children s health issues
Atrial and Ventricular Septal Defects
Treatment of Atrial and Ventricular Septal Defects
Sometimes medications, a plug or other specialized device inserted through a catheter, or surgery Treatment depends on the type and size of the defect and whether it is causing symptoms. Because atrial septal defects usually cause no symptoms, affected children do not usually need any medication. If the hole persists beyond age 2 to 3 years, unless the hole is small and not causing enlargement of the right side of the heart, doctors usually recommend a procedure to close the defect to prevent complications. Atrial septal defects that are located in the center of the wall between the upper chambers can often be closed during a procedure done in the cardiac catheterization laboratory. During this procedure, a long thin tube (catheter) is inserted into the large vein in the groin and then carefully pushed up through the blood vessel until it reaches the heart. Once the catheter is in the proper location, the closure device is threaded through the catheter and out of the tip of the catheter, allowing the device to expand and seal the hole. Atrial septal defects that are very large or located at the edges of the atrial septum usually need to be closed surgically with a patch. Children with atrial septal defects need to take antibiotics before visits to the dentist or before certain surgeries (such as on the respiratory tract) for 6 months after closure of the defect. These antibiotics are used to prevent a serious heart infection called Infective Endocarditis . After 6 months, children no longer need to take antibiotics before these procedures. Children with small ventricular septal defects usually require no treatment. However, some smaller VSDs located near the aortic valve can cause the valve to leak (aortic regurgitation). If children have aortic regurgitation, doctors usually do surgery to close the VSD and sometimes repair or replace the aortic valve. Infants with symptoms related to moderate or large VSDs may first be treated with medications, such asfurosemide(a diuretic, which pulls excess fluid out of the body),digoxin(to help the heart to pump more forcefully), and/or an angiotensin-converting enzyme (ACE) inhibitor (to relax blood vessels and help the heart to pump more easily). These medications help relieve symptoms and allow time for the VSD to close on its own. If symptoms do not resolve or the VSD does not get smaller, doctors usually do surgery to close the VSD. Certain types of ventricular septal defects can sometimes be closed with a catheter device, but this type of closure is less likely to be appropriate than with atrial septal defects. Children with ventricular septal defects need to take antibiotics before visits to the dentist and before certain surgeries (such as on the respiratory tract) for the 6-month period after closure of the defect. However, if there is a residual defect, then antibiotics for those situations should be continued indefinitely. These antibiotics are used to prevent a serious heart infection called Infective Endocarditis . 