Ventricular Septal Defect – Perimembranous VSD

Ventricular Septal Defect

My STEAM project will be discussing ventricular septal defects, also known as VSD, through a personal short story and drawing. The course objective used is “Explain the structure and function of the heart”.

Part I: The News

                  “Hey Family, I don’t know what to say other than Taylor is fine but not fine.” The pain I heard in this sentence when my sister sent out the e-mail to all her family gutted me. Sweet Taylor is her first and only son and at two months, her and her husband learned what a Ventricular Septal Defect was and how it was about to impact their family.

                  Taylor’s symptoms indicated something in his body was not functioning properly. When the pediatrician saw him at his two-month checkup, she noticed he was not gaining weight as he should, and his breathing was faster than it should be. She also heard a heart murmur and immediately referred them to a cardiologist. Taylor was given an echocardiogram and an EKG and discovered he had a large hole in the lower part of his heart and narrowing of his aorta. This was causing his blood to be recirculated back into his lungs. The extra blood caused his lungs to be a little “wet” causing him to breath more rapidly in order to circulate the same amount of oxygen through his small body. As a result, he was burning more calories and unable to gain weight.

                  My sister was informed that heart surgery may need to be performed to close the hole, but the cardiologist would like to wait a few months and monitor Taylor’s condition. Taylor was too small to perform the surgery immediately. It was not life-threatening at this time. The main priority was to supplement Taylor’s food with formula to gain weight and put him on a medication that reduces the amount of fluid in his lungs.

Part II: The Study

                  I had to understand what VSD was and how it was about to impact my sister’s family, so I dove deep into research. Septal defect is considered a congenital heart disease and is the most common, making up 20-25% of all CHD’s. (Raos, 2024) Immediately, I needed to know the survival for children with VSD.

                  According to one of the largest population-based studies performed in Denmark with the longest follow-up of patients with VSD, those with VSD have an increased late mortality by three-fold compared with that of the Danish general population. However, survival did improve in the modern era of medicine for patients with unrepaired and surgically closed VSD. (Eckerström et al., 2023) Although my nephew was at a slightly higher risk for late morality, I knew modern day medicine and advancements will help him drastically. So, I continued on with my research to learn more about ventricular septal defects.

                  VSD’s are classified based on their size, number and location within the ventricular septum of the heart. Sizes include large, medium or small and are often an assessment tool for those who need intervention. The defects may also be single, paired or multiple. There are four classifications of VSD for location. First is the perimembranous where the defect is located in the subaortic area of the ventricular septum membrane. Second is supracristal, where the defect is located in the subpulmonary area of the conal septum. Thirdly, atrioventricular where the defect is found in the inlet septum. The fourth location is muscular. The defect in muscular VSD is found in the ventricular septum muscle. (Raos, 2024)

                  Having some knowledge of what VSD is, I sought out to research if my nephew would likely need surgery to close the hole in his heart. The doctors were able to determine that Taylor had a large perimembranous ventricular septal defect, with left to right shunting, located near the pulmonary and aortic valves. He also had mild dilation of the left atrium and mild dilation and hypertrophy of the right ventricle. According to the thorough article “Recent Advances in Managing Septal Defects: Ventricular Septal Defects and Atrioventricular Septal Defects”, Taylor would most likely need surgical intervention in order to close his VSD. It states that if the pulmonary-to-systemic flow ratio is 2:1, the VSD is moderate to large with enlarged left artium and ventricle or elevated pulmonary artery pressure (or both) exist, surgery should be performed to prevent pulmonary vascular obstructive disease. (Raos et al., 2018) As Taylor grows, his heart will continue to work in overdrive to pump oxygen to his body, most likely resulting in an even larger left atrium and right ventricle. The authors do assure, however, that the closure of VSDs is safe with a mortality rate less than 3%. It is also rare to have residual complications, and the heart returns back to normal function after surgery. (Raos et al., 2018)

Part III: The Happy Ending

                  Taylor’s doctors determined that surgery was indeed necessary as they continued to monitor his VSD. At seven months of age, he had open heart surgery to repair the perimembranous hole in his heart. The surgery was successful, and Taylor has no lingering side effects. I read a study after his surgery that was encouraging. The study involved 24 children with surgically corrected VSDs compared to a control group of kids in primary schools. The results concluded that children with closed VSDs were reported to have an increased quality of life while internalizing problems were decreased. These results also concluded that proactive parenting behavior played a crucial role in the healing of VSD adolescents. (Lang et al., 2022) Both Taylor and his parents are living a happy life full of hiking, fishing, soccer, camping and so much more thanks to the advancements of modern-day medicine.

Citations:

1. Eckerström, F., Nyboe, C., Maagaard, M., Redington, A., & Hjortdal, V. E. (2023). Survival of patients with congenital ventricular septal defect. European heart journal, 44(1), 54–61. https://doi.org/10.1093/eurheartj/ehac618
2. Lang, L., Gerlach, J., Plank, A. C., Purbojo, A., Cesnjevar, R. A., Kratz, O., Moll, G. H., & Eichler, A. (2022). Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement. Journal of clinical medicine, 11(23), 7242. https://doi.org/10.3390/jcm11237242
3. Rao, P. S., & Harris, A. D. (2018). Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects. F1000Research, 7, F1000 Faculty Rev-498. https://doi.org/10.12688/f1000research.14102.1
4. Rao P. S. (2024). Diagnosis and Management of Ventricular Septal Defects. Reviews in cardiovascular medicine, 25(11), 411. https://doi.org/10.31083/j.rcm2511411