Ventricular Septal Defect Treatment in India

Introduction

To most expecting parents, all they want is a child who is healthy and ready to take on the world. However, in some cases, things don’t go according to plan, and the child needs a little extra help moving forward. One of these cases is when the child is born with a ventricular septal defect (VSD).

 There are several advancements in ventricular septal defect treatment and surgery that make it much easier for you to keep your child safe and healthy. VSDs are the most common kind of congenital heart defect, and treatment for ventricular septal defect is usually successful and without complications.

What is Ventricular Septal Defect?

The heart is made up of four distinct chambers that are separated by walls and valves. The four chambers are the right atrium, left atrium, right ventricle and left ventricle. A ventricular septal defect is a type of congenital heart defect where a hole forms in the wall (septum) between the two ventricles^[1].

The septum or wall between the two ventricles separates the left ventricle, which pumps out oxygen-rich blood into the bloodstream, from the right ventricle, which pumps oxygen-depleted blood into the lungs to be oxygenated again.

A hole in this wall may cause blood from the left ventricular to flow into the right ventricle and then back into the lungs. This forces the heart to work harder since the volume of oxygenated blood leaving the heart is reduced. Depending on the size and location of the VSD, the burden on the heart can increase to damaging levels. This is why it is critical to address VSDs early on.

Types of Ventricular Septal Defect

There are four ventricular septal defect types categorized based on the location of the septal defects.

• Muscular VSD: When the VSD defect is located lower down the ventricular septum (wall) where it is muscular, it is known as a muscular VSD. It is the most common type of congenital septal defect.
• Perimembranous Ventricular Septal Defect: A ventricular septal defect on the upper portion of the ventricular wall is known as a perimembranous ventricular septal defect.
• Conoventricular Ventricular Septal Defect: If the congenital septal defect is located just below the aortic and pulmonary valves, then it is known as a conoventricular ventricular septal defect.
• Inlet Ventricular Septal Defect: This is a ventricular septal defect located next to the tricuspid and mitral valves in the heart and is known as an inlet VSD.

Causes and Contributing Factors of Ventricular Septal Defect in Indian Children

A congenital septal defect is caused by problems during the development of the child’s body during pregnancy. A ventricular septal defect occurs when the wall or septum between the two ventricles does not form completely, leaving a hole in the heart through which blood from one ventricle can flow into the other. The exact cause for this problem is unknown, but the following risk factors can be suspected to play a role: 

1. Genetic disorders

The body’s genetic information is carried forward via chromosomes that contain DNA. When there is an abnormality or mutation in the development of the chromosome, it is known as a genetic disorder. Some examples of genetic disorders that can cause ventricular septal defects are Down’s syndrome, DiGeorge syndrome and Holt-Oram syndrome^[2].

2. Asian heritage

Analysis of data on congenital VSD indicates that Asians are more likely to develop a congenital VSD than other races. The reasons behind this are not clear, however, it is considered when screening for congenital heart defects.

3. Family history of congenital heart diseases

A family history of congenital heart disease is a risk factor for ventricular septal defects^[7]. Consult your doctor to get a screening based on family history and genetic conditions to see if your child is at risk of developing a congenital VSD or any congenital heart disease.

General information and statistics of the condition in India

According to the Indian Academy of Pediatrics, more than 2 lakh children are estimated to have been born with some type of congenital heart disease in India and at least 20% of them require early medical intervention^[8].

Access to early screenings and diagnostics gives parents an excellent chance to combat VSD in babies, with over 90% of such children reaching adulthood with a fairly uncompromised long-term future.

A study published in the Indian Journal of Child Health observed that around 46% of VSD heart defects closed on their own. Among the ventricular septal defect types, Muscular VSDs closed on their own around 80% of the time, while perimembranous VSDs closed on their own around 25% of the time. Large VSDs are more likely to be perimembranous and less likely to close on their own. They will require some level of medical or surgical intervention. According to the study, only 12% of VSD patients had a family history of congenital heart disease^[3].

To Summarize

• VSDs are the most common form of congenital heart defect and can be addressed very successfully with the right ventricular septal defect treatment.
• There are four different ventricular septal defect types that are categorised based on the location of the defect on the ventricular wall.
• VSDs can be treated effectively, and a majority of patients who receive early treatment for ventricular septal defect reach adulthood without complications.

Signs and Symptoms of Ventricular Septal Defect in Infants

1. Weakness or easily fatigued

One of the most common VSD symptoms is a sense of fatigue and weakness. This is because the heart is unable to pump enough oxygenated blood to the body on a consistent basis. While this symptom impacts newborns as well, it can be difficult to notice.

2. Difficulty in Feeding

The baby may not be able to breastfeed efficiently because of weakness. This leads to excessive dullness and irritableness in them. 

3. Shortness of breath

Hyperventilating or difficulty drawing breath normally is one of the VSD symptoms that you should look out for when it comes to infants. As an adult, if you are having trouble breathing, consult a doctor to find out why.

4. Bluish Colour (Cyanosis)

Blood is red when it is rich in oxygen. When the blood is not carrying enough oxygen, the depleted blood sometimes sticks around the small blood vessels (capillaries) and turns purple. This is called cyanosis and it usually appears first on the hands, feet and lips where it is called peripheral cyanosis. Depending on the level of oxygen in the blood, the skin may also change colour and appear bluish.

5. Heart murmurs

A VSD murmur is a type of noise that can be heard by a doctor using a stethoscope. If your doctor detects a murmur, then you may need to take additional tests to find out what may be causing it. A murmur can be harmless, but it should be investigated just in case it is a VSD murmur.

6. Arrhythmias

Our heartbeats are driven by electrical signals in the body caused by reactions between different electrolytes. Sometimes, the signals are uncoordinated, and the heart beats at an irregular rhythm. This is known as arrhythmia. Like murmurs, arrhythmias may be harmless sometimes, but they always need to be investigated by a doctor so that you can be sure.

When do the symptoms start to show?

You may not have any VSD symptoms if the size of the hole is small. Large VSDs will usually present symptoms at a very early stage, usually shortly after birth. However, in some cases, patients can reach adulthood without any consistent symptoms.

When to see a doctor?

VSD symptoms may not be that easy to identify for someone who is not medically trained. A ventricular septal defect is most likely to be diagnosed through a routine checkup. Most VSDs are detected in newborns by paediatricians who perform regular examinations in their post-delivery routine.

Potential outcomes if symptoms are left undiagnosed

Over time, without treatment for a ventricular septal defect, the heart will be forced to work harder to pump blood to the body. When the heart is overburdened, it is more likely to be damaged and begin to fail as a result. During this process, the VSD symptoms will intensify and make daily activities difficult.

To Summarize

• In most cases, VSD in babies is detected and treated early on. Sometimes, however, a VSD heart defect will go undetected until adulthood.
• It is important to get a general checkup once a year so that any septal defect symptoms or VSD murmurs that show up later on can be checked and addressed.
• VSD symptoms overlap with several other heart diseases, so a VSD has to be conclusively diagnosed by a medical professional (preferably a cardiologist) using scans and imaging technology.

Diagnosis of Ventricular Septal Defect

1. Physical examination

During a routine physical examination, your doctor will examine the breathing and heart rhythm with a stethoscope. If your doctor detects a VSD heart murmur or any kind of arrhythmia, additional tests will be recommended. Your doctor will also take a look at your medical history which may indicate any increased risks of a ventricular septal defect.

2. ECG / EKG

An electrocardiogram tracks the electrical signals that drive your heartbeat using small, harmless electrodes against the skin. The activity is recorded as a graph which can be read by the doctor to check if there are any abnormalities that need to be investigated further.

3. Chest X-Ray

While an X-ray may not provide a clear view of a VSD, it can identify certain conditions that indicate the presence of a VSD. An enlarged heart and fluid build-up in the lungs are two indicators that would show up on a chest X-ray.

4. Echocardiogram

Using sound waves, it is possible to generate images and videos of the heart. This is a non-invasive procedure that can be used to monitor the heart of a child in the womb to check for abnormalities. An Echo is an effective way to confirm whether there is a VSD in babies and to get an idea of the size and location of the defect.

5. Coronary catheterisation

Also known as cardiac catheterisation, this procedure involves using a flexible, thin tube or catheter to navigate through the blood vessels towards the heart. The catheter is usually inserted through the groin or arm and into the large blood vessels that lead back to the heart. This procedure allows the doctor to identify a range of congenital heart defects and also understand how well or poorly the heart is functioning.

Preparing for the diagnosis – what mothers need to be aware of while prepping their babies

Ventricular septal defects are congenital heart disorders, and there is little that can be done to prevent them. However, by detecting it early, especially through prenatal monitoring, it is possible to plan for ventricular septal defect treatment very effectively.

During pregnancy, follow a healthy, balanced diet that includes sufficient amounts of folic acid and other key nutrients. Make sure to get some amount of exercise and to be up to date on all your vaccinations. Infections can pose a risk to the development of a foetus. If you have diabetes, make sure to keep your blood sugar levels under control through diet and any prescribed medication.

A majority of VSDs close on their own, in which case the doctor may advise medical monitoring. If medical or surgical intervention is required, consult your doctor on what you need to do for your specific case.

To Summarize

• Prenatal checkups are crucial for expecting mothers. It is possible to detect a ventricular septal defect while the foetus is still in the womb. Early detection makes it easier to create a ventricular septal defect treatment plan.
• Most VSDs are detected during a normal physical examination. Yearly checkups are important for adults and for newborn children, and routine checkups every 3 months can help detect VSDs.
• There are several different methods for ventricular septal defect treatment and diagnosis. Consult your doctor to know which methods are most suitable.

Ventricular Septal Defect Surgical Repair

Observation/Medical monitoring and drug therapy

In most cases, the treatment for a ventricular septal defect is through surgery^[4], however, sometimes doctors may prescribe a watchful waiting treatment. A large number of VSDs close spontaneously. To control some of the more dangerous symptoms of VSD, such as fluid build-up in the lungs, doctors may prescribe drugs.

An asymptomatic VSD does not cause any problems, and in this case, watchful waiting is often used while the patient’s health and quality of life are not significantly affected by the VSD.

Preparing for the Surgery

• Physical evaluation: This is a routine examination that helps a doctor or surgeon understand the patient’s physical conditions and also to look for any symptoms or abnormalities in the patient.
• Blood tests: Routine blood work that examines important readings like haemoglobin levels, platelets, cholesterol, blood sugar, etc., helps the doctors check for abnormalities that could increase the risks of surgery.
• Chest X-Rays: X-ray imaging helps surgeons make a surgical plan. Noting the location of the VSD and any enlargement of the heart, the surgeon is able to decide what is the best method by which to apply ventricular septal defect treatment.
• Electrocardiogram: This is to check for any arrhythmias and abnormalities in the way your heart beats. If the heart beats too fast (tachycardia) or too slowly (bradycardia), it can cause some complications during the hole in the heart surgery.

Surgical procedure

• Intra-cardiac surgery 

In an open heart intra-cardiac surgery, the surgeon aims to fix abnormalities like VSDs that are on the inside of the heart. The surgery requires a heart-lung machine while the heart is being operated on to ensure the rest of the body is getting blood.

The surgeon gains access to the heart through an incision in the chest. After that, a patch is applied to the hole in the heart and sutured (stitched) to close it. Over time, the tissues in the heart will grow over the patch, and the possibility of the VSD opening again is practically zero.

• Catheter intervention

This is a minimally invasive method using a catheter that is inserted into the body through a blood vessel in the groin. The catheter then travels towards the heart through the bloodstream, and once it is inside, a special surgical mesh is sutured over the hole in the heart. Over time, the mesh integrates with the tissues of the heart and the VSD is closed for good.

Indian Cities Catering to VSD Surgical Procedures

Most major cities in India have medical facilities that offer cardiology and paediatric cardiology speciality. Here are some of the cities where you can definitely expect to find experienced surgeons for ventricular septal defect treatment:

• Mumbai
• Delhi
• Raipur
• Gurgaon
• Kolkata
• Chennai
• Bangalore
• Pune
• Hyderabad
• Calicut
• Kochi

General costs of VSD surgical procedures in India

The cost of a hole in the heart surgery in India is estimated to be around 3-4 lakhs depending on the case and the complications. From prepping for surgery till discharge, it can take anywhere between 10-15 days, although this varies with each case. The cost of surgery can be very less in government hospitals and few trust let hospitals. People eligible for Ayushman Bharat Yojna can avail of the benefits for this surgery if approved.

What are post-op procedures after the Hole in the Heart surgery?

1. Problems your child may have

The wound from open-heart surgery is likely to cause some amount of discomfort and pain. This is normal and goes away as the wound heals.

In some cases, it is possible that the wound may catch an infection. Monitor it carefully and make sure you are regular with your checkups at the doctor.

2. Activity restrictions 

Until the wound completely heals, movement should be minimal and heavy lifting of all kinds should be avoided. Do not try any kind of exercise or physical activity unless your doctor has given you the consent to.

3. Medical follow-up

Lifelong routine medical checkups are crucial to ensure that the medical patch is firmly in place and that the surgical wounds are healing well. It is also important to check for any possible complications after the surgery. Sometimes, another congenital defect may be detected which was previously overlooked because of the VSD.

To Summarize

• The best treatment for a ventricular septal defect is usually surgery since the hole in the heart is completely sealed off.
• In some cases with an asymptomatic VSD, doctors may opt to monitor the VSD if it is considered to be harmless.
• Hole in heart surgery is usually very effective, and after recovering from surgical wounds and a few rounds of medical follow-up, patients are usually free to live life normally.

Complications of VSD if left untreated

An undiagnosed or untreated VSD can cause the heart to work harder than it needs to. It also has some other complications that can lead to a poorer quality of life and risk of other diseases such as:

1. Pulmonary hypertension

This is a condition where your blood pressure increases in the arteries around the right side of your heart and in your lungs. Pulmonary hypertension caused by a VSD is also known as secondary pulmonary hypertension. Significant damage to the blood vessels can cause a reversal in the flow of blood through the hole in the heart, known medically as Eisenmenger syndrome. Pulmonary hypertension treatment involves taking medications or, in some cases, undergoing surgeries like atrial septostomy or lung transplant. 

2. Heart failure

VSD causes blood from the left ventricle to flow into the right ventricle. This means that there is a reduced amount of blood available to be distributed to the body. As a result, the heart is forced to work harder to oxygenate all the cells in our bodies. The extra strain can damage the heart muscles and eventually lead to heart failure.

3. Cardiac infections

Although it is rare for this complication to affect a VSD patient, it does occur over time in cases where there is an untreated VSD, especially with secondary pulmonary hypertension. Patients with VSD have a risk of developing infective endocarditis, which is usually a buildup of bacteria on the interior lining of the heart and its valves. It can also be caused by other organisms like fungi. Infective endocarditis treatment involves taking medications or undergoing medical procedures like heart valve surgery. 

4. Poor growth and development 

Infants who have not received treatment for ventricular septal defect are likely to have poorer growth and development than infants who have been successfully treated.

Precautions VSD children and adults need to take to prevent complications

While an asymptomatic VSD is usually nothing to worry about, there are some risks that require caution. A septal defect can be a place where bacteria or other organisms can latch on to and cause infections like endocarditis (inflammation of the inner lining of your heart’s chambers and valves).

• Make sure to disinfect any cuts or wounds as soon as possible.
• Make sure you clean the brush thoroughly before and after use.
• Make it a point to get a dental checkup once every six months. Tooth or gum disease can release bacteria into the bloodstream.
• Complete a full course of antibiotics when prescribed by your doctor for any infection.

Tips for expecting mothers 

The exact cause of VSD is not known, and hence, it is difficult to prevent. But here are a few tips to minimise the risk of any developmental anomaly in a child:

1. Healthy diet

Switch to a balanced diet that has more whole foods and fewer processed foods. Including more whole grains, lean meats, leafy greens, vegetables and fruits will give you the right kind of nutrition. An increased intake of vitamin B9, also known as folic acid, supports foetal development. Avoid fast foods and refined foods like white bread, maida and white rice.

2. Seeking early prenatal care, even before you’re pregnant

When you decide to have a child, getting early prenatal care is an excellent idea. It helps you plan the pregnancy and make the lifestyle changes necessary to give both mother and child the best chances of a successful pregnancy and delivery. Be sure to share the details of your medical history and any medications you might be taking.

3. Keeping physically active

With the guidance of your doctor, you should prepare to get the benefits of exercise throughout your pregnancy. It will help you combat gestational diabetes, keep your body running more efficiently and make it easier for you to have a successful delivery.

4. Avoid the use of alcohol or drugs and tobacco

When you are pregnant, it is best to avoid all forms of intoxication completely. Not only does this improve your health, but it also boosts your chances for a healthy pregnancy and successful delivery^[5].

5. Control  blood sugar levels

Although it is not conclusive, some studies indicate that uncontrolled diabetes increases the risk of congenital heart defects^[6]. Adopting a healthy lifestyle and controlling your blood sugar can counteract these risks.

Planning a pregnancy with a history of VSD

If either parent or any of the ancestors of an expecting couple have a history of VSD, share this information with a prenatal care provider. Prenatal care is extremely effective when it comes to protecting the health of both the mother and child.

Additionally, adopt better habits and improve your lifestyle. A good diet that contains heart-healthy foods, regular exercise and quitting poor habits like smoking, drinking and drugs can go a long way towards delivering a healthy child.

To Summarize

• Leaving a VSD untreated and unmonitored can lead to a number of health complications like pulmonary hypertension and endocarditis. Get a full explanation of your case from your doctor, and if treatment is necessary, get it as soon as you can.
• Following a good lifestyle with a proper diet, exercise and reductions in smoking, drinking, and drugs can help expecting mothers deliver a healthy child more easily.
• Maintaining good hygiene is essential to VSD management in adults. If you have not had your septal defect treated, make sure to take extra care to disinfect wounds and to visit the dentist at least twice a year.

Also Read: Truncus Arteriosus in Indian Infants

Frequently Asked Questions (FAQs)

References

1. Dakkak W, Alahmadi MH, Oliver TI. Ventricular septal defect. StatPearls – NCBI Bookshelf. 2024 [cited 2025 Mar 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/
2. Perrot A, Rickert-Sperling S. Human genetics of ventricular septal defect. Advances in Experimental Medicine and Biology. 2024 Jan 1 [cited 2025 Mar 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/38884729/ 
3. Pillai LS, Unnikrishnan D, Ahamed MZ. Study of clinical profile and outcome of ventricular septal defects diagnosed in infancy. Indian Journal of Child Health. 2019 Oct 1 [cited 2025 Mar 11]. Available from: https://mansapublishers.com/index.php/ijch/article/view/1814
4. Mongeon FP, Burkhart HM, Ammash NM, Dearani JA, Li Z, Warnes CA, et al. Indications and outcomes of surgical closure of ventricular septal defect in adults. КАРДИОЛОГИЯ УЗБЕКИСТАНА. 2010 Mar 1 [cited 2025 Mar 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/20298987/ 
5. Strandberg-Larsen K, Skov-Ettrup LS, Grønbaek M, Andersen AMN, Olsen J, Tolstrup J. Maternal alcohol drinking pattern during pregnancy and the risk for an offspring with an isolated congenital heart defect and in particular a ventricular septal defect or an atrial septal defect. Birth Defects Research. 2011 May 17 [cited 2025 Mar 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/21591246/
6. Maduro C, De Castro LF, Moleiro ML, Guedes-Martins L. Pregestational diabetes and congenital heart defects. Revista Brasileira Ginecologia E Obstetrícia [Internet]. 2022 Oct 1;44(10):953–61. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9708403/ 
7. Wang X, Wang J, Zhao P, Guo Y, Wu L, Sun J, et al. Familial congenital heart disease: data collection and preliminary analysis. Cardiology in the Young [Internet]. 2012 Oct 1;23(3):394–9. Available from: https://pubmed.ncbi.nlm.nih.gov/23021226/ 
8. Congenital heart disease in India: a status report. Indian Pediatrics. [cited 2025 Mar 11]. Available from: https://www.indianpediatrics.net/dec2018/dec-1075-1082.htm

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