Congenital heart disease ( CHD ) occurs in 0.7～1 % of all newborn babies. Ventricular septal defect ( VSD ) is the most common form of CHD.

VSD is a defect of the interventricular wall between the right ventricle ( RV ) and the left ventricle ( LV ). Part of the LV volume is pumped through the VSD to mix with the RV volume. When the VSD is medium to large in size, the blood volume shunted through the VSD is significantly large and there will be volume overloading on the RV, lung vessels and the left heart, which results in a status called congestive heart failure ( CHF ). Infants or children suffering from VSD and CHF usually present themselves with pulmonary congestion, cardiomegaly, distressful breathing, poor appetite and slow body weight gain.

The fundamental therapy of VSD of significant size is surgical repair of the defect. VSD repair is a process of open heart surgery which includes general anesthesia, cardiopulmonary bypass, blood transfusion, sternum open, cardiotomy, patch repair of the defect, as well as postoperative care in the intensive care unit. When the patient’s condition is stable, he/she will be transferred to general ward and usually is discharged home a few days later.

Home care after open heart surgery:

A. Wound care:

1. Once the stitches on the chest are removed, the patient is allowed to take a shower, as long as the skin wound is kept dry and clean after the shower.
2. To minimize the scar formation as much as possible, surgical tapes to strengthen the skin can be kept on the wound for half a year. However, if any allergic reaction occurs, remove the tapes.
3. If any sign of infection or inflammation occurs on the wound, come back to outpatient clinic to see your doctor.
4. Prevent falling down or any stabbing force on patient’s sternum, especially the first few months after repair.

B. Nutrition:

1. Eat balanced and low salt diet
2. Frequent but small amount feedings in early post-operative period.
3. When home medications including digoxin and diuretics are taken, more potassium-rich food is required, such as orange juice, banana, guava, papaya, tomato, and etc.
4. To improve appetite, encourage the patient to dine with family.
5. Make the food diverse and appealing, like steamed dumplings, noodles, pasta, steamed eggs, and etc.
6. more vegetables and fruits intake and proper exercise can help bowel move and prevent constipation.

C. Home medicine:

1. Digoxin syrup:

Effect: improve cardiac contractility

Notice:

• Give precise dosage with a 1 cc syringe at right timing as prescribed
• Side effects of overdosages: poor appetite, nausea, vomiting, diarrhea, photophobia, blurred vision, bradycardia, arrhythmia, and etc.
• Eat more potassium-rich fruits.

2. Diuretics:

Effect: increase urine output and reduce volume loading on heart

Notice:

• Observe daily urine amount (weigh diaper) and any puffy face or leg edema
• If urine is excessive, eat more potassium-rich fruits.

3. Vasodilators:

Effect: reduce pressure loading on heart

Notice:

• In case overt hypotension occurs ( cold sweating, palpitation, shortness of breath, tachycardia, and pallor ), stop medication and take the patient to our ER or OPD

D. Regulations on physical activity and prevention of airway infection:

Only intensive exercise is limited. However, the patient’s heart and lung functions have not fully recovered yet and should be kept away from crowded environment and public area.

E. Alert to the following urgent symptoms and send patient back to our ER or OPD once any of the following conditions occurs:

shortness of breathing, very rapid or very slow heart rate / pulse rate, marked face pallor, obvious edematous eyelids or legs, high fever, repeated vomiting, low urine output, and very poor appetite

F. Vaccination:

Postpone vaccination schedule for at least 2 - 3 months.

G. Regular OPD follow-up:

The first OPD visit will be arranged at 3 - 7 days after discharge. Thereafter, depending on clinical requirement, a week to a month interval for OPD visits will be arranged.