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VSD Closure Indications — EECC MCQ

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ModerateCongenital Heart Disease (Adult)VSD Closure IndicationsEECC

A 20-year-old woman with an unrepaired moderate-sized perimembranous VSD has developed progressive exertional dyspnoea. Echocardiography shows Qp:Qs 2.2:1, PA systolic pressure 45 mmHg, and RV dilatation. What intervention is recommended?

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Correct answer: E — VSD closure (percutaneous device or surgical) is indicated for haemodynamically significant VSD (Qp:Qs >1.5:1) with volume overload, provided PVR is not severely elevated

The 2020 ESC ACHD Guidelines recommend VSD closure for: (1) significant left-to-right shunt (Qp:Qs ≥1.5:1) with evidence of LV volume overload (LV dilatation); (2) history of IE; (3) progressive AR associated with the VSD (particularly subarterial/doubly committed VSD). Contraindications: Eisenmenger syndrome (irreversible PH with shunt reversal, PVR >5 WU or PVR/SVR >0.33). For borderline PVR (2.3-5 WU), the treat-and-close approach may be considered. Percutaneous device closure is increasingly used for perimembranous VSDs (with careful assessment of proximity to the aortic valve and conduction system), while surgical closure remains the standard for large or unfavourably positioned defects. Post-closure complications include residual shunt, heart block, and device embolisation.

Reference: ESC (2020): ACHD Guidelines