Ventricular Septal defect (VSD)�occurs when any portion of the ventricular septum does not close after the seventh week of gestation. These defects could be single or multiple. VSD occurs in any portion of�the Interventricular septum, including the membranous, muscular, inlet or outlet septum or a combination of locations.

The reason of any delay in closure is unknown. Defects in the inlet septum may be caused by incomplete fusion of the right endocardial cushion with the muscular septum. The outlet VSD may be caused by failure of fusion of the conal septum. Muscular defects may be caused by lack of merging of the walls of the trabecular septum or excessive resorption of muscular tissue during ventricular growth and remodeling. Membranous VSD is caused by failure of fusion of the endocardial cushions, the conotruncal ridges, and the muscular septum.

Classification

VSD's are typically classified according to the location of the defect in 1 of the 4 ventricular components: the inlet septum, trabecular septum, outlet/infundibular septum or membranous septum.

In a healthy heart, blood that returns from the body which is low in oxygen comes to the right-sided filling chamber (right atrium). From here it is pumped to the lungs and the oxygen enriched blood returns to the left atrium and then to the left ventricle. This blood is then pumped out to the body through the aorta which is a large blood vessel that carries the blood to the smaller blood vessels in the body.

The right and left-sided pumping chambers (ventricles) are separated by shared wall, called the ventricular septum.

In the event of a VSD this oxygen-rich blood mixes with the oxygen-poor blood and goes back to the�lungs. The blood while flowing through the hole makes an extra noise, which is known as a heart murmur and can be heard with a stethoscope.

VSD's can be located in different places on the ventricular septum and they can be different sizes. The symptoms and medical treatment of the VSD will depend on those factors. In some rare cases, VSDs are part of more complex types of congenital heart disease.

Symtoms

Other symptoms that may indicate a problem include:

1. A bluish tinge or color (cyanosis) to the skin around the mouth or on the lips and tongue
2. A lack of appetite or difficulty feeding
3. Lack of weight or inability to gain weight or weight loss
4. Low or decreased activity level
5. Prolonged or unexplained fever

Diagnosis

A VSD can be diagnosed using any of the following techniques:

• A chest X-ray that gives a picture of the heart and surrounding organs.
• An electrocardiogram (EKG), which records the electrical activity of the heart.
• An echocardiogram (echo), which uses sound waves to produce a picture of the heart and to visualize blood flow through the heart chambers. This is often the primary tool used to diagnose VSD.
• A cardiac catheterization, which provides information about the heart structures as well as blood pressure and blood oxygen levels within the heart chambers. This test is usually performed for VSD only when additional information is needed that other tests cannot provide.

In most of the cases general anesthesia is used. The anesthesiologist monitors the vital signs and the patient is kept comfortable throughout the operation. Breathing is controlled by a ventilator that is connected to an�endotracheal tube�or a laryngeal mask airway. It would take about 45 minuites to an hour to recover from general anesthesia. The pain numbing medicines typically will have an effect for 2 to 4 hrs after surgery

Techniques for VSD closure devices

Surgical closure is the most common technique adopted.

The other technique used is to introduce a Polyester patch using a patch delivery and fixation system. Briefly, the system includes two parts: the catheter-based patch delivery that consists of a self-expanding Nitinol frame with a grip device and the patch fixation device. A polyester patch is appropriately trimmed, and then attached to the frame by 0.1 mm Nitinol release wire. The polyester patch is attached to the septum by Nitinol mini-anchors, deployed using a pistol-type anchor delivery device.

In a cardiac catheterization a thin, flexible tube called a catheter is inserted into a blood vessel in the leg that leads to the heart. A cardiologist guides the tube into the heart to make measurements of blood flow, pressure and oxygen levels in the heart chambers. A special implant, shaped into two disks formed of flexible wire mesh, can be positioned into the hole in the septum. The device is designed to flatten against the septum on both sides to close and permanently seal the VSD.

The other major cardiac procedures are:

• Coronary Angioplasty
• Heart Valve replacement�... etc

Few Major Hospitals for VSD are:

• Wockhardt Hospitals
• Narayana Hrudayalaya
• Asian Heart Institute and research center
• Piyavate Hospital
• Florence Nightingale Hospital

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