex, making surgery much more difficult and risky.
Depending on the location, septal defects are generally classified in China as
1, perimembranous type (the most common, accounting for the vast majority of small septal defects)
2, outflow tract type including sub-stem type (because it is often combined with aortic valve prolapse, the size of the ultrasound suggestion may be small, it is generally recommended that early routine surgery, a small number of patients really have great concern about scar can try minimally invasive sealing, but be prepared for unsuccessful sealing or even cause damage to the aortic valve) and supra-crural type
3, myocardial type (this type may be multiple, interventional treatment is recommended as a priority, some cases are extremely difficult to treat)
4. inflow tract type (rare cases occurring alone).
Small ventricular septal defect generally refers to a single defect less than 1/3 of the diameter of the aorta or less than 5 mm (for adults), but relatively speaking, ventricular septal defects are more complex than atrial septal defects, and individual analysis is required.
The small ventricular septal defects generally encountered clinically are of the perimembranous type and are often combined with membranous tumors. A membranous tumor is not a tumor, but a structure formed by the spontaneous healing of a septal defect, formed by tricuspid valve adhesions and fibrin deposition, when the defect is still a hole from the left ventricular side, but becomes many small holes on the right ventricular side, like a small wind-blown bag with several holes in the bottom. Some people even believe that a small perimembranous ventricular septal defect at birth can be considered a normal condition because this is the part of the septum that heals the latest, just as there is a speed in running, and running slower than most people does not mean being lame. Some of the myocardial ventricular septal defects are also small and will be even smaller when the heart contracts, resulting in a smaller fractional flow.
Small ventricular septal defects have a certain rate of self-healing, so there is no need to rush to treat them in young children, and it is generally believed that the chances of them growing over the age of 5 are not high. It is only then that treatment needs to be considered, because of several disturbances as follows.
1, heart murmur leads to every visit to the doctor or medical examination may be found to have congenital heart disease and lead to corresponding concerns and even life and work;
2. Possible infective endocarditis.
3, possible mild cardiac function effects.
I would like to remind again that despite the above-mentioned effects, surgery is generally not recommended routinely for small ventricular septal defects in Europe and the United States, so you should consider carefully, depending on what and how strong your willingness to request surgery is.
Means of treatment
There are three main streams: conventional surgery, percutaneous interventional occlusion, and small incisional occlusion. Unlike atrial septal defects, where percutaneous interventional occlusion is recommended as a priority, in some cases conventional surgery is not possible; in perimembranous septal defects, it depends on the specific case; in outflow and inflow tracts, conventional surgery is recommended as a priority.
Lastly, it is a good idea to give yourself a few days to rationalize your thinking and decide to deal with this God’s mistake; it is a good idea to mention that large ventricular septal defects, which may cause pulmonary hypertension and heart failure earlier, need to be operated on in early childhood, and in a few severe cases, they cannot even be cured in one stage and require staged surgery.