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Ventricular Septal Defect
1Harvard Medical School and Massachusetts General Hospital, 55 Fruit Street, VBK 615, Boston, MA 02114-2696, USA.
Insights
Most childhood ventricular septal defects (VSDs) close spontaneously. Surgical intervention for VSD is reserved for specific cases with complications or significant defects, while device closure remains investigational.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Ventricular septal defects (VSDs) are the most common congenital heart malformations in children.
- Spontaneous closure is frequent for small VSDs, necessitating clinical monitoring and endocarditis prophylaxis.
Purpose of the Study:
- To outline current management strategies for ventricular septal defects (VSDs) in children.
- To delineate indications for surgical and investigational device closure of VSDs.
Main Methods:
- Clinical follow-up for small VSDs.
- Surgical repair for VSDs with associated lesions or functional deterioration.
- Medical management for moderate to large VSDs in infancy.
- Investigational device closure for specific VSD types.
Main Results:
- Small VSDs often close spontaneously, requiring only clinical follow-up and prophylaxis.
- Surgical closure is indicated for VSDs with specific associated lesions (e.g., aortic regurgitation, outflow obstruction) or signs of ventricular dysfunction.
- Medical management is crucial for congestive heart failure in infants with moderate to large VSDs.
- Early surgical closure (by 9 months for large, 2 years for moderate VSDs) is recommended to prevent pulmonary vascular disease and volume overload.
Conclusions:
- Management of VSDs depends on defect size, associated lesions, and clinical presentation.
- Timely intervention is critical for moderate and large VSDs to prevent long-term complications.
- Device closure shows promise but requires further investigation.
Abstract:
Ventricular septal defects (VSDs) are the most common congenital heart malformations seen in children. Because spontaneous closure occurs frequently, patients with small VSDs should be followed clinically with no limitations except endocarditis prophylaxis. Surgical closure is recommended for only small defects with significant associated lesions such as aortic regurgitation, aortic valve prolapse, right or left ventricular outflow obstruction, tricuspid regurgitation, left ventricle to right atrial shunt, or recurrent endocarditis. Enlarging left ventricular size or deteriorating left ventricular function would also be an indication for surgical repair. Moderate and large VSDs in infancy often require treatment of congestive heart failure with diuretics, digitalis, and afterload reduction. Surgical closure before 9 months of age is indicated for large VSDs and by 2 years of age for moderate shunts to prevent pulmonary vascular obstructive disease and the consequences of long-standing volume overload. Device closure of VSD is still in the investigational stage but holds promise for treatment of apical or multiple muscular VSDs.