Bidirectional Shunting In Infants With Subarterial Ventricular Septal Defect Can Be Treated Surgically

When it comes to subarterial ventricular septal defect (VSD) with bidirectional shunting, the possibility of surgical intervention largely depends on the child's age and pulmonary artery pressure measurements. In infancy, if the VSD is large, it may coincide with pulmonary hypertension, which is often physiological during the neonatal period. In such cases, early surgical repair may be both feasible and necessary to prevent further complications.

Early Surgical Intervention Is Crucial

For infants presenting with bidirectional shunting, prompt surgical treatment is often recommended. The presence of bidirectional flow typically indicates elevated pulmonary artery pressure. Timely surgery can prevent the progression of pulmonary vascular disease and significantly improve long-term outcomes. Pediatric cardiologists and cardiac surgeons work together to assess the best timing for intervention based on echocardiographic findings and hemodynamic data.

Risks In Older Patients

In contrast, older children, adolescents, or even adults with long-standing subarterial VSD may develop irreversible, organic pulmonary hypertension. In these cases, surgery may not be immediately possible—or even advisable—without first lowering pulmonary artery pressure through medical therapy. Oral medications such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or prostacyclin analogs may be used to manage pulmonary arterial hypertension before considering surgical closure.

Post-Treatment Monitoring

Once pulmonary pressures have been adequately reduced and surgical repair becomes viable, patients must undergo continuous follow-up. Regular cardiac evaluations, including echocardiograms and sometimes cardiac catheterization, are essential to monitor for any residual defects or late complications. With proper management, even patients who initially had advanced pulmonary hypertension can experience significant improvement in quality of life after successful VSD closure.