What Types of Ventricular Septal Defects Require Surgical Treatment?

Ventricular Septal Defects (VSDs) can present with a wide range of clinical symptoms, depending on their size, location, and the degree of intracardiac shunting. Small VSDs, especially those located in the membranous region, often result in minimal shunting and do not significantly elevate pulmonary artery pressure. These types of restrictive VSDs typically do not require surgical intervention and may even close spontaneously over time.

When Surgery is Not Necessary

In particular, muscular VSDs caused by underdeveloped muscle tissue, if isolated and less than 3mm in diameter, may not require surgical correction. These defects often have a high likelihood of spontaneous closure, especially in early childhood, and may not significantly impact cardiac function or development.

Indications for Surgical Intervention

Significant Shunting and Elevated Pulmonary Pressure

However, larger VSDs that result in significant left-to-right shunting of blood can place extra strain on the heart and lungs. If the defect leads to elevated pulmonary artery pressure or begins to impair normal growth and development, surgical closure becomes necessary. This is especially important to prevent long-term complications such as heart failure or pulmonary hypertension.

Location Near Major Valves

Another clear indication for surgery is when the VSD is located beneath the semilunar valves, particularly under the pulmonary valve. These subpulmonary VSDs are in close proximity to the right coronary cusp of the aortic valve. Prolonged shunting in this area can lead to distortion or prolapse of the adjacent aortic valve leaflet, potentially causing aortic regurgitation. Early surgical intervention is strongly recommended in these cases to prevent irreversible damage to the aortic valve and to preserve long-term cardiac function.