Ventricular Septal Defect (VSD) - Transcatheter device closure

Introduction

The heart has four chambers- two at the top (atria) and two at the bottom (ventricles). The wall between the two bottom chambers is called the ventricular septum. A VSD is a hole in this wall. This hole lets blood flow from the left ventricle (which sends blood to the body) into the right ventricle (which sends blood to the lungs).

 Signs and symptoms

A VSD allows some oxygen-rich blood from the left ventricle to flow into the right ventricle and back to the lungs instead of going out to the body. This can make the heart and lungs work harder than normal. 

Children with a small VSD often have no signs. Larger VSDs can cause: 

  • Fast breathing or feeling short of breath
  • Poor weight gain or feeding difficulties
  • Tiredness
  • Frequent chest infections 

Closing the VSD helps the heart work better and prevents long term problems. 

Diagnosis

A VSD is diagnosed by a doctor by: 

  • listening to the heart: they may hear a murmur
  • echocardiogram (heart ultrasound): this confirms the presence, size and location of the hole and how blood flows through it
  • electrocardiogram (ECG): this checks the heart rate and rhythm
  • chest X-ray: this shows the size of the heart and increased blood flow to the lungs 

Small VSDs sometimes close on their own. Larger ones may need treatment to prevent strain on the heart and lungs. 

If you have questions, talk to your child’s cardiologist or cardiac nurse. They are here to support you and your family. 

Treatment

Transcatheter VSD closure is a minimally invasive procedure performed in the cardiac catheterisation laboratory (also known as the cath lab). It closes the hole using a special device, without the need for open-heart surgery.  

Not all VSDs can be closed this way. It depends on the size and position of the VSD. An echocardiogram gives a good assessment of this information. During the procedure a test called a Trans-oesophageal Echocardiogram (TOE) is done to check for more information. 

Trans-oesophageal Echocardiogram (TOE)

  • is a special probe which is placed in your child’s oesophagus (food pipe) while they are asleep under anaesthetic
  • a TOE gives very clear images of the heart
  • only after seeing these images can the doctor be sure the VSD can be closed with a device
  • sometimes the doctor sees something on the TOE that means the VSD cannot be safely closed. If this happens, the procedure is stopped. This is uncommon. 

A transcatheter VSD closure involves: 

The procedure is done under general anaesthetic, so your child will be asleep and feel no pain

A TOE is done to check the VSD and make sure a device can be used

A small tube (catheter) is placed in a blood vessel in the leg (groin)

Using X-ray and ultrasound guidance, the doctor moves the catheter up to the heart and across the hole

A closure device (a small plug or double disc made of fine mesh) is placed across the VSD to close it

Once in position, the device stays securely in place, and heart tissue gradually grows over it

The catheters are removed, and a small dressing is put on the leg

The device stays in place permanently and becomes part of the heart wall over time, helping the heart work normally

The procedure takes about 1–2 hours and most children recover quickly

 Management

Risk and complications

Transcatheter VSD closure is very safe, but all medical procedures have some risks including: 

  • bruising or bleeding at the catheter site
  • the device moving (embolization) before it settles – rare
  • temporary or very rarely permanent irregular heart rhythm- very rare
  • small leaks around the device (these often close on their own)- rare
  • damage to heart structure- very rare
  • Infection- very rare 

Your child’s cardiologist will explain these and answer your questions before the procedure. 

Caring for your child after the procedure

In hospital:

  • Your child will wake up in recovery and be monitored
  • The leg used for the catheter must stay straight for a few hours
  • Most children can eat and drink when awake
  • An echocardiogram and sometimes an ECG will be done to check the device
  • Most children go home later the same day or the next morning 

At home:

  • Remove the dressing after 24 hours
  • No baths or swimming for 72 hours (quick shower is okay)
  • Back to school or daycare after 2 days
  • No rough play, cycling, or contact sports for a week
  • Your child may need aspirin for a few months to help healing
  • A follow-up scan will check the device and heart function