The Surgical Indications for Ventricular Septal Defect Repair

Ventricular septal defect (VSD) is the most common type of congenital heart disease, accounting for approximately 25% of all cases. Small VSDs often decrease in size or even close spontaneously within the first year of life. Studies suggest that about 25% to 40% of VSDs may close naturally by the age of 3 to 4 years. Small defects, particularly those located in the membranous or muscular regions of the septum, are more likely to heal without intervention. Interestingly, even in about 7% of cases involving large VSDs complicated by heart failure, spontaneous closure has been observed.

When Is Surgery Necessary?

Despite the potential for natural closure, large VSDs at any age that do not respond to medical treatment require surgical intervention. If an infant develops pulmonary hypertension or a pulmonary-to-systemic blood flow ratio greater than 2:1, surgery becomes essential to prevent long-term complications. Additionally, supracristal VSDs—regardless of size—typically require surgical repair due to the high risk of progressive damage and complications.

Considerations for Small VSDs

Even small VSDs carry certain risks. One major concern is the increased likelihood of developing infective endocarditis, a serious infection of the heart lining. Because of this risk, it is generally recommended that children undergo surgical repair before entering school age. This preventive approach helps reduce the chances of infection and ensures better long-term cardiac health.

Conclusion

Understanding the natural progression of VSDs is crucial in determining the appropriate treatment path. While many small defects may close on their own, timely surgical intervention remains vital for larger defects or those associated with symptoms and complications. Early diagnosis and treatment planning by a pediatric cardiologist can significantly improve outcomes for children with VSD.