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Hole in Heart
I am 36 years old man, I have problem in my heart a mall subpulmonic ventricular septal defect of 0.04 cms, some docters they recomended for  surgery, but some doctors they don't recomend for surgery, please help me shall I make surgery, phycically I feel good.
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367994 tn?1304957193
There is no easy answere to your question (surgery or no surgery). Whether or not to have surgery depends on the view of pathophysiology as it relates ventrigular septum defect and prognosis.  The defect allows a interaction between the systemic and pulmonary circulations. As a result, flow moves from a region of high pressure to low pressure (from the LV to the RV, ie, left-to-right shunt).

In the long term pathophysiologic effects of a VSD are secondary to hemodynamic effects secondary to a left-to-right shunt and changes in the pulmonary vasculature.
For a perspective blood flow through the defect from the left ventricle (LV) to the right ventricle (RV) results in oxygenated blood entering the pulmonary artery (PA). This extra blood in addition to the normal pulmonary flow increases blood flow to the lungs and subsequently increases pulmonary venous return into the left atrium (LA) and ultimately into the LV. This increased LV volume results in LV dilatation and then hypertrophy. It increases the end-diastolic pressure and consequently LA pressure and then pulmonary venous pressure.

The increased pulmonary blood flow raises pulmonary capillary pressure, which can increase pulmonary interstitial fluid. When this condition is severe, patients can present with pulmonary edema. Therefore, both PA pressure and pulmonary venous pressure are elevated in a VSD. The increase in pulmonary venous pressure is not seen with an atrial septal defect because LA pressures are low, as blood can readily exit it through the atrial communication.

Finally, as blood is shunted through the VSD away from the aorta, cardiac output decreases, and compensatory mechanisms (enlarged LV, etc.) are stimulated to maintain adequate organ perfusion. The degree of the left-to-right shunt determines the magnitude of the changes described above. The left-to-right shunt depends on 2 factors: 1 is anatomic, and 1 is physiologic. The anatomic factor is the size of the VSD. In a normal heart, RV pressure is about 25% that of the LV. In a large VSD, this pressure difference is no longer maintained because these holes offer no resistance to blood flow. They are also consequently called nonrestrictive VSDs. ON THE CONTRARY, IN A SMALL VSD, the normal pressure difference between the ventricles is maintained. These are called restrictive VSDs because flow across the defect is somewhat restricted....  If your doctors are recommending surgery, intraventricular pressure is consideration and size of defect is not the sole determinent.

Doppler echocardiography provides additional physiologic information (ie, RV pressure, PA pressure, interventricular pressure difference). A measurement of LA and LV diameters provides semiquantitative information about shunt volume. The size of the defect is often expressed in terms of the size of the aortic root.


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The thing you are hoping is for no reoccurrence.  My friend of 33 has had a stroke and no after effects but now she is aware she has a hole in her heart.  To opt for surgery will mean she doesn't have to worry for the rest of her life if another clot will form and go to her brain.  Sometimes the after effects could mean being a prisoner in your body that does not do what you desire or think for it to do.
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