The VSD

As October moved along, Nathan's health continued to make good, but small, improvements. Unfortunately, because of a heart condition known as Ventricular Septal Defect (VSD), Nathan was really unable to make any remarkable progress.

A VSD is a hole in the wall of the heart (the septum) that separates its left and right sides and occurs between the two lower chambers (ventricles).

In a normally functioning heart, the left side of the heart only pumps blood to the body, and the heart’s right side only pumps blood to the lungs. When a VSD exists, a large amount of oxygen-rich blood from the heart’s left side is forced through the defect into the right side. This blood is pumped back to the lungs, even though it has already been refreshed with oxygen (see diagram above).

Unfortunately, this causes the heart to pump more blood. The heart, especially the left atrium and left ventricle, will begin to enlarge from the added work. High blood pressure may occur in the lungs’ blood vessels because more blood is there. This increased pressure is known as pulmonary hypertension. Over time, increased pulmonary hypertension may permanently damage the blood vessel walls.

In order to have the heart function properly and reduce the pulmonary hypertension, the VSD needs to be closed. VSD closure is usually performed by sewing a patch over the hole to close it completely. Eventually the normal heart lining tissue grows to cover the patch and it becomes a permanent part of the heart. This option requires open-heart surgery.

A second option for closing the VSD involves "plugging" the hole with a special device through a procedure in the catheterization lab. The procedure is less invasive than open heart surgery, but had never really been tried on someone as tiny as Nathan before. So there were inherent risks involved with this as well.

Talk about being stuck between a rock and a hard place and a fire breathing dragon!

If we did nothing, Nathan's heart would sooner or later over work itself and eventually stop.

Or we could subject him to the rigors and risks of open heart surgery.

Or we could try a new procedure that has a small proven success rate, but absolutely zero results (good or bad) for someone Nathan's size.

So we were again left with an extremely important decision to make regarding Nathan's life.