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Treatments and drugs
By Mayo Clinic staffMany babies born with a small ventricular septal defect won't ever need to have the defect surgically closed. After birth, your doctor may want to observe your baby and treat any symptoms while waiting to see if the defect will close on its own.
Children and adults who have a ventricular septal defect that is large or is causing significant symptoms usually need surgery to close the defect. If your baby has a ventricular septal defect that needs surgical repair, the procedure will likely be scheduled in your baby's first year of life.
Medications
Medications for ventricular septal defect may include those to:
- Keep the heartbeat regular. Examples include beta blockers (Lopressor, Inderal, others) and digoxin (Lanoxin, Lanoxicaps, Lanoxin Pediatric).
- Increase the strength of the heart's contractions. Examples include digoxin (Lanoxin).
- Decrease the amount of fluid in circulation. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).
Procedures
Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles. Two approaches are currently used:
- Surgical repair. This is the procedure of choice in most cases. Surgical repair of a ventricular septal defect usually involves open-heart surgery, which is done under general anesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses patches or stitches to close the hole.
- Catheter procedure. This method may be used to close a ventricular septal defect when surgical repair isn't possible. Patching during catheterization doesn't require opening the chest. Rather than opening the chest, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart. The doctor then uses a small mesh patch or plug to close the hole. This procedure is associated with a higher rate of complications than is surgical closure, and more research is needed to fully understand its safety and efficacy.
After repair, your doctor will schedule regular medical follow-up to ensure that the ventricular septal defect remains closed. Depending on the size of the ventricular septal defect and the presence or absence of any other problems, your doctor will tell you how frequently you or your child will need to be seen.
Surgery to close a ventricular septal defect generally has excellent long-term results.
Preventive antibiotics
If you've been told in the past that you or your child needs to take antibiotics before dental or medical procedures to reduce the risk of infective endocarditis, talk with your doctor. Today experts believe that endocarditis is much more likely to occur from exposure to random germs than from a typical dental exam or surgery. Current guidelines recommend preventive antibiotic treatment only for those people at highest risk of serious complications from infective endocarditis.
Your doctor may still recommend preventive antibiotics if you:
- Have other heart conditions or artificial valves
- Have a large ventricular septal defect that's causing a low blood oxygen level
- Have had a repair with artificial (prosthetic) material
For most people with a ventricular septal defect, practicing good oral hygiene and getting regular dental checkups is the most effective strategy for preventing endocarditis.
- What are holes in the heart? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/holes/holes_whatare.html. Accessed Aug. 4, 2009.
- Ventricular septal defect (VSD). American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=11066. Accessed Aug. 4, 2009.
- Webb GD, et al. Congenital heart disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec134&displayedEid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec166&uniq=152762796&isbn=978-1-4160-4106-1#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50064-9%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed Aug. 4, 2009.
- Dummer KB, et al. Pathophysiology and clinical features of isolated ventricular septal defects in infants and children. http://www.uptodate.com/home/index.html. Accessed Aug. 4, 2009.
- McMackin,CJ, et al. Ventricular septal defect. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008. http://www.mdconsult.com/das/book/body/152762796-4/871305879/1701/628.html#4-u1.0-B978-0-323-04134-8..50025-2--subchapter8_13432. Accessed Aug. 4, 2009.
- Congenital heart defects. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4565. Accessed Aug. 4, 2009.
- Dummer KB, et al. Management of isolated ventricular septal defects in infants and children. http://www.uptodate.com/home/index.html. Accessed Aug. 4, 2009.
- Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation. 2007;116:1736.
- Genetic counseling for adults with congenital heart disease. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=11083. Accessed Aug. 20, 2009.
