Is Surgery Necessary for Atrial and Ventricular Septal Defects?

When a child is diagnosed with an atrial septal defect (ASD) or ventricular septal defect (VSD), parents often wonder whether surgery should be performed immediately. If the defect is small — typically less than 5mm in size — and does not cause noticeable symptoms, it may not require immediate intervention. In such cases, doctors often recommend regular monitoring to assess whether the defect closes on its own over time. This approach is especially common when the child is growing normally and feeding well without signs of distress.

When to Consider Surgical Intervention

However, if the child has both an ASD and a VSD, and the combined effect results in significant blood shunting, early surgical correction is generally advised. The decision to operate depends on the overall hemodynamic impact of the defects and the potential for complications such as heart failure or pulmonary hypertension. In such cases, timely intervention can prevent long-term damage to the heart and lungs.

Evaluating Defect Size and Symptoms

If both defects are relatively small, surgery is often scheduled after the child reaches six months of age. However, if either the ASD or VSD is large — particularly if the VSD is classified as non-restrictive, meaning it allows unrestricted blood flow and is larger than half the diameter of the aorta — the situation becomes more urgent. In these cases, doctors will evaluate several factors including growth delays, feeding difficulties, and the frequency of respiratory infections like colds or pneumonia.

Timing the Procedure

If symptoms are severe and occur frequently, early surgical repair is strongly recommended to improve quality of life and reduce the risk of complications. On the other hand, if the child experiences minimal symptoms and maintains healthy growth and development, the procedure can often be delayed until the child is between two and three years old. This allows for a more mature cardiovascular system and potentially reduces surgical risks.

In summary, the decision to proceed with surgery for septal defects should be based on a comprehensive evaluation of the defect size, hemodynamic impact, and the child's overall health. Regular follow-ups with a pediatric cardiologist are essential to determine the optimal timing for intervention.