50. What are the indications to close a ventricular septal defect?
The indications to close a ventricular septal defect either percutaneously or surgically are:
1. When the Qp/Qs is > 1.5 and there is LV systolic or diastolic dysfunction causing clinical heart failure.
2. Prior endocarditis
3. When the Qp/Qs is > 1.5 and the pulmonary pressures are no more than two thirds of systemic pressure.
4. When the Qp/Qs is > 2 and there is evidence of volume overload of the LV
5. When acute VSD develops after myocardial infarction
If Eisenmenger’s syndrome is present, closure of a VSD is NOT recommended and can be fatal. In this situation, the only remedy is heart-lung transplantation.