Ventricular Septal Defect

Ventricular septal defect (VSD) is one of the most common congenital heart defects, occurring in 2-6 out of every 1,000 live births and accounting for over 20% of all cardiac anomalies. VSDs vary in size and can be classified as small, moderate, or large.

Small defects typically do not cause symptoms and are often discovered when a heart murmur is detected by a healthcare provider. Echocardiography is used to confirm the diagnosis and check for any additional abnormalities. In most cases, children with small VSDs do not require specific treatment but should be monitored by a cardiologist every 2-3 years until the defect closes.

Moderate defects, like small ones, may not present significant symptoms but are often noticed due to the presence of a murmur. These children may experience a faster heart rate and poor weight gain during infancy. Moderate VSDs require close follow-up, and surgical closure may be needed if the defect does not shrink or close by age 2-3 or if the child has poor weight gain associated with the VSD.

Large VSDs lead to a substantial left-to-right shunt, causing increased blood flow to the lungs and elevated pulmonary artery pressure. Children with large VSDs typically show symptoms early in infancy, including:

• Increased heart rate
• Rapid breathing, often with chest retractions
• Difficulty feeding and fatigue while sucking
• Sweating, particularly on the forehead during feeding
• Poor weight gain despite adequate calorie intake
• Frequent chest infections, sometimes requiring hospitalization

Diagnosis is confirmed through echocardiography. Treatment usually starts with medications to manage heart failure symptoms, such as:

• Furosemide: Helps reduce congestion by increasing urine output
• Digoxin: May be used to regulate heart rate in small infants
• Calorie supplementation: Promotes faster weight gain

The definitive treatment for large VSDs is surgical closure. This procedure is typically safe for infants aged 3-4 months and weighing 3-4 kg. Hospitalization lasts about 8-10 days, and most infants require diuretics and pain relief for 3-4 weeks post-surgery. Follow-up care includes annual check-ups for the first 4-5 years, followed by every 3-5 years. The long-term prognosis is excellent, with most children recovering well after treatment.