Ventricular Septal Defect Surgery for Children

Ventricular septal defect (VSD) surgery is a type of heart surgery. It's done to fix a hole between the left and right ventricles of the heart.

The heart has 4 chambers: 2 upper (atria) and 2 lower (ventricles). Blood that is high in oxygen flows from the left atrium to the left ventricle and out to the body. The vital organs then use the oxygen. Blood with less oxygen flows from the right atrium to the right ventricle and out to the lungs. There, the blood picks up more oxygen. Normally a wall (septum) is present between the left and right atria and between the left and right ventricles. A child with a VSD has a hole in the wall between the left and right ventricles. The hole lets blood flow abnormally from the left ventricle into the right ventricle. As a result, too much blood may go to the lungs.

During this surgery, a surgeon makes a cut down the front of the chest and divides the breastbone to reach the heart. A heart-lung machine is used to pump blood and act as the lungs during the surgery. Then the surgeon patches up the hole between the ventricles. Over time, the child’s own cells grow over the patch. This anchors it in place even more.

The purpose of this surgery is to ease symptoms caused by the VSD and to prevent future symptoms. No one knows what causes most cases of this common heart defect.

Not everyone with a VSD needs to have the hole fixed. Very small holes in the ventricular septum may not let much blood pass between the ventricles. In these cases, the heart and lungs don’t have to work harder. And no repairs are needed. These smaller holes don’t cause any symptoms. Sometimes these small holes will close on their own naturally. Your child’s healthcare provider might wait to see if that happens before planning to do a repair, especially in a very young child.

If your child has a larger VSD, they may need some type of repair. Infants and children with larger VSDs often have symptoms, such as breathing faster and harder than normal. They may also not gain weight normally. A large, unrepaired VSD can over time cause higher (elevated) pressure in the blood vessels in the lungs. The higher pressure can lead to decreased oxygen levels in the body.

Healthcare providers often advise some type of repair for children who have a large VSD, even if they don’t have symptoms yet. It can prevent long-term damage to the lungs. Healthcare providers often do the surgery in infants or children. Sometimes adults also need this type of repair if their VSD was not found during childhood.

Surgery is still the standard of care. But a minimally invasive procedure using cardiac catheterization may be an choice to fix the VSD for some children. This approach uses a long, flexible tube (catheter) inserted through a blood vessel in the groin instead of open-heart surgery. This is a newer method that may have a higher rate of complication. But it may also lead to faster recovery times than surgery. Ask your child’s healthcare provider about the pros and cons of surgery or another repair procedure.

Most children do well with VSD surgery. But complications do sometimes occur. Specific risk factors may vary based on age, the size of the defect, and other health problems. Possible risks include:

• Excess bleeding
• Infection
• Blood clot, which can lead to stroke or other problems
• Abnormal heart rhythm, which in rare cases can cause death
• Heart block, which can make a pacemaker necessary
• Complications from anesthesia

Late complications are also possible. But they are rare. These might include problems with the heart valves. Very rarely, the patch used to fix the defect might become loose. Then another surgery will be needed. Ask your child’s healthcare provider about the specific risk factors for your child.

Ask your child’s healthcare provider how to help your child get ready for VSD repair. Have your child follow any directions for not eating or drinking before the surgery. Your child may also need to stop taking any medicine beforehand.

Your child’s healthcare provider may want some extra tests before the surgery. These might include:

• Chest X-ray
• Electrocardiogram, to look at the heart rhythm
• Blood tests, to check general health
• Echocardiogram, to look at heart anatomy and blood flow through the heart
• Cardiac catheterization, to measure the pressure in the heart and lungs.

Talk with your child’s healthcare provider about what to expect during the surgery. In general:

• Your child will be given anesthesia before the surgery starts. It’s often done through an IV (intravenous) line. Your child will sleep deeply and painlessly during the surgery. They won’t remember it later.
• The repair will take a few hours.
• The surgeon makes a cut (incision) down the middle of the chest. They will separate the breastbone to reach the heart.
• Your child will be attached to a heart-lung machine. This machine will act as your child’s heart and lungs during the procedure.
• The surgeon often reaches the wall between the septum by looking through one of the heart valves. The surgeon closes the hole in the ventricle with a tightly woven patch material.
• Once the procedure is done, the heart-lung machine will be removed.
• Your child’s breastbone will be put back together with wires.
• The surgeon will close the muscle and the skin. A bandage will be applied.

Ask your child’s healthcare provider what will happen after the VSD surgery. In most cases, the surgery will permanently cure the VSD. No activity restrictions will be needed. After the procedure in the hospital, you can generally expect the following:

• Your child may spend a few hours in a recovery room. Or the surgery team may take them straight to the intensive care unit (ICU).
• Healthcare staff will closely watch your child's heart rate, blood pressure, oxygen levels, and breathing.
• Your child will get pain medicine if needed.
• Your child’s healthcare provider may order follow-up tests, such as an electrocardiogram or an echocardiogram.
• By the second day, your child should be up and moving around as much as possible.
• Your child will likely be able to go home a few days after the surgery.

At home after the procedure:

• Ask what medicines your child needs to take. Your child may need to take certain medicines for a short time after the surgery. Give pain medicines as needed.
• Most children can get back to their normal activities when they get home. But they may tire more easily for a while. They shouldn't do activities that might lead to blows to the chest.
• Your child may need to have stitches removed in a follow-up appointment. Keep all follow-up appointments.
• Call your child’s healthcare provider if your child has more swelling, more bleeding or drainage, a fever, or severe symptoms. A little drainage from the site is normal.
• Follow all the instructions your child’s healthcare provider gives you about medicine, exercise, diet, and wound care.
• For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures. They can help prevent an infection of the heart valves.

For a short time after the procedure, your child will need regular checkups by a cardiologist. After that, your child will need to see a cardiologist only now and then. After recovering from surgery, most children are able to lead normal lives without any activity restrictions.

Before you agree to the test or the procedure for your child make sure you know:

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how you will get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much you will have to pay for the test or procedure