Ventricular Septal Defect of 7mm in Children – Is Surgery Necessary?

When a child is diagnosed with a 7mm ventricular septal defect (VSD), one of the first considerations is the patient's age. If the child is an infant, a hole of this size can lead to significant left-to-right shunting of blood, which may result in pulmonary hypertension and other complications. In such cases, surgical intervention is typically recommended to prevent long-term damage and ensure proper cardiac function.

Factors That Influence the Need for Surgery

The decision to operate is not based solely on the size of the VSD but also on its location and how it affects surrounding heart structures. For example, if the defect is located beneath the aortic or pulmonary valve—referred to as a high-risk or supracristal defect—there is an increased risk of aortic valve prolapse and regurgitation. These types of VSDs rarely close on their own and can lead to serious complications if left untreated.

Monitoring and Spontaneous Closure Possibilities

In some older children, a 7mm VSD might show signs of natural closure or reduction in size due to the formation of a false septal aneurysm or tissue adhesion around the defect. If the shunt is decreasing and the child is showing no symptoms, doctors may suggest observation for a period of time. However, if the VSD remains open beyond the age of 2 or 3 years, surgical repair becomes more advisable to prevent complications such as endocarditis or valve dysfunction.

Long-Term Risks of Delaying Surgery

Delaying surgery in cases where the VSD is hemodynamically significant or located in a high-risk area can lead to irreversible damage. A persistent defect may cause progressive dilation of the heart chambers, chronic pulmonary hypertension, and increased susceptibility to infections like bacterial endocarditis. In particular, defects near the outflow tract or aortic valve can lead to aortic regurgitation, which worsens over time and may require more complex interventions later.

Conclusion – When to Consider Surgical Intervention

In summary, a 7mm VSD does not always require immediate surgery, but careful evaluation is essential. The location of the defect, the patient's age, and the presence of symptoms or complications all play a crucial role in determining the appropriate timing for surgical repair. Early intervention is often the best course of action when dealing with defects in high-risk areas to avoid long-term cardiovascular issues and ensure the child's healthy development.