Overview

The Normal Heart and How It Works

The normal heart is a strong, hard-working pump made of muscle tissue. It’s about the size of a person’s fist. The heart has four chambers. The upper two chambers are the atria, and the lower two are the ventricles (Figure A). Blood is pumped through the chambers, aided by four heart valves. The valves open and close to let the blood flow in only one direction.

The four heart valves are:

The tricuspid valve, located between the right atrium and the right ventricle;
The pulmonary (pulmonic) valve, between the right ventricle and the pulmonary artery;
The mitral valve, between the left atrium and left ventricle; and
The aortic valve, between the left ventricle and the aorta.

Each valve has a set of “flaps” (also called leaflets or cusps). The mitral valve normally has two flaps; the others have three.

Dark bluish blood, low in oxygen, flows back to the heart after circulating through the body. It returns to the heart through veins and enters the right atrium. This chamber empties blood through the tricuspid valve (B) into the right ventricle





The right ventricle pumps the blood under low pressure through the pulmonary valve into the pulmonary artery. From there the blood goes to the lungs where it gets fresh oxygen (C). After the blood is refreshed with oxygen, it’s bright red. Then it returns to the left heart through the pulmonary veins to the left atrium. From there it passes through the mitral valve (D) and enters the left ventricle.






The left ventricle pumps the red oxygen-rich blood out through the aortic valve into the aorta (E). The aorta takes blood to the body’s general circulation. The blood pressure in the left ventricle is the same as the pressure measured in the arm.


What is it ?

A ventricular septal defect (VSD) is a defect in the septum between the right and left ventricle. The septum is a wall that separates the heart’s left and right sides. Septal defects are sometimes called a “hole” in the heart. It’s the most common congenital heart defect in the newborn; it’s less common in older children and adults because some VSDs close on their own.


What causes it?

In most people, the cause isn’t known but genetic factors may play a role. It’s a very common type of heart defect. Some people can have other heart defects along with VSD.


How does it affect the heart?

Normally, the left side of the heart only pumps blood to the body, and the heart’s right side only pumps blood to the lungs. When a large opening exists between the ventricles, a large amount of oxygen-rich (red) blood from the heart’s left side is forced through the defect into the right side. This blood is pumped back to the lungs, even though it has already been refreshed with oxygen. Unfortunately, this causes the heart to pump more blood. The heart, especially the left atrium and left ventricle, will begin to enlarge from the added work. High blood pressure may occur in the lungs’ blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls. When the defect is small, not much blood crosses the defect from the left to the right and there’s little effect on the heart and lungs.


How does the VSD affect me?

In childhood a large opening may have caused breathing difficulties and therefore, most of these children had surgery to close the defect. Therefore, large VSDs in adults are uncommon, but when they are present, can cause shortness of breath.

Most adults have small VSDs that don’t usually cause symptoms symptoms because the heart and lungs don’t have to work harder. On physical examination, small VSDs produce a loud murmur. Even small VSDs may occasionally be a source of infection called endocarditis.


What if my VSD is very small or closed by itself?

Many children who had a VSD did not need surgery or other treatments, and many of these defects closed on their own. Adults who were told they “had a hole in their heart” that closed on its own usually have no murmur and a normal EKG. If an echocardiogram is performed, it may show an outpouching called a ventricular septal aneurysm in the area where the VSD was located. If the aneurysm isn’t recognized as an expected finding after a VSD has closed, it can lead to unnecessary concern and testing

Medical Follow-up :

A cardiologist should examine you regularly. If your VSD is small or was closed as a child and no other problems are detected, visits every 3–5 years are probably sufficient.


What will I need in the future?

Medications may be required only if you have heart failure (which is very uncommon) or if you have pulmonary hypertension. Your cardiologist can monitor you with noninvasive tests if needed. These include electrocardiograms, Holter monitors, exercise stress tests and echocardiograms. They will help show if more procedures, such as a cardiac catheterization, are needed. Activity Restrictions

Most patients won’t need to limit their activity. However, if you have pulmonary hypertension or your heart doesn’t pump as well as it used to, you may need to limit your activity to your endurance. Your cardiologist will help determine if you need to limit your activity


What are the risks associated with congenital heart surgery ?

Risks associated with congenital heart surgery vary widely accor ding to the specific procedure and the patient’s condition at the time of surgery.

They can include : -

Bleeding
Infection
Need for re-operation
Damage to nerves in the chest area
Brain damage
Death



What should we watch out for after surgery ?

Before the patient is discharged from the hospital, your family will be given detailed instructions that are individualized for the specific procedure performed.

However, in general, patients should contact their doctor for any of the following after congenital heart surgery : -

Redness, swelling, or oozing/bleeding from incision
Fever
Altered mental status, excessive fatigue
Feeding/eating problems
prolonged or worsening pain

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