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Case Report
IntroductIon
The spectrum of congenital heart disease (CHD) is diverse. 
Shunt lesions, disorderly lesions, obstructive lesions, 
and complex lesions involved with the usual mixing and 
functioning of the single ventricles can be generally categorized 
as defects. Type surgical operations are often undertaken in 
early childhood to reduce long-term problems stemming 
from aerodynamic pressure or recurring ankylosis. Mortality 
related to the procedure was subcircumstantially reduced with 
improved techniques and experience.[1]
Causes include complications with the child’s genes or 
chromosomes, such as Down syndrome; taking drugs during 
breastfeeding; or alcohol or opioid addiction; A virus disease 
in a female in the first trimester of pregnancy, such as 
rubella (German measles).
Symptoms include breathlessness; physical performance 
challenges; a bluish tint on the skin, fingertips, and 
lips (physicians call it cyanosis due to a loss of blood oxygen); 
rapid respiration and inadequate diet; severe change in weight; 
diseases in the lungs; and unable to work.[2]
The	most	commonly	affected	heart	condition	is	a	ventricular	
septal defect (VSD) in both gender which has a prevalence 
of about 20% in children with heart defects.[3] It is expected 
that 25%–40% of VSDs will close by age 2, and it is unlikely 
that they will continue after age 10.[4] In multiple places 
and	sizes,	VSDs	exist.	There	are	different	forms	of	tissue	in	
the ventricular septum, with one part comprising mostly of 
A Case Report of a 12‑year‑old Girl with Ventricular Septal 
Defect: Correlation with Functional Capacity and Quality of Life
Akhila Puranik, Vaishnavi V. Siroya, Lynn Fernandes, Bhavna Gandhi, Ashish Wasudeorao Bele, Irshad Qureshi1
Departments of Community Health Physiotherapy and 1Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), 
Wardha, Maharashtra, India
Congenital heart and vessel malformations occur in 5–8 per 1000 live births, resulting in an occurrence of around 0.7%. Some of these 
malformations (10%–15%) do not need correction. The key aims of recovery are to remove impairments, disabilities, and disabilities, 
improve quality of life (QOL), and minimize disease-related morbidity and postoperative disease. Aim: This study aimed to investigate 
the	 effect	 of	 exercise	 programs	 of	 2	weeks	 on	 the	 outcomes	 of	 functional	 capacity	 and	QOL	 in	 a	 postoperative	 surgery.	A	 12‑year	
ventricular septal defect survivor underwent primary treatment consisting of open-heart surgery. The patient was given an exercise program 
comprising	 techniques	of	 clearance,	 re‑expansion	maneuver,	 vibration,	percussion,	 compression,	manual	hyperinflation,	positioning,	
postural	drainage,	cough	stimulation,	aspiration,	breathing	exercise,	and	increased	expiratory	flow	mobilization.	For	2	week	(three	times/
day), functional capacity and QOL were measured before and after completion of the exercise program. Considerable improvement in 
functional capacity and QOL was observed after 2 weeks of the multiple techniques and exercise intervention. The complementation 
intervention	was	found	to	be	effective	for	improving	various	physiological	aspects	associated	with	open‑heart	surgery.	This	case	study	
concluded	that	the	complementation	intervention	was	effective	for	improving	various	physiological	aspects	associated	with	open‑heart	
surgery including QOL.
Keywords: Functional capacity, quality of life, ventricular septal defect
Address for correspondence: Dr. Ashish Wasudeorao Bele, 
Department of Community Health Physiotherapy, Ravi Nair Physiotherapy 
College, Datta Meghe Institute of Medical Sciences (DU), Sawangi (Meghe), 
Wardha ‑ 442 107, Maharashtra, India. 
E‑mail: bele.ashish321@gmail.com
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DOI: 
10.4103/jdmimsu.jdmimsu_73_21
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How to cite this article: Puranik A, Siroya VV, Fernandes L, Gandhi B, 
Bele AW, Qureshi I. A case report of a 12-year-old girl with ventricular 
septal defect: Correlation with functional capacity and quality of life. J Datta 
Meghe Inst Med Sci Univ 2021;16:768-72.
Abstract
Submitted: 17‑Feb‑2021 Revised: 18‑Apr‑2021
Accepted: 28‑Sep‑2021 Published: 24‑Jun‑2022
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Puranik, et al.: Ventricular septal defect, functional capacity, and quality of life in 12 year in girl
Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 16 ¦ Issue 4 ¦ October-December 2021 769
the	muscle	 and	 another	 of	 smaller,	 fibrous	 tissue.	The	 size	
and location of the septum hole will partly determine the 
consequences of the VSD. The septal defects of the ventricular 
occasionally develop and become smaller or similar instead. 
This is because most cardiologists do not need immediate 
surgery when a baby is born with a septal ventricle defect but 
instead look at the baby and seek drugs to relieve the signs of 
congestive heart failure and decide if the defect closes itself. 
There is also a shortage to a certain level at present of less 
significant	cardiac	abnormalities.[5] This is why CHD therapy 
is intended to reduce morbidity in the long run and increase 
the quality of life (QOL) of the patient. In consideration of the 
financial	costs	currently	being	expended	on	invasive	clinical	
interventions, a rise in time and resources is warranted by 
successful recovery initiatives to improve the QOL for the 
medical population in a prompt way.[6]
Functional capacity is a person’s capability to carry out aerobic 
training for optimum consumption of oxygen in cardiovascular 
medicine.[7] Functional capacity is better evaluated with respect 
to unique life-cycle activities a person will have to perform. For 
youngsters, success in education and playing and engagement 
in family life are practical criteria. For adults, practical skills 
in the workforce and practices relating to raising and engaging 
with	 their	 children	 are	 significant,	 and	 in	many	 situations.	
Any screening techniques analyze in some depth the capacity 
to perform activities relevant to age. Functional capacity 
assessments, which involve overwhelmingly older adults, are 
especially stressed among those that need long-term care. In 
actual reality, it appears to be calculated that an individual’s 
lack	of	capacity	to	conduct	certain	therapeutic	tasks	satisfies	
his	requirement	for	long‑term	wellness	and	fitness	for	public	
finance	or	insurance	benefits.	Two	general	words	have	come	
to mean functional capability in relation to older people and 
other citizens who need long-term care: The ability to carry out 
“daily life tasks” (DLAs) and the ability to carry out “day-day 
instrument tasks.” Functional capacity can be evaluated by 
questions about what a person can do (i.e. jumping up from 
a chair, exhibiting the capacity to carry and take food in a 
tablespoon, opening a water bottle, and taking the right amount 
of pills) or displays of practical capabilities. Questions on what 
an entity does can also be evaluated. To acquire information, 
the	calculation	technique	should	be	modified.	Rehabilitation	
programs, often sometimes in great depth, ought to know the 
potential. Real functioning could be morecritical than the 
ability for program assessments and quality assurance. For 
example, someone may be able to bathe without assistance, but 
they may not, for example, do so because of the regulations of 
their nursing homes. Some claim that what matters for QOL 
is real liberty.[2]
A Practical Ability Assessment (FCE) tests a worker’s 
capability relevant to his/her job engagement. The FCE method 
contrasts the position and arrangements of the employee to 
the demands of the workplace. In general, the FCE’s key goal 
is to determine the willingness of an individual to engage in 
the task, even though other day-to-day instrumental tasks 
promoting the role can also be assessed. The practical ability 
assessment (FCA) may also be referred to as related forms of 
testing.	A	specific	fundamental	expertise	of	the	physiotherapist	
based on their experience is the capacity to evaluate an 
action in depth to assess the appropriate components for the 
practice in a professional manner. The FCEs usually enable 
the assessor to evaluate the individual’s ability to perform 
multiple	work‑specific	 tasks	 and	whether	 these	 skills	meet	
the fundamental components of work performance. While 
FCEs may be participated by people from other disciplines, 
the physiotherapist brings unrivaled knowledge and expertise 
to the complex and dynamic interactions between the person, 
environment, and task.[8]
QOL is the desire of the patient to have regular events in 
general. In medical treatment, QOL is an important factor. 
Certain therapies will dramatically impact the QOL without 
offering many benefits, while others increase the QOL 
considerably.[9]
The WHO described QOL in the sense of their cultures and 
value systems, in relation to their goals, aspirations, values, 
and concerns as an individual’s view of their life role. The 
definition	is	dynamic	and	dynamic,	influenced	by	the	physical,	
psychological, personal values, social and their interaction with 
the	most	 significant	 characteristics	 of	 their	 environment.[10] 
QOL is determined to some degree by their heart problems in 
adults with CHD, but it relies strongly on their expectations. 
Conventionally, death, physical morbidity, and functional 
status are at the core of clinical research’s long-term outcomes 
steps.	QOL	findings	 have	 not	 been	 shown	 to	 be	 in	 good	
association	with	significant	clinical	effects	as	complementary	
to “hard” clinical evidence. In addition, QOL results provide 
advice to health-care practitioners on the option of particular 
therapies and the distribution of capital by policymakers.[11]
Patient history
Our patient was a 12-year-old girl who was referred to our 
hospital	 due	 to	 suffering	 from	 shortness	 of	 breath	 and	 an	
orthopedist lasting several days. The patient reported having 
a systolic murmur since childhood that had been originally 
diagnosed as ventricular septal defect 1 month back. She 
has a history of having episodes of chest pain, palpitations, 
and breathlessness after performing strenuous activities. The 
pain gets subsided with medications. Before 1 month, she 
experienced heavy breathlessness which was sudden in onset, 
and she underwent electrocardiography and cardiographs and 
was diagnosed with congenital ventricular septal defect; then 
for further surgery, she came to AVBRH.
Clinical findings
Heart and respiratory sound
High-frequency systolic murmur was mainly audible in the left 
parastatal.	Moist	rales	were	in	the	bilateral	lower	lung	field.
Electrocardiogram
Normal sinus rhythm, 55 BP. QS pattern in V1, V2; ST 
depression in V5, V6.
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Puranik, et al.: Ventricular septal defect, functional capacity, and quality of life in 12 year in girl
Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 16 ¦ Issue 4 ¦ October-December 2021770
Echocardiography
Left to right shunt signal and remembrances inlet-type VSD 
were seen; pulmonary artery dilated, severe pulmonary 
hypertension; left arch – mild hypothalamic.
X‑ray
Posterior-anterior radiograph shows cardiomegaly, pulmonary 
outflow	tract	is	convex,	and	the	pulmonary	arterial	markings	
are increased [Figure 1].
Diagnosis
The patient was diagnosed with VSD.
Operative procedure
Open repair of VSD was done through hysterectomy, cardiac 
bypass, and cardiologist. The patient recovered within 5 days 
and was shifted toward from intensive care unit. The testing 
procedures and the information regarding the exercise protocol 
were explained to the patient, and informed consent was 
obtained.	Specific	assessment	of	physical	activity,	functional	
capacity.
Therapeutic intervention
Medical management
In. Contrivance, In. Kamikaze, In. Proletarian, Tab. Prenatal, 
Tab. Semiarid, Gyp. Paracetamol, Gyp. Multivitamin.
Physiotherapy management
Physiotherapy is given pre- and postoperative period to reduce 
the risk of pulmonary complications physiotherapy used 
techniques of clearance, re-expansion maneuver, vibration, 
percussion,	compression,	manual	hyperinflation,	positioning,	
postural drainage, cough stimulation, aspiration, breathing 
exercise,	and	increased	expiratory	flow	mobilization.
The patient underwent a 2-week exercise intervention along 
with usual care for open-heart surgery. All training sessions 
were	supervised	by	a	qualified	physiotherapist.	Each	exercise	
session was of 1-h duration, thrice a day for 2 weeks.
Treatment protocol
•	 Preoperative	treatment:
•	 The	most	 important	 physiotherapy	 intervention	
preoperative for the patient and family is education. 
We started with educating the family about the defect, 
treatment protocol, and postoperative complications
•	 The	preoperative	treatment	was	done	for	2	weeks	and	
was performed twice a day. The treatment consisted 
of breathing exercises to increase the lung volumes, 
improve the respiratory function and chest expansion, 
and to promote relaxation
•	 Then,	 the	 patient	was	 given	 upper	 limb	mobility	
exercises to improve the mobility, to maintain a good 
range motion, and to prevent contractures.
•	 Postoperative	treatment:
•	 After	 the	 surgery,	 the	main	 goal	was	 to	mobilize	
secretions and increase aeration and mobility. The 
postoperative treatment was given was 2 weeks and 
was performed thrice a day.
•	 Regular	 position	 changes	were	 done	 to	 avoid	 the	
accumulation of secretions in the lungs
•	 Incentive	spirometry	was	given	to	prevent	atelectasis
•	 Segmental	expansion	technique	was	performed	which	
elicits	a	stretch	reflex	that	facilitates	airflow
•	 Coughing	technique	was	given	to	mobilize	secretions
•	 Postural	 drainage	 (percussion	 and	 vibration)	was	
given for dislodging pulmonary secretions for airway 
clearance. Proper position was given to the patient 
while performing the postural drainage
•	 Range	of	motion	exercises	were	given	to	prevent	the	
forming of contractures and to maintain a good range 
of motion
•	 Ambulation	was	given	to	decrease	both	pulmonary	
and circulatory complications; the patient used to 
ambulate for about 5–10 fts.
Outcome measures
Outcome 
measure
Instrument Procedure
Functional 
capacity
6 min walk 
test
Greatest distance (meters) achieved 
by walking back and forth along the 
100-foot corridor for 6 min in the 
presence of a trained physiotherapist
QOL PCQLI PCQLI is use to evaluate the clinical and 
patient factors such as disease severity, 
medical care utilization, patient-parent 
consensus, and patient self-perception, 
competency, and behavior on HRQoL in 
the pediatric cardiac population
QOL: Quality of life, PCQLI: Pediatric quality of life inventory, 
HRQOL: Health-related QOL
results
Functional capacity
We observed that the functional capacity improved slightly by 
4.3% in the present case postexercise training.In the present 
study, restoration functional capacity was documented. Skeletal 
Figure 1: Posterior–anterior view of radiograph shows cardiomegaly, 
pulmonary outflow tract is convex, and the pulmonary arterial markings 
are increased
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Puranik, et al.: Ventricular septal defect, functional capacity, and quality of life in 12 year in girl
Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 16 ¦ Issue 4 ¦ October-December 2021 771
muscle changes that might have led to improvement in muscle 
strength and functional capacity include increases in oxidative 
enzymes, capillary density, myoglobin concentrations, and 
muscles’ glycogen.
Quality of life
The	present	case’s	QOL	improved	significantly	after	2	weeks	
of exercise preparation. As a whole, because QOL involves 
specific	 psychological	 and	 physiological	 realms,	 positive	
improvements in the various physical parameters (strength 
parameters, pain) and psychological parameters (sleep 
parameters) may have led to the improvement of the present 
case’s QOL.
dIscussIon
The initiation of a rigorous recovery program enhances the 
physical activity and, as a result, the QOL. The goal is to 
reduce impairments, disabilities, increase the QOL, and 
decrease morbidity and postoperative illness associated with 
the disease. In the early recovery of patients after surgical 
correction of congenital heart defects, the therapy program 
tends to be a justified complement to holistic treatment. 
Comprehensive heart recovery eliminates the issues about 
different types of physical activity that are frequently 
experienced in this community of patients and, as a result, 
increases the functional ability of the patients. As a whole, the 
QOL encompasses particular psychological and physiological 
domains, which may have contributed to positive changes in 
the	different	physical	parameters	(strength	parameters,	pain)	
and psychological parameters (sleep parameters).[12]
Moreover, for children with CHD, all age-appropriate modes 
of operation should be made available. There are numerous 
coordination activities in the nursery and elementary school 
era. At the ages of 8–10, specialized resistance and endurance 
training are neither necessary nor effective. At this age, 
improved strength and cardiovascular performance are 
the product of enhanced motor control. However, special 
compensation may be suggested if children show muscular 
imbalance resulting from a lack of motion or unbalanced 
load (for example, constant sitting).[13]
After	2	weeks	of	exercise	intervention,	significant	changes	in	
functional capability and QOL were observed. The exercise 
program consisting of clearance strategies, re-expansion 
maneuver, vibration, percussion, compression, manual 
hyperinflation, positioning, postural drainage, breathing 
exercise,	and	enhanced	mobilization	of	expiratory	flow	was	
given to the patient. The complementation intervention has been 
shown	to	be	successful	in	enhancing	different	physiological	
aspects associated with accessible great surroundings.
Young kids who stay asymptomatic and have a tiny VSD have 
a strong performance. In these children, however, the presence 
of anemia, infection, or endocarditis can cause symptoms. 
However,	if	the	defect	is	not	fixed,	the	results	in	individuals	
with a large VSD are bad. The continued shunt from left to right 
ultimately leads to pulmonary hypertension and Eisenmenger 
syndrome growth.[14]
A substantial decline in mortality has contributed to 
improvements in the treatment of CHD. More and more 
children with CHD are reaching adulthood, making morbidity 
an increasing CHD within this population. Compensation 
of adverse effects of CHD by objective-oriented QOL 
enhancement. Preventive diagnostics and care must be 
undertaken at an early stage, with the goal of detecting and 
alleviating	deficits	through	the	use	of	specific	interventions.	
This is the explanation for CHD rehabilitative intervention, 
targeting a long-term decline in morbidity and improvement 
in	the	QOL	of	the	patient.	Taking	into	account	the	financial	
outlay currently targeted at intrusive therapeutic interventions, 
it is warranted to increase the expenditure of time and funds 
aimed at improving the QOL of this group of patients through 
the institution of adequate rehabilitation measures in a timely 
manner.[15]
conclusIon
This case study concluded that the complementation 
intervention	was	effective	for	improving	various	physiological	
aspects associated with open-heart surgery including QOL.
Financial support and sponsorship
Self.
Conflicts of interest
There	are	no	conflicts	of	interest.
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Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 16 ¦ Issue 4 ¦ October-December 2021772
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