34
Specific Conditions
4.1.2. Ventricular Septal Defect
COR LOE
Recommendations
Diagnostic
1 B-NR
1. Patients with an unrepaired VSD should be assessed for the
presence of PAH to guide decisions about medical therapy
and repair.
1 B-NR
2. In adults with a perimembranous VSD being considered
for repair, evaluation to exclude RV outflow tract (RVOT)
obstruction or double-chambered right ventricle (DCRV) is
recommended to improve management planning.
1 C-LD
3. Adults with a VSD (repaired or unrepaired) and PAH should
be followed by specialists with expertise in ACHD and
pulmonary hypertension to reduce morbidity and mortality.
erapeutic
1 B-NR
4. In adults with a VSD, a significant left-to-right shunt (Qp:Qs
≥1.5), and significant or progressive LV dilatation with
no evidence of PAH (PVR ≤2 Wood units), closure of the
defect is recommended to eliminate the shunt and preserve
ventricular function.
2a C-LD
5. In adults with a VSD, LV volume overload, Qp:Qs ≥1.5:1,
and mild PAH (PVR >2 but <5 Wood units), closure of the
VSD is reasonable to eliminate the shunt, in order to reduce
the risk for progressive PAH and the burden of chronic
volume overload on the LV.
2a C-LD
6. In adults with an outlet or perimembranous VSD causing
progressive moderate or greater aortic regurgitation, closure
of the VSD is reasonable to preserve aortic valve function.
2b C-LD
7. In adults with a recent history of infective endocarditis
involving a VSD, closure of the VSD may be reasonable to
reduce the risk for recurrent endocarditis.
2b C-LD
8. In adults with a VSD, Qp:Qs ≥1.5, and PAH (PVR 5 to 8
Wood units) without hypoxemia, if PVR drops to <5 Wood
units with PAH therapies, usefulness of closure of the VSD
is uncertain to reduce the risk for progressive PAH and the
burden of chronic volume overload on the left ventricle.
3: No
Benefit
B-NR
9. In adults with a VSD, Qp:Qs <1.5, and no other indications,
closure should not be performed to avoid unnecessary
perioperative risks.
3: Harm B-NR
10. In adults with a VSD and Eisenmenger physiolog y, VSD
closure should not be performed to avoid escalating
morbidity and mortality.
