VSD surgery's prices vary in India according to the hospital and the city. Approximate cost for VSD closure in India is $4600.
VSD closure is very much affordable in India this preferred by many international patients. The success rate of VSD closure is 95%and approx 93 % of cases have absolutely normal exercise capacity.
There are an approximate 16 days stay including pre-operative and post-operative days.
It is a congenital anomaly in which the ventricular septum, the wall dividing the left and right ventricles of the heart is have an opening varying from pin size to complete absence of the ventricular septum, creating one common ventricle. The large membranous or muscular defects may close spontaneously up to the age of 20. The defect can occur at many different areas in the ventricular septum, the most common being in the membranous and muscular parts of the septum. Muscular defects can be single or multiple.
The muscular septum has three components: the inlet, infundibular, and trabecular or muscular septa.
When multiple muscular VSDs occur with a very large communication between the ventricles, it is also known as Swiss cheese VSD.
Types of VSD-
PerimembranousVSD – it is the most common type. It may be seen in 70% of the cases. It involves a varying amount of adjacent muscular septum. The VSD seen with TOF is a large non-restrictive perimembranous defect with extension into the sub pulmonary region.
TrabecularVSD – It is the second most common VSD. It occurs in 5-20% of cases. Trabecular muscular VSD is subdivided into distinct regional groups such as; mid muscular, apical, anterior, and posterior.
InfudibularVSD- The infudibular or conus septum separates the tricuspid and pulmonary valves. In this type of VSD the aortic valve may collapse through the VSD, with resulting AR and reduction of the VSD shunt. It occurs in approximately 5-7% cases, however, in far Eastern countries the infundibular defects account for 30%. This defect is also named as SupracristalVSD.
Inletdefects – the inlet VSD is typically seen with endocardial cushion defects. It is found in 5-8% of cases. They are also called canal –type. This type of defect is near the mitral and tricuspid valve, which are typically structurally normal.
Patients with small VSDs are asymptomatic, with normal growth and development. Small defects may be associated with a thrill at the left sternal edge, usually in the fourth interspace. The murmur is usually holosystolic , but it may be shorter if it is in the muscular septum because the defect may be occluded during late systole. Whereas large defects also produce a mitral diastolic flow rumble at the apex, large VSD defect is also associated with delayed growth and development, repeated pulmonaryinfection, CHF and decreased exercise tolerance.
In subaortic defects a diastolic murmur of aortic regurgitation is heard and in pulmonary stenosis a systolic ejection murmur at the left sternal border is heard.
CARDIOVASCULAR EXAMINATION –
APEX- apex is usually formed by hypertrophied left ventricle. It is localized and hyperkinetic in moderate –large VSD.
LEFT PARASTERNAL AREA- Hyperkinetic left parasternal lift is noted in moderate VSD without pulmonary hypertension.
PULMONARY AREA- Visible or palpable pulsation occurs in moderate –large left to right shunt or pulmonary hypertension. Systolic thrill suggests supracristal VSD.
LEFT STERNAL BORDER- Systolic thrill is consistent with VSD in the 3rd -4th ICS.
RIGHT STERNAL BORDER- Systolic thrill suggests LV to RA communication in the 4thICS.
PRECORDIAL PERCUSSION-Flat note or dullness in the pulmonary area occurs in moderate –large shunt or with pulmonary hypertension. Enlarged RA may be noted in Gerbodes defect.
Treatment of CHF with diuretics, after-load reducers and sometimes digoxin.
No exercise restriction is required in the absence of pulmonary hypertension.
Non surgical device closure of selected muscular VSDs is possible when the defect is not too close to cardiac valves and when it is difficult to access surgically.
Procedure – Direct closure of the defect is performed under cardiopulmonary bypass, preferably through an atrial approach rather than through a right venrticulotomy.
Indications and timing –
Infants with CHF and growth retardation unresponsive to medical therapy should be operated on at any age, including early infancy.
Infants with a large VSD and evidence of increasing PVR (pulmonary vascular resistance) should be operated as soon as possible.
Infants who respond to medical therapy may be operated on by the age of 12 to 18 months.
Asymptomatic children may be operated on between 2 and 4 years of age.
Percutaneous closure of VSD-
Devices used for VSD closure include;
Rashkind double umbrella device.
Sideris buttoned device.
STAR flex system.
Amplatzer muscular and perimembranous VSD occlude devices.
Successful closure of VSD, which is remote from cardiac valves, has been reported by using the double- umbrella clamshell device.
Several patch material are available, including nativepericardium,bovinepericardium,PTFE (Gore –Texorimpra) or Dacron.
Suture techniques include horizontal pledgeted mattress sutures and running polypropylene suture.
Care must be taken to avoid any injury to aortic valve with sutures and to avoid any injury to the conduction system located on the left ventricular side of the interventricular septum near the papillary muscle of the cones.
Multiple muscular VSDs are a challenge to close, achieving a complete closure can be aided by the use of fluorescein dye.
1. What is VSD ?
Ans- It is congenital defect in which there is an abnormal connection between the lower chambers of heart i.e. the ventricles.
2. What are the chances of having VSD if mother is affected by it previously?
Ans- As the studies says , there are 6% chances if the mother of the child is affected by VSD previously. However sometimes it may get unnoticed due to a very inconspicuous amount of the defect .
3 . What is the treatment method if a patient is having VSD and patent ductus arteriosus (PDA)?
Ans-If the PDA is large the ductus alone is closed in first 6-8 weeks and the VSD may be treated later . If the VSD is large and non-restrictive , the VSD is closed earlier and the PDA is ligated at the time of VSD repair.
4. What is the success rate of VSD closure surgery ?
Ans- The success rate of VSD closure is 95% , if the VSDis significantly small then it may close even without any surgical intervention after some time of age .
5. Is VSD life threatening?
Ans- If the VSD is large and restrictive it may need immediate surgical action . It may be life threatening in case reported late . There are a very few cases of death due to VSD , however negligence to presentation might give bad results .
6. What is the time period for the VSD closure?
Ans- It is wise to present the case between 6- 8 months of age , however small VSDs may even close later in life .
There is an approximate time duration of 16 days for VSD closure including pre- operative and post - operative days .
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