Open-Heart Surgery for Ventricular Septal Defect: A Comprehensive Overview

Among all surgical specialties, cardiac surgery does not involve minor procedures. What may be considered a straightforward operation in heart surgery would typically be classified as a major procedure in other medical fields. One such example is open-heart surgery for ventricular septal defect (VSD), a condition where there is a hole in the wall separating the two lower chambers of the heart. This type of surgery requires opening the chest cavity, accessing the heart directly, and repairing the defect under highly controlled conditions.

The Role of Cardiopulmonary Bypass in Heart Surgery

Since the heart must continuously pump blood to sustain life, it cannot be stopped or rested during surgery. To address this challenge, a critical step in open-heart procedures is the establishment of cardiopulmonary bypass (CPB), also known as extracorporeal circulation. This process involves using a heart-lung machine that temporarily takes over the function of the heart and lungs, allowing the surgical team to operate on a still, bloodless heart.

Before the actual repair begins, surgeons connect the patient to the heart-lung machine. Once CPB is established, blood flow to the heart is temporarily halted by clamping the major vessels. This creates a controlled environment where the heart is empty of blood, enabling the surgeon to clearly visualize and access the internal structures, including the location of the septal defect.

Repairing the Ventricular Septal Defect

With the heart stabilized and drained of blood, the surgeon proceeds to open the heart chamber and locate the ventricular septal defect. The hole is then carefully closed using either sutures or a synthetic patch, depending on its size and position. The goal is to restore the normal anatomical structure and prevent abnormal blood flow between the ventricles.

Completing the Surgical Procedure

Once the repair is complete, the surgeon closes the incision made in the heart muscle. The next step involves restarting the heart. This may be achieved through medication or controlled electrical cardioversion to restore normal rhythm. As the heart resumes beating, the surgical team gradually weans the patient off the heart-lung machine and monitors vital signs to ensure stability.

Successful completion of the surgery depends on two key phases: the safe establishment of cardiopulmonary bypass and the precise repair of the intracardiac defect. Both require meticulous coordination among the surgical, perfusion, and anesthesia teams to ensure the best possible outcome for the patient.