Ventricular Septal Defect
A ventricular septal defect (VSD) is a hole in the portion of the heart muscle which separates the right and left ventricles. The management of a patient with an isolated VSD is related to the size of the defect.
A small VSD does not cause symptoms or enlargement of the heart. However, patients should recognize the importance of the appropriate use of antibiotics to help prevent bacterial endocarditis, an infection of the heart. An occasional patient with a VSD can develop a leak in the aortic valve.
A moderate size VSD may result in cardiac enlargement. Endocarditis and abnormalities of the aortic valve can also occur. VSD closure is advised for patients with symptoms, elevated pulmonary artery pressure, or cardiac enlargement.
A large VSD requires cardiac surgery early in life to prevent irreversible damage to the pulmonary vascular bed, a condition known as pulmonary vascular obstructive disease (PVOD). Severe PVOD produces high resistance in the pulmonary arteries and generally makes an adult patient inoperable for VSD closure. Patients with severe symptoms from PVOD may be candidates for heart-lung transplantation.
Adults who have had uncomplicated VSD repair during childhood generally have an excellent prognosis. Periodic follow-up is advisable to assess for arrhythmias as well as the late development of associated cardiac defects.