Ventricular Septal Defect Transcatheter Repair for Children

What is a transcatheter closure of VSD in children?

Transcatheter closure of a ventricular septal defect (VSD) is a type of heart procedure. It closes a hole between the left and right ventricles of the heart. It does not make a cut (incision) in the chest wall.

The heart has four chambers: two upper (atria) and two lower (ventricles). Blood that is high in oxygen flows from the left atrium to the left ventricle and out to the body, where the vital organs use the oxygen. Blood with less oxygen flows from the right atrium to the right ventricle and out to the lungs. There, it picks up more oxygen. Normally, a wall is present between the left and right atria and between the left and right ventricles. A child with a VSD has a hole in the wall between the left and right ventricles. The hole causes blood to flow abnormally from the left ventricle into the right ventricle. As a result, too much blood can go to the lungs. This causes the heart and lungs to work harder.

Transcatheter closure of a VSD uses a flexible tube called a catheter. This tube contains a small device used to close the hole. The healthcare provider threads the tube through a blood vessel in the groin and into the heart, next to the wall between the ventricles. The provider then releases the small device and uses it to plug up the hole in the wall. Then the tube is removed from the body.

Why might my child need a transcatheter closure of VSD?

The purpose of this procedure is to ease symptoms caused by the VSD and to prevent future symptoms. No one knows what causes most cases of this common heart defect.

Not everyone with a VSD needs to have the hole closed. Very small holes in the ventricular septum may not let much blood pass between the ventricles. In these cases, the heart and lungs don’t have to work harder. So the VSD doesn’t need to be closed. These smaller holes don’t cause any symptoms. Sometimes these small holes will close up on their own. Your child’s healthcare provider might wait to see if that happens before planning to do a procedure, especially in a very young child.

If the VSD is larger, your child may need some type of closure. Infants and children with larger VSDs often have symptoms, such as breathing faster and harder than normal. They may also not gain weight normally. Over time, a large VSD can cause high (elevated) pressure in the blood vessels in the lungs. The higher pressure can lead to decreased oxygen levels in the body.

Healthcare providers often advise some type of surgery or procedure for children who have a large VSD, even if they don’t have symptoms yet. It can prevent long-term damage to the lungs. Healthcare providers often do the procedure in infants or children. Sometimes adults also need this type of procedure if their VSD was not found during childhood.

Currently, the standard treatment for VSD repair is open heart surgery, not transcatheter closure. This type of open heart surgery needs the use of a heart-lung machine. But your child’s healthcare provider might suggest transcatheter closure depending on the type of VSD. Your child’s provider might also suggest transcatheter closure if the staff at your cardiac center have a lot of experience doing the procedure. Transcatheter closure often has a shorter recovery time. But it may have a higher rate for complications. Ask your child’s healthcare provider about the pros and cons of this or another procedure. Transcatheter closure may be considered for some reasons. For example, it may be done if the particular defects are technically challenging to close with open heart surgery. Or it may be done if using a heart-lung machine isn't a choice for certain reasons.

What are the risks of a transcatheter closure of VSD for a child?

All procedures have risks. Some possible risks of this procedure include:

• Excess bleeding

• Infection

• Blood clot, which can lead to stroke or other problems

• Abnormal heart rhythm, which can cause death in rare cases

• Heart block, which can make a pacemaker necessary

• Collection of blood (hematoma) in the groin

• Device traveling through the heart or vessels (embolization)

• Problems with the heart valves

• Complications from anesthesia

In rare cases, the device used to fix the defect might become loose. That will need another procedure. Ask your child’s healthcare provider about the specific risk factors for your child.

How do I help my child get ready for a transcatheter closure of VSD?

Ask your child’s healthcare provider how to help your child get ready. Have your child follow any directions you are given about not eating or drinking before the procedure. Your child may also need to stop taking any medicine before the procedure.

Your child may need some extra tests before the procedure. These might include:

• Chest X-ray. This test shows the structures in and around the chest.

• Electrocardiogram. This test is done to check the heart rhythm.

• Blood tests. These are done to check your child's general health.

• Echocardiogram. This test is done to see the heart anatomy and blood flow through the heart.

What happens during a transcatheter closure of VSD for a child?

Talk with your child’s healthcare provider about what to expect during the procedure. In general:

• Your child will be given anesthesia before the procedure starts. It’s often done through an IV (intravenous) line. Your child will sleep deeply and painlessly during the procedure. Your child won’t remember it later.

• The procedure will take about two hours.

• The healthcare provider puts a small, flexible tube (catheter) into several blood vessels in the groin. One of the catheters will have a small device inside it.

• The provider threads the catheter through the blood vessel all the way to the ventricular septum.

• The provider may use X-ray images and an echocardiogram to see exactly where the catheter is. Sometimes the provider may use a transesophageal echocardiogram to help view the catheter. For this, the ultrasound camera is inserted into your child’s throat.

• The provider pushes the small device out of the tube and plugs the hole in the wall between the ventricles. Then the provider secures the device in place.

• Once the procedure is done, the catheter will be removed through the blood vessel.

• The healthcare provider will close and bandage the site where the tube was inserted.

What happens after a transcatheter closure of VSD for a child?

Ask your child’s healthcare provider about what will happen after the VSD transcatheter closure. After the procedure in the hospital, you can generally expect the following:

• Your child will spend several hours in a recovery room.

• Healthcare staff will closely watch your child's vital signs. These include the heart rate, blood pressure, oxygen levels, and breathing.

• Your child may need to lie flat for a few hours after the procedure without bending their legs. This will help prevent bleeding.

• Your child’s provider might give your child medicine to prevent blood clots.

• Your child will get pain medicine if needed.

• Your child’s provider may order follow-up tests, such as an electrocardiogram or an echocardiogram.

• Your child will likely need to stay in the hospital for at least a day.

At home after the procedure:

• Ask what medicines your child needs to take. Your child may need to take antibiotics or medicines for a short time to prevent blood clots. Give pain medicines as needed.

• Don't let your child do any strenuous activities. Encourage them to rest.

• If your child has stitches, they will be removed at a follow-up appointment. Keep all follow-up appointments.

• Call your child’s healthcare provider if your child has more swelling, more bleeding or drainage, a fever, or severe symptoms. A little drainage from the site is normal.

• Follow all the instructions your child’s healthcare provider gives you about medicine, exercise, diet, and wound care.

• For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures. They can help prevent an infection of the heart valves.

After the procedure, your child will need regular checkups by a cardiologist. After a period of time, your child may need these visits less often. After recovering from the procedure, most children are able to lead normal lives without any activity restrictions.

Next steps

Before you agree to the test or procedure for your child, make sure you know:

• The name of the test or procedure

• The reason your child is having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• When and where your child is to have the test or procedure

• Who will do the procedure and what that person’s qualifications are

• What would happen if your child did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or your child has problems

• How much you will have to pay for the test or procedure