What is the treatment for Ventricular Septal Defect (VSD)?

From the Guidelines

Treatment for ventricular septal defect (VSD) should be individualized based on the size of the defect, symptoms, and presence of complications such as aortic regurgitation or pulmonary hypertension, with the goal of improving morbidity, mortality, and quality of life. The management of VSD can be divided into several categories, including:

• Small restrictive defects, which may be watched conservatively without need for operative intervention, as the overall survival rate is 87% for all patients with unoperated VSD at 25 years 1
• Moderate VSDs, which may require closure if there is evidence of left ventricular volume overload and hemodynamically significant shunts (Qp:Qs ≥1.5:1), and PA systolic pressure is less than 50% systemic and pulmonary vascular resistance is less than one third systemic 1
• Large VSDs, which may require surgical repair or catheter-based closure, but only in the absence of severe pulmonary arterial hypertension (PAH) and severely elevated pulmonary vascular resistance, as the presence of these conditions incurs a high perioperative risk 1
• VSDs with complications such as aortic regurgitation, which may require surgical closure of the VSD and repair of the aortic valve 1
• VSDs with pulmonary hypertension, which may require treatment with PAH therapies before closure, and closure may be considered if there is a net left-to-right shunt and a decline in pulmonary vascular resistance with PAH therapies 1

The timing of VSD closure depends on the individual patient's characteristics, including the size of the defect, symptoms, and presence of complications. Surgical closure of VSD is recommended for adults with a VSD and evidence of left ventricular volume overload and hemodynamically significant shunts (Qp:Qs ≥1.5:1), if PA systolic pressure is less than 50% systemic and pulmonary vascular resistance is less than one third systemic 1. Alternatively, catheter-based closure of VSD may be considered for patients with suitable anatomy and without significant pulmonary hypertension or other complications. Regular follow-up with a cardiologist is important to monitor heart function and adjust treatment as needed.

From the Research

Treatment Options for Ventricular Septal Defect (VSD)

• Surgical closure of VSD is a safe and effective therapy, with a low risk of death, complete heart block, and reoperation 2
• Transcatheter closure of VSD is a less invasive alternative to surgical closure, with a lower incidence of minor adverse events, less blood transfused, faster recovery, and lower medical expenses 3
• The choice of treatment depends on the type and size of the VSD, as well as the patient's overall health and medical history

Surgical Repair of VSD

• Surgical closure of VSD can be performed on patients of all ages, from infants to adults 2, 4
• The procedure is typically performed under cardiopulmonary bypass, and the VSD is closed using a patch or direct suture technique
• The risk of complications, such as complete heart block and reoperation, is low 2, 4

Transcatheter Closure of VSD

• Transcatheter closure of VSD is a minimally invasive procedure that involves inserting a device through a catheter to close the VSD 3, 5
• The procedure is typically performed on patients with perimembranous VSDs, and the device is deployed through a vein in the leg
• The success rate of transcatheter closure of VSD is high, with a low incidence of complications 3, 5

Risk Factors for Complicated Course

• Low weight at operation, genetic syndrome, and long bypass time are independent risk factors for a prolonged intensive care stay and prolonged ventilation time 4
• However, low body weight at operation is not associated with an increased risk of complications or major adverse events 4