FAQs

A VSD is an opening in the muscular wall (septum) that separates the two lower pumping chambers of the heart, allowing blood to shunt from the left ventricle to the right ventricle.

VSDs are classified by location into perimembranous, muscular, inlet (AV canal type) and outlet (subarterial) defects. Each location has implications for surgical or device closure approach.

Small VSDs are often picked up only as a heart murmur in a well baby. Larger defects may cause fast breathing, poor feeding, sweating during feeds, recurrent chest infections and poor weight gain in infancy.

Diagnosis is confirmed by echocardiography, which shows the defect location, size and the direction and volume of shunt. ECG and chest X-ray are supportive investigations.

Small VSDs may be observed up to 4 — 5 years. Moderate defects with left ventricular dilatation are typically closed at 1 — 2 years. Large defects with heart failure or pulmonary hypertension are closed within the first 3 — 6 months of life.

Medication does not close a VSD. Diuretics and anti-failure drugs may help control symptoms while the child is being prepared for definitive closure.

VSDs can be closed either surgically (open heart, on cardiopulmonary bypass) or non-surgically using a transcatheter device placed in the cath lab, depending on the location, size and anatomy.

Muscular and selected perimembranous VSDs are well suited to device closure. Large defects, inlet VSDs and defects close to the aortic valve are usually managed surgically.

The device approach avoids open surgery, sternal incision and bypass. Hospital stay is shorter (usually 1 — 2 days), recovery is faster and there is no scar.

Surgical closure is done through a midline sternotomy on cardiopulmonary bypass. The defect is patched using pericardium or synthetic material. Excellent long-term outcomes are standard at experienced centres.

Follow-up echocardiograms are typically done at 1, 3, 6 and 12 months, then annually. Aspirin is usually given for 6 months after device closure. Endocarditis prophylaxis may be advised in select cases.

Through a small puncture in the groin, a catheter is guided into the heart under fluoroscopy and echocardiography. A self-expanding device is then deployed across the VSD to seal it.

TOF is a cyanotic congenital heart defect consisting of four features: a large VSD, overriding aorta, right ventricular outflow obstruction and right ventricular hypertrophy.

Babies present with bluish discolouration (cyanosis), shortness of breath on crying or feeding, and sometimes “cyanotic spells” — episodes of intense blueness and irritability.

Echocardiography is the primary investigation and reliably demonstrates all four components. ECG shows right ventricular hypertrophy.

Cardiac catheterization or CT angiography may be required to map the pulmonary artery anatomy and any associated coronary artery anomalies before surgery.

Medication does not correct TOF. Beta-blockers can reduce the frequency of cyanotic spells while the child is being prepared for surgery.

Definitive treatment is surgical: complete intracardiac repair with VSD closure and relief of the right ventricular outflow obstruction. Some infants need a temporary shunt first.

Most children undergo complete repair between 4 and 12 months of age. Earlier surgery may be needed for severe cyanosis or frequent spells.

Even in mildly symptomatic children, surgery within the first year is preferred to avoid progressive right ventricular damage and reduce long-term complications.

Lifelong cardiology follow-up is recommended. Periodic echo, ECG and occasionally cardiac MRI assess the right ventricle and pulmonary valve function.

Femoral pulses are weak or absent and there is no good pulse trace on lower-limb saturation monitoring. Severe coarctation is a medical emergency and needs prompt assessment.

Cyanotic conditions can be missed in the first 48 hours. Pre-discharge pulse oximetry from one upper and one lower limb is recommended. An echo is advised if either limb saturation is below 95% or there is more than 5% difference between limbs.

A newborn presenting with shock after the first 48 hours should be suspected of having a duct-dependent lesion. Prostaglandin infusion to keep the ductus arteriosus open can be life-saving until definitive diagnosis.

ASDs are classified into ostium secundum (the most common), ostium primum, sinus venosus and coronary sinus types, based on the location of the defect in the atrial septum.

Most children with an isolated ASD are asymptomatic and are picked up on a routine murmur or echo. Larger defects can cause easy fatigue, recurrent chest infections and right-sided heart enlargement over time.

Significant ASDs are usually closed between 3 and 5 years of age, before school. Earlier closure is considered in children with symptoms or marked right heart dilatation.

Ostium secundum ASDs with adequate rims are ideally suited to transcatheter device closure. Primum, sinus venosus and coronary sinus defects need surgical repair.

If the rims are adequate and the defect is centrally located, device closure is preferred. Otherwise, surgical patch closure is performed.

No sternotomy, no scar, shorter hospital stay (typically 1 day), faster return to school and routine activities.

Aspirin is generally given for 6 months after device closure. Endocarditis prophylaxis is advised for the first 6 months as well.

Follow-up echocardiograms are scheduled at 1, 3, 6 and 12 months, then annually. Long-term outcomes are excellent.

The ductus arteriosus is a fetal blood vessel that normally closes shortly after birth. If it stays open beyond the newborn period, it is called a patent ductus arteriosus.

A small PDA may only be heard as a murmur. Larger PDAs cause fast breathing, poor feeding, sweating during feeds, recurrent chest infections and poor weight gain.

Significant PDAs are closed once diagnosed, typically by 6 months to 1 year of age. Very large PDAs causing heart failure are closed sooner.

Medication (ibuprofen or paracetamol) can help close a PDA in preterm babies. Beyond the neonatal period, medication is not effective.

If medical therapy fails or is contraindicated, transcatheter device closure or surgical ligation are options, with transcatheter closure now possible even in small preterm infants at experienced centres.

The vast majority of PDAs beyond the newborn period are closed transcatheter using a coil or device. Surgery is reserved for very specific anatomy.

Same-day or overnight procedure, no thoracotomy, no scar and rapid recovery.

Surgical ligation of the PDA is done through a small left-sided incision. It is most often used in selected preterm infants or unusual anatomy.