Common Congenital Heart Defects

The Parent's Guide to Children's Congenital Heart Defects: What They Are, How to Treat Them, How to Cope With Them
by Gerri Freid Kramer, Shari Maurer

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Name of defect: Ventricular Septal Defect

Definition/anatomy: A VSD is a hole or opening between the right and the left ventricles. It may be very small, in which case surgery isn't necessary. The majority of these VSDs become smaller or even close on their own. If the VSD is large, the left side of the heart will have to pump harder because it is supplying the blood to the entire body and at the same time back into the lungs via the right ventricle. This extra workload may lead to heart failure. In addition, the extra blood flow to the lungs can lead to lung disease. Therefore, all large VSDs should be closed surgically. The best treatment for a medium-sized VSD is less clear. In general these cases can be followed medically because they may become smaller or occasionally close.

Possible symptoms: Infants show symptoms of heart failure (difficulty feeding, excessive sweating, failure to grow). Older children experience shortness of breath with exertion.

Prognosis: Excellent. This defect is very amenable to surgical correction.

Treatment and surgical options: A patch is sewn over the opening between the left and the right ventricles.

Surgical timing: The timing depends on the size of the hole. Large VSDs should be closed within the first eighteen months of life.

Medications and medical care presurgery: In infancy, the presurgical care will depend on whether the baby has heart failure, in which case digitalis and furosemide are used.

Medications and medical care postsurgery: Once the VSD is closed and the heart has recovered, long-term medications are not necessary. Prophylactic antibiotics to prevent endocarditis are needed for only the first six months after surgery. Once the patch has healed and no residual shunt is present, no antibiotic pretreatment for dental work is necessary.

Possible restrictions: If the defect is small or has been surgically closed, the child has no restrictions on physical activity.

Long-term concerns: VSDs that aren't fully closed require prophylactic antibiotics before dental procedures. Long-term complications are extremely rare.

Medical advances to watch for: Closure of VSDs by catheterization may become available for certain cases.

Coping

My five-year-old was just diagnosed with CHD. Do I tell him? If so, how? How do I tell a toddler? What about a preteen?

Dr. Jonathan Slater: I would get some picture books appropriate to a five-year-old, or stuffed animals with organs (special companies make these, and Child Life departments often have them), and explain quite simply what the problem is, stressing how it will be fixed. A toddler can understand that he is sick and the doctors are making him better if you use appropriate terms such as "boo-boo inside," pointing to the chest. A preteen can follow more complicated diagrams and direct (but still optimistic) explanations. Preteens can also question doctors themselves.

Day-to-Day Living

How can new parents tell if their baby has difficulty eating or shortness of breath?

Dr. Welton Gersony, Dr. Beth Printz and Dr. Emily Jackness: Sometimes it's difficult for a parent who doesn't have any experience in childcare. Obviously, the more serious the problem, the easier it will be to tell. If a newborn baby takes an hour to drink four ounces because he tires after every few sucks, this is evidence of difficult feeding. Regarding shortness of breath, you should call your doctor if your infant consistently breathes more than sixty times per minute. Also call you doctor if your baby pulls in his ribs or sternum (breastbone) while breathing fast, or if you think your baby is having difficulty eating or is experiencing shortness of breath.

My child is refusing to take his medication. How can I encourage him?

Dr. Ruth Collins-Nakai: Most children will learn to take medicine easily if it just becomes a routine. For infants, the medicines will be liquids, and the trick is to put the dropper into the side of the mouth but very far back and squirt the medicine into the back of the mouth so the baby has no choice but to swallow it. For older children, when you are teaching them to swallow pills, place the pill in the center of the tongue and as far back as possible, then give them a drink of a favorite juice or milk. Praise them when they do it well and it some becomes routine. Sometimes it is necessary to grind up a pill and put it in applesauce or yogurt on a spoon (again far back in the mouth).

Some medicines taste terrible! For instance, a liquid that is often used to sedate children for procedures, called chloral hydrate, tastes quite bitter and almost mentholated. Again the trick is to get the medicine as far back in the mouth so they are forced to swallow, followed by something they like (liquid or solid).

TIPS FOR GIVING MEDICATIONS

"I used plastic syringes and as soon as he was able to hold the syringe, I let him help give the med. If they are involved, you are not giving it to them, they are doing it themselves and they take the meds better. Praise, praise, praise for doing good!"

- Sue Dove, mom to Scott (single ventricle)

"If we knew for sure that she didn't swallow it (the medicine), we would blow in her face and that would cause her to swallow the meds."

- Deanna Lopez, mom to Christina (pulmonary atresia stenosis, pacemaker)

Copyright © 2001 by Gerri Freid Kramer and Shari Maurer. Excerpted by permission of Three Rivers Press, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Gerri Freid Kramer is the mother of Max, age 6, who was born with CHD.

Shari Maurer is the mother of Elisabeth, age 7, who also has CHD.