What Are Large VSD and AVSD in Children? VSD and AVSD, which are among the congenital heart diseases, are structural defects that affect the normal blood circulation of the heart. VSD (Ventricular Septal Defect) is a hole between the right and left ventricles, the two lower chambers of the heart. AVSD (Atrioventricular Septal Defect) is a developmental defect of the walls in the central part of the heart and of the valves between the atria and ventricles. In complete AVSD, there are openings between the atria and ventricles and a common atrioventricular valve. In these diseases, more blood than normal going to the lungs can make the heart work harder and cause circulation problems over time. Early evaluation and appropriate surgical timing are important especially in large VSD and complete AVSD cases. What Is a Large VSD? VSD is one of the common congenital heart anomalies in children. Small VSDs may close on their own or can be followed without any intervention. However, in large VSDs, a large amount of blood may pass from the left ventricle to the right ventricle. This increases the amount of blood going to the lungs and creates a load on the heart and lung circulation. In severe untreated cases, heart failure and pulmonary vascular disease may develop. What Is AVSD? AVSD occurs as a result of the abnormal development of the walls in the center of the heart and of the atrioventricular valves. It can be seen mainly in two forms: Complete AVSD: There are openings between the upper and lower chambers of the heart and a common atrioventricular valve. It generally requires surgical treatment in early infancy. Partial AVSD: There is generally an opening between the atria and a structural defect in the left atrioventricular valve. The timing of treatment is determined according to the effects of the disease. AVSD may be seen more often in children with Down syndrome. However, it can also occur in children without Down syndrome. What Are the Symptoms of Large VSD and AVSD in Children? Symptoms may vary according to the size of the opening in the heart, the condition of the valves, and the amount of blood going to the lungs. The most common symptoms are as follows: - Rapid breathing and shortness of breath - Tiring quickly during feeding - Excessive sweating - Inadequate weight gain - Frequent respiratory tract infections - Weakness and tiring quickly - Delayed growth and development - Signs of heart failure in advanced cases Sweating during feeding, rapid breathing, and failure to gain weight in infants in particular may be important warning signs. How Are Large VSD and AVSD Diagnosed? The diagnosis of these diseases is made by a pediatric cardiology specialist through examination and imaging methods. 1. Physical Examination Hearing a murmur in the heart or detecting signs of heart failure may raise suspicion of the disease. 2. Echocardiography (ECHO) It is the main diagnostic method that evaluates the location and size of the openings in the heart, the structure of the valves, and blood flow. 3. Electrocardiography (ECG) Findings related to heart rhythm and strain on the heart chambers are examined. 4. Chest X-Ray It provides helpful information about heart size and blood circulation in the lungs. 5. Cardiac Catheterization It may be performed in selected patients in whom the pressure and resistance of the lung vessels need to be evaluated in detail. In Which Situations Does a Large VSD Require Surgery? Not every VSD requires surgery. However, large openings can lead to serious circulation problems. Surgical treatment may come into question in the following situations: - Development of signs of heart failure - Persistence of feeding and growth problems despite medication - Excessive blood flow to the lungs - Marked enlargement of the left heart chambers - Risk of developing pulmonary vascular disease - Impairment of heart valve function In VSDs that create a large and marked circulatory load, surgery is generally planned in infancy. When Is AVSD Surgery Performed? In infants with complete AVSD, surgical treatment is mostly performed in the first 3–6 months of life. However, earlier intervention may be needed in infants with serious heart failure, feeding difficulty, or growth delay. In partial AVSD, the timing of surgery is determined according to the enlargement of the heart chambers, the degree of valve leakage, and the child's clinical condition. Surgical intervention performed early and at the right time can reduce the risk of permanent damage to the lung vessels. How Is Large VSD Surgery Performed? In large VSD surgery, the aim is to close the opening between the ventricles and eliminate the abnormal passage of blood in the heart. The operation is generally performed with open heart surgery. During the surgical procedure: 1. The opening in the heart is evaluated. 2. The hole is closed using a suitable surgical patch or, in selected cases, stitches. 3. The heart valves and surrounding structures are protected. 4. After the repair, heart function and blood flow are checked. Although closure with a catheter is possible in some types of VSD, the surgical method is more often preferred in large and complex openings. How Is AVSD Surgery Performed? AVSD surgery is a comprehensive surgical procedure that involves closing the openings inside the heart and reorganizing the atrioventricular valves. During the operation: - The opening between the atria is closed. - The opening between the ventricles is repaired. - The common atrioventricular valve is reconstructed appropriately so that it functions as two separate valves. - Valve leaks are corrected as much as possible. - The heart's blood circulation and valve functions are checked. The surgical technique varies according to the type of AVSD and the anatomical features of the heart. Are Large VSD and AVSD Operations Risky? These operations are important procedures performed by experienced pediatric heart surgery teams. Surgical risks vary according to the child's age, weight, heart anatomy, and accompanying health problems. Possible complications include: - Bleeding and infection - Heart rhythm and conduction disorders - Small residual openings in the heart - Leakage or narrowing in the heart valves - Temporary impairment of heart function - The need for reintervention in later years In AVSD operations in particular, regular follow-up of valve function is important. The Recovery Process After Surgery After surgery, infants and children are closely followed in the pediatric heart surgery intensive care unit. During the recovery process: - Heart rhythm and function are monitored. - Breathing and oxygen level are checked. - The functioning of the heart valves is evaluated. - Feeding and weight gain are followed. - Necessary medication treatments are arranged. - The surgical repair is checked with echocardiography. The length of hospital stay and the speed of recovery may vary according to the scope of the operation performed and the child's general health condition. Can Children Live Normally After VSD and AVSD Surgery? After successful surgical treatment, many children can show normal growth and development. In particular, closing a large VSD in time helps reduce the load on the heart and improve circulation. Successful results can also be achieved in children who have had AVSD surgery. However, valve leakage or narrowing may develop in some patients in later years. For this reason, it is important to continue pediatric cardiology check-ups regularly. Why Are Early Diagnosis and Surgical Treatment Important? Large VSD and AVSD are serious congenital heart diseases that can cause heart failure and permanent damage to the lung vessels when left untreated. Early diagnosis in infancy in particular helps in evaluating feeding and growth problems and determining the right time for treatment. Surgical repair performed in time can reduce the load on the heart and lower the risk of long-term complications. Remember: The treatment plan is different for every child with large VSD and AVSD. Early diagnosis, heart surgery performed at the appropriate time, and regular cardiological follow-up are of great importance for children's healthy growth and the protection of their quality of life.