Ventricular Septal Defect: Diagnosis, Treatment, and Expert Opinions

Q: Ventricular Septal Defect: Diagnosis, Treatment, and Expert Opinions

Hello： In the case of a ventricular septal defect (VSD), if the defect is not very large and does not significantly increase pulmonary artery pressure, surgery may not be necessary. <br>This is because surgery and anesthesia carry certain risks. <br>Based on your situation, it se

Ventricular septal defect (VSD)

Eight years ago, I was first diagnosed with a ventricular septal defect (VSD) at a regional hospital.
In March of this year, I needed surgery for a salivary gland tumor at a veterans' hospital, which required general anesthesia.
During the cardiology consultation, an echocardiogram was performed, but it did not reveal the ventricular septal defect.
The doctor initially suspected mitral valve prolapse, but due to significant heart murmurs, a transesophageal echocardiogram was conducted.
During the examination, the physician and the technician discussed whether or not the defect was present.
Ultimately, when I returned to the outpatient clinic to review the results, the outpatient physician initially stated there was no defect, but after reviewing the report, he confirmed its presence.
The doctor explained that the defect is located near the tricuspid valve, which can sometimes make it difficult to visualize.
He advised that surgery is not necessary and that I should have regular check-ups every six months.
Six months later, I returned to the regional hospital for another echocardiogram.
The outpatient physician mentioned that my condition was similar to what it was eight years ago, with little change, and that there was no ventricular hypertrophy.
He suggested that regular check-ups were not necessary but recommended considering surgery.
One of the physicians in the echocardiography room, while observing and guiding the technician, noted that there were indeed blind spots during the imaging process and expressed concern about the significant heart murmurs.
He recommended that I undergo a cardiac catheterization, even if I did not wish to have surgery.
When I later asked the outpatient physician if a cardiac catheterization was necessary, he stated that it is typically performed as a pre-surgical assessment and that it was not needed if I did not intend to have surgery.
The opinions of the three physicians seem to differ, and I am uncertain whose advice to follow.
Additionally, are there any more advanced methods for repairing a ventricular septal defect currently available? Is it still necessary to perform a sternotomy for the surgery?

Li Li, 30~39 year old female. Ask Date: 2004/10/25

Dr. Huang Guosheng reply Cardiology

Hello: In the case of a ventricular septal defect (VSD), if the defect is not very large and does not significantly increase pulmonary artery pressure, surgery may not be necessary.
This is because surgery and anesthesia carry certain risks.
Based on your situation, it seems that surgery may not be required, but it is essential to prevent the occurrence of endocarditis.
Currently, the surgical method for repairing a ventricular septal defect still relies on surgical closure, as there are no alternative methods available.

Reply Date: 2004/10/25

More Info

Ventricular Septal Defect (VSD) is a congenital heart defect characterized by an abnormal opening in the ventricular septum, the wall dividing the left and right ventricles of the heart. This condition can lead to significant hemodynamic changes, including increased blood flow to the lungs and potential heart failure if left untreated. Understanding the diagnosis, treatment options, and expert opinions surrounding VSD is crucial for effective management.

Diagnosis of VSD
The diagnosis of VSD typically involves a combination of clinical evaluation, echocardiography, and sometimes advanced imaging techniques. In your case, the initial diagnosis was made eight years ago through an echocardiogram, which is the standard method for identifying VSD. However, it is not uncommon for VSDs, especially smaller ones or those located near the tricuspid valve, to be missed during echocardiographic assessments. This can occur due to the presence of significant heart murmurs or anatomical variations that obscure visualization.

In your recent evaluations, the echocardiogram did not clearly demonstrate the VSD, leading to confusion among the medical team. The presence of a significant heart murmur can complicate the interpretation of echocardiographic findings, as it may mask the underlying defect. The use of transesophageal echocardiography (TEE) is often recommended in such cases, as it provides a clearer view of the heart structures and can help confirm or rule out the presence of a VSD.

Treatment Options
The treatment for VSD depends on several factors, including the size of the defect, the presence of symptoms, and the overall hemodynamic impact on the heart. Small VSDs that do not cause significant symptoms or complications may be monitored over time, as many can close spontaneously during childhood. In contrast, larger defects or those causing significant symptoms typically require intervention.

Surgical repair of VSDs has traditionally involved open-heart surgery, where the chest is opened, and the defect is closed with a patch or sutures. However, advancements in minimally invasive techniques have emerged, allowing for less invasive approaches to repair VSDs. These techniques may involve catheter-based interventions, where a device is delivered through a catheter to close the defect without the need for a large incision. This approach can reduce recovery time and associated risks.

Expert Opinions and Recommendations
Given the differing opinions among the physicians you consulted, it is essential to consider the context of each recommendation. The cardiologist who suggested that surgery might not be necessary if the defect is stable and not causing significant issues is likely taking a conservative approach, which is common in cases where the patient is asymptomatic. However, the suggestion from the echocardiography specialist to consider catheterization for further evaluation is valid, especially if there is uncertainty regarding the defect's size or impact.

If you are contemplating surgery, it is crucial to have a thorough discussion with a cardiothoracic surgeon who specializes in congenital heart defects. They can provide insights into the latest surgical techniques, including minimally invasive options, and help you weigh the risks and benefits of surgery versus continued monitoring.

Conclusion
In summary, VSD is a condition that requires careful monitoring and management. The variability in opinions among healthcare providers highlights the complexity of diagnosing and treating this defect. It is advisable to seek a second opinion from a specialized center with experience in congenital heart disease, particularly if you are considering surgical options. Advances in treatment techniques may offer less invasive alternatives, and a comprehensive evaluation will help determine the best course of action for your specific situation. Regular follow-ups and open communication with your healthcare team will be key in managing your condition effectively.

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