Ventricular Septal Defect Transcatheter Repair for Children
What is VSD transcatheter repair for children?
Ventricular septal defect (VSD) transcatheter repair is a type of heart procedure. It fixes a hole between the left and right ventricles of the heart, without making an incision in the chest wall.
The heart has 4 chambers: 2 upper (atria) and 2 lower (ventricles). Blood that is high in oxygen flows from the left atrium to the left ventricle and out to the body, where the vital organs use the oxygen. Blood with less oxygen flows from the right atrium to the right ventricle and out to the lungs. There, it picks up more oxygen. Normally, a wall is present between the left and right atria and between the left and right ventricles. A child with a VSD has a hole in the wall between the left and right ventricles. The hole causes blood to flow abnormally from the left ventricle into the right ventricle. As a result, too much blood can go to the lungs.
VSD transcatheter repair uses a flexible tube called a catheter. This tube contains a small device, often shaped like an umbrella. The healthcare provider threads the tube through a blood vessel in the groin and into the heart, next to the wall between the ventricles. He or she releases the small device and uses it to plug up the hole in the wall. Then the tube is removed from the body.
Why might my child need VSD transcatheter repair?
The purpose of this procedure is to ease symptoms caused by the VSD and to prevent future symptoms. No one knows what causes most cases of this common heart defect.
Not everyone with a VSD needs to have the hole repaired. Very small holes in the ventricular septum may not allow much blood to pass between the ventricles. In these cases, the heart and lungs don’t have to work harder. So the VSD doesn’t need to be fixed. These smaller holes don’t cause any symptoms. Sometimes these small holes will close up on their own naturally. Your child’s healthcare provider might wait to see whether that happens before planning to do a repair, especially in a very young child.
If your child has a larger VSD, he or she may need some type of repair. Infants and children with larger VSDs often have symptoms like breathing faster and harder than normal. They may also fail to gain weight normally. A large, unrepaired VSD can eventually cause elevated pressure in the blood vessels in the lungs. The higher pressure can lead to decreased oxygen levels in the body.
Healthcare providers often recommend some type of repair for children who have a large VSD, even if they don’t have symptoms yet. It can prevent long-term damage to the lungs. Healthcare providers often do the procedure in infants or children. Sometimes adults also need this type of repair if their VSD was not found during childhood.
Currently, the standard treatment for VSD repair is open heart surgery, not transcatheter repair. This type of open heart surgery requires a heart-lung machine. But your child’s healthcare provider might suggest transcatheter repair depending on the type of VSD. Your child’s healthcare provider might also suggest transcatheter repair if the staff at your cardiac center have a lot of experience doing the procedure. Transcatheter repair usually results in less recovery time. But it may have a higher rate for complications. Ask your child’s healthcare provider about the pros and cons of transcatheter repair or another repair procedure. Some reasons to consider transcatheter closure may be that the particular defects are technically challenging to close with surgery or for people unable to use a heart-lung machine for various reasons.
What are the risks of VSD transcatheter repair for a child?
Most children do well with VSD transcatheter repair. But complications do sometimes develop. Specific risk factors may vary based on age, the size of the defect, and other health problems. Possible risks include:
- Excess bleeding
- Blood clot, which can lead to stroke or other problems.
- Abnormal heart rhythm, which can cause death in rare cases
- Heart block, which can make a pacemaker necessary
- Collection of blood (hematoma) in the groin
- Device traveling through the heart or vessels (embolization)
- Problems with the heart valves
- Complications from anesthesia
Rarely, the device used to fix the defect might become loose. That will require another procedure. Ask your child’s healthcare provider about the specific risk factors for your child.
How do I help my child get ready for VSD transcatheter repair?
Ask your child’s healthcare provider how to help your child get ready. Your child should not eat or drink anything after midnight before the day of the procedure. Your child may also need to stop taking any medicine before the procedure.
Your child’s healthcare provider may want some extra tests before the procedure. These might include:
- Chest X-ray
- Electrocardiogram, to look at heart rhythm
- Blood tests, to check general health
- Echocardiogram, to look at the heart's anatomy and blood flow through the heart
What happens during VSD transcatheter repair for a child?
Talk with your child’s healthcare provider about what to expect during the procedure. In general:
- Your child will be given anesthesia before the procedure starts. It’s usually done through an IV. Your child will sleep deeply and painlessly during the operation. He or she won’t remember it afterward.
- The repair will take about 2 hours.
- The healthcare provider puts a small, flexible tube (catheter) into several blood vessels in the groin. One of the catheters will have a small device inside it.
- The provider threads the catheter through the blood vessel all the way to the ventricular septum.
- The provider may use X-ray images and an echocardiogram to see exactly where the catheter is. Sometimes he or she may use a transesophageal echocardiogram, with the ultrasound camera inserted into your child’s throat.
- The provider pushes the small device out of the tube and plugs the hole in the wall between the ventricles. He or she secures the device in place.
- Once the procedure has been completed, the catheter will be removed through the blood vessel.
- The healthcare provider will close and bandage the site where he or she inserted the tube.
What happens after VSD transcatheter repair for a child?
Ask your child’s healthcare provider about what will happen after the VSD transcatheter repair. After the procedure in the hospital, you can generally expect the following:
- Your child will spend several hours in a recovery room.
- Medical staff will closely watch your child's heart rate, blood pressure, oxygen levels, and breathing.
- Your child may need to lie flat for several hours after the procedure without bending his or her legs. It will help prevent bleeding.
- Your child’s healthcare provider might give your child medicine to prevent blood clots.
- Your child will get pain medicine if needed.
- Your child’s healthcare provider may order follow-up tests, like an electrocardiogram or an echocardiogram.
- Your child will probably need to stay in the hospital for at least a day.
At home after the procedure:
- Ask what medicines your child needs to take. Your child may temporarily need to take antibiotics or medicines to prevent blood clots. Give pain medicines as needed.
- Have your child avoid strenuous activities. Encourage him or her to rest.
- If your child has stitches, they will be removed at a follow-up appointment. Be sure to keep all follow-up appointments.
- Call your child’s healthcare provider if your child has increased swelling, increased bleeding or drainage, a fever, or severe symptoms. A little drainage from the site is normal.
- Follow all the instructions your child’s healthcare provider gives you about medicine, exercise, diet, and wound care.
- For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures. They can help prevent an infection of the heart valves.
For a short time after the procedure, your child will need regular checkups by a cardiologist. After that, your child will need to see a cardiologist only now and then. After recovering from the procedure, most children are able to lead normal lives without any activity restrictions.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
October 30, 2017
Ayden, Scott, MD,Bass, Pat F., III, MD, MPH