The Surgical Indications For Ventricular Septal Defect Repair

Ventricular septal defect (VSD) is the most common form of congenital heart disease, accounting for approximately 25% of all cases. Small VSDs may shrink or even close naturally within the first year of life. Studies indicate that around 25% to 40% of VSDs can spontaneously close by the age of three to four years. Small defects, particularly those located in the membranous or muscular portions of the septum, are more likely to heal on their own. Interestingly, even some large VSDs—around 7%—in infants with heart failure may have the potential to close without surgical intervention.

When Is Surgery Necessary?

Despite the possibility of spontaneous closure, large VSDs that do not respond to medical treatment require surgical correction regardless of the patient's age. If an infant develops pulmonary hypertension or exhibits a pulmonary-to-systemic blood flow ratio greater than 2:1, surgery becomes essential. Additionally, certain types of VSDs, such as supracristal defects, also necessitate surgical intervention even if the defect size is not significantly large.

Preventive Surgery For Small VSDs

Even small VSDs can pose risks, particularly an increased chance of developing infective endocarditis—a serious infection of the heart lining. To mitigate this risk, surgical repair is often recommended before the child begins school. This preventive approach helps ensure long-term cardiac health and reduces the likelihood of complications later in life.