What To Do About Ventricular Septal Defect

Ventricular septal defect (VSD) is the most common type of congenital heart disease, accounting for approximately 20% to 57% of all congenital heart conditions, excluding bicuspid aortic valve anomalies. Most VSD cases occur in isolation, although about 40% are associated with other cardiovascular malformations.

Understanding VSD and When Treatment Is Needed

Ventricular septal defects vary in size and location, which significantly influences the clinical approach and timing of treatment. Infants and children with large VSDs often present with symptoms such as feeding difficulties, frequent respiratory infections, and congestive heart failure. These signs typically indicate the need for early surgical intervention. Older children with a pulmonary-to-systemic flow ratio exceeding 2:1, along with audible heart murmurs, radiographic evidence of pulmonary congestion, and echocardiographic confirmation of left-to-right shunting, should also undergo prompt surgical correction.

Moderate-Sized VSDs

Patients with moderate-sized defects may remain asymptomatic initially but can develop complications such as recurrent pulmonary infections and growth delays. In such cases, if imaging reveals cardiac enlargement, pulmonary congestion, or developing pulmonary hypertension, early surgical repair is strongly recommended to prevent long-term complications.

Small VSDs and Spontaneous Closure

Small VSDs have a high likelihood of spontaneous closure, especially in early childhood, with membranous defects being the most common type to resolve naturally. However, if signs of cardiac enlargement, pulmonary congestion, or infective endocarditis arise, timely surgical intervention becomes necessary despite the initially small defect size.

Special Considerations in VSD Management

Subpulmonic or "supracristal" VSDs carry a higher risk of associated aortic valve prolapse and subsequent aortic insufficiency. These anatomical variants warrant early surgical correction to prevent progressive valve damage. In contrast, when Eisenmenger syndrome develops—characterized by irreversible pulmonary hypertension and cyanosis—surgical repair is no longer indicated, and management focuses on symptom control and supportive care.

Medical Management and Supportive Care

While surgery remains the definitive treatment for significant VSDs, medical therapy plays a crucial role in managing complications. Preventive measures such as antibiotic prophylaxis are essential to reduce the risk of infective endocarditis. Additionally, treating pulmonary infections and managing heart failure with appropriate medications is vital in preoperative care.

In cases of severe pulmonary infection unresponsive to standard antibiotic therapy or refractory heart failure despite optimal medical treatment, emergency surgical intervention should be considered to stabilize the patient and improve long-term outcomes.