What are the most common type of VSD?

A Ventricular septal defect is a condition in which there is a hole in the septum (wall) that separates the right and left ventricles (lower chambers) of the heart. Normally, the septal wall prevents the blood from two ventricles from mixing. With VSD, the hole in the septum allows the oxygen-rich blood from the left chamber to flow into the right side of the heart. The blood with high oxygen then gets pumped into the lungs, rather than out to the vital organs of the body. This causes the heart and lungs to work harder. 

Ventricular septal defects can be classified into different types: membranous, perimembranous, supracristal (infundibular or subpulmonic) and muscular.

• Membranous VSD is known to be the most common type of ventricular septal defect by far. It accounts for almost 80% of all defects. This type of VSD found in the upper section of the ventricle and It lies just below the aortic valve and tricuspid valve septal leaflet. Membranous VSD can extend into the inlet or muscular septum, which may undergo closure either by tricuspid septal leaflet tissue or prolapse of an aortic cusp. When the defect involves muscular septum, it is also commonly known as perimembranous. 

Other VSDs and their prevalence - 

• Supracristal VSD: Also known as infundibular or outlet type VDS. It occurs in the outlet septum of the right ventricle, below the aortic and pulmonary valves (semilunar valves). It is the most uncommon type of VSD and accounts for only 6% of all VSDs. However, within the Asian population it accounts for approximately 30%. The chances of aortic valve prolapse and regurgitation are more common in this as there is a lack of support of the right and/or the noncoronary cusps of the aortic valve. Supracristal VSDs defects usually do not close spontaneously. 
• Inlet or atrioventricular VSD: This septal defect is located near to where the blood enters the ventricles through the tricuspid and mitral valves. It is just below the inlet valves (tricuspid and mitral) in the inlet part of the septum of right ventricular. Inlet VSDs only accounts for 8% of all defects. It is usually seen in patients with Down syndrome. 
• Muscular VSD: Also called trabecular VSD. The hole is located in the muscular septum of the heart. The area is usually bordered by muscle in the apical, central and outlet parts of the interventricular septum. It does not involve cardiac valve. The defects/holes can be many, having a Swiss cheese like appearance. They account for up to 20% of VSDs in children. The incidence rate is lower in adults as they have a tendency to close spontaneously.

A Gerbode defect is also a sub type of ventricular septal defect, although this causes a left ventricular to right atrial shunt.

How does the VSD affect a person?

In children, a large opening in the septal wall can cause difficulties in breathing and therefore, many children with VSD are recommended for surgery to close the defect. 

The infants with large septal openings may have the following symptoms:

• Heavy or fast breathing
• Sweating
• Tiredness 
• Weight gain is poor

However, large VSDs in adults are not as common, but affected people experience shortness of breath. Mostly, adults have small VSDs that usually do not present symptoms as the heart and lungs are not required to work harder. But even small VSDs can occasionally lead to infection in the heart, known as endocarditis. Under physical examination, a loud heart murmur (whooshing sound) can be detected in cases of small VSDs. 

Treatment options

A small VSD opening is likely to close on its own and do not need medical intervention. Medium to large VSDs can lead to serious health problems in children and treatment is required to manage the condition. 

Several hospitals in India offer highly effective and successful VSD treatment to children and adults. The country being a medical hub attracts a number of patients from all around the world to avail the country’s high standard medical care facilities. The highly affordable cost of VSD surgery in India brings hope of a better life to many children and their families. 

The methods to treat a VSD are following:

Lower the amount of fluid in the lungs and in circulation: Medications, called diuretics, such as furosemide (Lasix) are given to reduce the volume of blood that is to be pumped.

Maintain regular heartbeat: Medications such as beta blockers, including metoprolol (Lopressor), propranolol (Inderal LA) , and digoxin (Lanoxin, Lanoxin Pediatric) are used for this.

Surgical treatment for VSD treatment:

This involves plugging or patching the opening in the septum between the ventricles. Specialists including cardiologists, cardio-vascular surgeons and other perform the procedure. Depending on the size of VSD, symptoms presented and overall health, the options for surgical treatment of VSD include cardiac catheterization or open-heart surgery.