A case study on congenital cyanotic heart disease with Ventricular Septal Defect (VSD) managed by surgical closure with RVOT resection

Sowmiya1*, Hemalatha2, Sripreethi3, Jaya Menon4

1Critical Ward Senior Staff Nurse, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

2Non Critical Ward Nursing Supervisor, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

3Nurse Educator, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

4Nursing Superintendent, Kauvery Heart city, Trichy, Tamil Nadu

*Correspondence

Abstract

Congenital heart diseases are among the most common birth defects affecting pediatric populations worldwide. Ventricular Septal Defect (VSD) is a frequent acyanotic lesion that may progress to cyanotic conditions when associated with outflow obstruction. This case study describes a 5-year-old male child diagnosed with congenital cyanotic heart disease associated with subaortic VSD, double-chambered right ventricle, and right ventricular outflow tract (RVOT) obstruction. The patient presented mild respiratory symptoms and was evaluated using echocardiography, confirming the diagnosis. Surgical intervention included VSD closure using a pericardial patch along with resection of RVOT obstruction and RVOT patch augmentation. Postoperative recovery was stable, with satisfactory vital parameters and no complications. This case emphasizes the importance of early diagnosis, timely surgical management, and comprehensive postoperative nursing care in improving outcomes and preventing long-term complications in pediatric cardiac patients.

Keywords

Congenital heart disease; Ventricular Septal Defect (VSD); Cyanotic heart disease; RVOT obstruction; Pediatric cardiac surgery; Pericardial patch

Introduction

Congenital heart diseases (CHDs) are structural abnormalities of the heart present at birth. Among them, Ventricular Septal Defect (VSD) is the most common. It involves an abnormal opening between the ventricles, leading to abnormal blood flow. Cyanotic CHDs result in decreased oxygenation, causing bluish discoloration. When associated with RVOT obstruction, it increases severity by restricting pulmonary blood flow. Early diagnosis and surgical correction are crucial to prevent complications such as heart failure, pulmonary hypertension, and growth retardation.

Case Presentation

The patient is a 5-year-old male

Chief Complaints: Cough, Cold

Diagnosis

  • Congenital cyanotic heart disease
  • Subaortic VSD
  • Double-chambered right ventricle
  • RVOT obstruction
  • Right coronary cusp prolapses

Preoperative Findings

  • Moderate restrictive perimembranous VSD
  • Good left ventricular function

Lab & Diagnostic Investigations

ECG

Echocardiogram (ECHO)

  • Congenital cyanotic heart disease
  • VSD present
  • Good LV function
  • Intraoperative Findings:
  • Moderate VSD with right coronary cusp prolapses
  • RVOT obstruction at infundibulum
  • Fibrous obstruction present
  • No significant gradient across RVOT

Vital Signs (Post-op)

BP90/60 mmHg
PR98/min
RR28/min
SpO₂96%
TemperatureAfebrile

Management

Medical Management

  • Antibiotics: Ceftriaxone (IV)
  • Nebulization: Budecort + Duolin
  • Antipyretics: Paracetamol syrup
  • Other supportive care medications as prescribed

Surgical Management

Date: 18.03.2026

Procedure Done

  • Closure of VSD
  • Resection of RVOT obstruction
  • RVOT patch placement

Surgical Steps

  • Median sternotomy performed
  • Cardiopulmonary bypass (CPB) initiated
  • VSD closed using pericardial patch
  • RVOT obstruction removed
  • RVOT widened using patch
  • Heart restored to sinus rhythm

Outcome

  • Surgery successful
  • No intraoperative complications

Nursing Management

Preoperative Care

  • Monitor vital signs
  • Maintain oxygenation
  • Reduce anxiety of child and parents
  • Prepare for surgery (NPO, consent, investigations)

Postoperative Care

  • Continuous monitoring (BP, HR, SpO₂)
  • Maintain airway and oxygen support
  • Pain management
  • Monitor surgical site for bleeding, infection
  • Fluid and electrolyte balance
  • Administer medications as prescribed

Discharge Advice

  • Follow medication schedule
  • Maintain wound hygiene
  • Avoid strenuous activity
  • Follow-up visit as advised

Warning Signs to Report

  • Severe pain
  • Fever
  • Pus/oozing from wound
  • Abnormal bleeding

Discussion

VSD is the most frequently occurring congenital heart defect. In this case, the presence of RVOT obstruction and double-chambered right ventricle increased complexity. Surgical correction remains the definitive treatment. Early intervention prevents complications such as

  • Heart failure
  • Pulmonary hypertension
  • Growth delay

The use of pericardial patch closure and RVOT resection is a standard and effective approach. The patient showed good recovery due to:

  • Timely diagnosis
  • Proper surgical technique
  • Effective postoperative care

Conclusion

This case demonstrates successful management of congenital cyanotic heart disease with VSD and RVOT obstruction in a pediatric patient. Early diagnosis, prompt surgical intervention, and comprehensive nursing care are essential for a favorable outcome. Proper follow-up and parental education play a crucial role in long-term recovery.

References

  1. World Health Organization. (2023). Congenital anomalies. https://www.who.int⁠
  2. American Heart Association. (2022). Congenital heart defects in children. https://www.heart.org⁠
  3. Centers for Disease Control and Prevention. (2023). Facts about ventricular septal defect. https://www.cdc.gov⁠
  4. Nelson Textbook of Pediatrics. (2020). Nelson textbook of pediatrics (21st ed.). Elsevier.
  5. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. (2018). Wolters Kluwer.
  6. Textbook of Pediatric Nursing by Parul Datta. (2019). Jaypee Brothers Medical Publishers.
  7. Essentials of Pediatric Nursing by Ghai. (2018). CBS Publishers.
  8. Journal of Thoracic and Cardiovascular Surgery. (2021). Surgical management of ventricular septal defects in children, 162(3), 1234–1242.
  9. Indian Journal of Pediatrics. (2020). Congenital heart disease in children: Clinical profile and outcomes, 87(5), 345–350.
  10. National Heart, Lung, and Blood Institute. (2022). Ventricular septal defect (VSD). https://www.nhlbi.nih.gov⁠

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