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 up 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, he
or she 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
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 option 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:
Blood clot, which can lead to stroke or other problems
Abnormal heart rhythm, which in rare cases can cause
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
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:
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
During the Test
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. He or she won’t remember it later.
The repair will take several hours.
The surgeon makes a cut (incision) down the middle of the
chest. He or she 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
Your child’s breastbone will be put back together with
The surgeon will close the muscle and the skin. A bandage
will be applied.
After the Test
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 several hours in a recovery room. Or the
surgery team may take him or her 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
At home after the procedure:
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.
can get back to their normal activities when they get home. But they may tire more
easily for a while. Children should not do activities that might lead to blows to
Your child may
need to have stitches removed in a follow-up appointment. Keep all follow-up
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
- The risks and benefits of the test or
- 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
- When and how you will get the
- 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