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Overview of VSD Closure in India
A Ventricular Septal Defect (VSD) is an abnormality characterised by a hole between the ventricles. The presence of a hole causes oxygenated blood to mix with deoxygenated blood, which can damage the heart and lungs. It can also lead to complications in the heart. For mild cases of VSD, intervention is not necessary, and the hole may close spontaneously. However, for larger holes, there will be an indication for intervention, which typically involves surgery to close the hole between the sides of the heart. It is called VSD Closure Surgery.
The cost of VSD Closure Surgery in India for Indian Patients is USD 2940 to USD 3920. The cost for International patients is USD 4410 to USD 5390. VSD is usually found in children, but there are 10% of VSD cases are found in adults. The VSD in adults is often related to other heart problems or effects of medications. VSD closure surgery improves symptoms and quality of life in patients with VSD.
What Is a Ventricular Septal Defect?
A ventricular septal defect (VSD) is a hole located in the wall between the two lower chambers (ventricles) of your child’s heart. If the wall is incomplete, then a VSD allows oxygen-rich blood from one side of the heart to mix with oxygen-poor blood from the other side of the heart. Your heart functions best when the wall separating the two sides of the heart prevents blood from mixing.
This defect is the most commonly diagnosed form of congenital heart disease (it is a defect that was present at birth). It frequently occurs in conjunction with other defects.
A small VSD usually has few or no symptoms and is considered benign. However, larger holes may require a repair to prevent complications and permanent damage.
Almost all VSDs are diagnosed in newborns. VSDs are diagnosed most often in childhood, and very rarely in adulthood. Because the defect almost always closes during childhood, a diagnosis as an adult would not typically occur for most people.
Types of VSD Closure:
There are four main types of ventricular septal defects (VSD), which are classified according to their location and the structure of the defect. The type of VSD may affect how blood travels between the ventricles, and management and training options will also differ by type.
Membranous VSD
This is the most common type, accounting for around 80% of cases. Membranous VSD is found in the upper part of the wall (septum) separating the ventricles. The hole may vary in size and, in some instances, may spontaneously close later in life.
Muscular VSD
Comprising around 20% of VSD cases in infants, the muscular VSD occurs in the lower muscular section of the septum. Defects in this part of the septum are usually present as multiple small holes instead of one defect. Many muscular VSDs will close spontaneously during childhood.
Inlet VSD
The inlet VSD defect occurs just below the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. The location presents challenges for the defect because blood entering the ventricles must pass through the defect before moving through the heart. Because of the position of the inlet VSD, it is commonly associated with congenital heart disease and other heart defects.
Outlet (Conoventricular) VSD
The outlet VSD defect lies close to the heart outflow tract, just below the pulmonary valve in the right ventricle and the aortic valve in the left ventricle. The defect affects the blood flow out of the heart because blood flowing out of the heart must pass through the hole in the location. Outlet VSD is less common than the muscular or inlet types of VSD. Outlet VSD cases are less common; when clinically significant complications arise, then surgical intervention would be required.
Procedure:
Open Heart Surgery
This is the traditional technique where the chest is opened to access the heart. The surgeon directly sutures or patches the hole in the lower part of the heart, or ventricular septal defect (VSD), with a patch of synthetic material or animal tissue.
Transcatheter Closure
This minimally invasive procedure uses a catheter fed through blood vessels to the heart. A device that is usually plugged is guided to the VSD site to close the hole. Over time, tissue grows over the device and seals the defect in the lower part of the heart.
Robotic-assisted Surgery
This approach uses small incisions with robotic arms controlled by the surgeon. It is less invasive than traditional open-heart surgery and offers the benefit of a shorter recovery time compared to open-heart surgery.
Hybrid Procedure
At times, a hybrid approach that combines catheter-based intervention with surgical repair may be considered, particularly in patients with complex VSDs. This approach allows a more individualised treatment plan.
Percutaneous Techniques
The newest approach is that of percutaneous techniques. This approach features special closure devices that can be less invasive for certain types of VSDs.
The basic stages of VSD closure surgery are as follows:
Anaesthesia: The provider administers the anaesthesia to lessen the sensation of pain and discomfort during the surgical procedure.
Incision: An incision is made in the centre of the chest to access the heart. The size of the incision will vary for each patient.
Cardiopulmonary Bypass: The patient's blood is circulated through a heart-lung machine, allowing the heart and lungs to be bypassed temporarily.
Closure of VSD: The surgeon will locate the VSD and carefully suture or patch the hole with synthetic materials or tissue from the patient's own body, depending on the size and location of the defect.
Assessment: Following the closure of the VSD, the surgeon will assess the repair for stability and whether it is obstructing flow in the heart.
Weaning from Bypass: In weaning from bypass, the heart is allowed to start pumping again in a controlled manner. The patient will be weaned off the heart-lung machine in a planned and controlled manner.
Closure: Incisions will be closed with sutures, and the chest will be closed.
Recovery: During the recovery stage, medications will be used to prevent infection and blood clotting. Activity will be increased in a planned and controlled manner during the recovery stage.
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Cost of VSD Closure in India
The cost of VSD Closure Surgery for Indian patients ranges from USD 2940 to USD 3920. International patients can expect to pay between USD 4,410 and USD 5,390. The patient must spend three days in the hospital and seven days out of it. The diagnosis and the facilities the patient chooses will determine the overall cost of the therapy.
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Indications of VSD Closure:
As far, there are no recognised reasons for ventricular septal defects. But occasionally, it occurs in conjunction with other birth abnormalities, illnesses, or genetic disorders, such as Down syndrome.
A VSD can occasionally be caused by a heart attack that tears a hole between the ventricles. Technically, this kind of rupture or defect of the ventricular septum is a side effect. However, the issue still has to be fixed because it is harmful.
Ventricular Septal Defect Symptoms
The size of the hole and the presence of additional cardiac disorders determine the symptoms of a ventricular septal defect (VSD). Tiny VSDs can not show any symptoms at all and may go undiagnosed. Larger flaws, however, could cause serious health problems.
Symptoms in Infants
- Poor feeding – Infants with a ventricular septal defect (VSD) may have increased energy demands on the heart and lungs compared to babies with normal hearts, which can make feeding more challenging. For example, feeding may tire babies with a VSD out without getting adequate nutrition.
- Slowed or no physical growth (failure to thrive) – Infants with a VSD may have difficulty gaining weight or growing normally because they have increased workload on the heart, and they burn off more calories to overcome a bulky, inefficient circulation.
- Rapid breathing or shortness of breath - Infants with a larger VSD will experience rapid breathing or shortness of breath, especially during feeding or activity, due to the increased blood flow to the lungs. At the same time, their body receives a reduced volume of oxygen from the body's abundant blood supply.
- Easily tired - Infants with a VSD may get tired easily in general, like when they are feeding, and may not seem to have worked very hard or do much activity. Still, they feel wiped out because their heart is pumping away much harder and faster than usual, attempting to supply enough oxygen-rich blood to their body.
Symptoms in Adults
- Breathlessness—particularly with exercise—An undiagnosed or unrepaired VSD may lead to difficulties with shortness of breath or fatigue in adult patients while exercising, because the body is unable to circulate enough oxygen, and the heart has to work harder to maintain oxygen circulation throughout the body.
- Heart murmur—just like in infants, patients with a VSD may have a heart murmur. The murmur sound comes from the turbulent blood flow between the right and left ventricles and can be detected by a stethoscope.
Risk Factors:
The following highlights some of the risk factors that can occur with VSD closure surgery:
Anesthesia Risks
The risk of allergic reactions, breathing issues, or allergic reactions to anaesthesia drugs.
Infection
VSD closure surgery, like any other surgery, has the same potential risk of surgical site infection or infection that can affect the heart or other organs.
Bleeding
There is a potential for excessive bleeding during or after the surgery that may require blood transfusions to correct this complication.
Arrhythmias
Arrhythmias can occur after the VSD closure surgery, which can complicate healing.
Residual VSD
There is a possibility that a small remnant will remain after surgery. This may require additional medication therapy and even re-operation.
Device Complications
For VSD in the transcatheter closure type, risks include device displacement, device infection, or other device-related problems.
Blood clots
There is a risk of forming blood clots in the heart or vessels at the time of or after the closure, so while there is no current risk of developing a serious blood clot complication, there is a risk.
Stroke
Blood clot development in vessels can travel to vessels in the brain and create the complication of a stroke.
Fluid Accumulation
Fluid accumulation around the heart or lungs is also a risk after open-heart surgery for VSD closure.
Scarring
Following the procedure, Scar tissue buildup in the heart or blood vessels can affect the heart's operation.
The need for Re-intervention
If the surgery did not succeed in closing the VSD before the surgery, then an additional open heart surgery will be necessary to perform the procedure, which can make the patient's condition worse.
Allergic reactions
Some patients are allergic to medications, surgical sewing materials, and the effects of anaesthesia.
Frequently Asked Questions (FAQ’s)
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The cost of VSD Closure Surgery for Indian patients ranges from USD 2940 to USD 3920. International patients can expect to pay between USD 4,410 and USD 5,390. The patient must spend three days in the hospital and seven days out of it. The diagnosis and the facilities the patient chooses will determine the overall cost of the therapy.
Numerous Indian hospitals, such as Apollo Hospitals, Max Healthcare, and Fortis Hospitals, are well-known for doing VSD (Ventricular Septal Defect) surgeries. Max Healthcare highlights its skilled staff, professional quality, and individualised treatment, whereas Apollo Hospitals is frequently praised for its proficiency in paediatric heart surgery for VSD. The ability of Fortis Hospitals to provide cardiac care is another area of recognition.