Reevaluation yearly, or perhaps longer intervals, is recommended for our patient in order to monitor left ventricular function. Routine use of antibiotics for presumed bacterial endocarditis prophylaxis in most congenital cardiac defects was discontinued in 2007, because no evidence exists attesting to its efficacy. It still remains important, however, to assess the patient's risk factors for bacterial endocarditis, including poor dental health and injection drug use. Onset of aortic regurgitation is even less likely when not present by age fifteen years. Spontaneous closure still occurs, although less often, with advancing age.
Uncomplicated small VSD
An uncomplicated, small ventricular septal defect requires no other treatment, because it is hemodynamically insignificant and there are almost no long-term complications. Most small ventricular septal defects close spontaneously, especially those located in the muscular septum.
Large VSD
A ventricular septal defect that produces heart failure and growth retardation may warrant surgical closure. Some ventricular septal defects in an infant can allow a large left-to-right shunt with neither significant heart failure nor significant symptoms. A decision regarding closure of such a defect must be individualized. Many such defects do not require closure, as the defect size can decrease with advancing age, while length percentile decreases minimally.
Growth retardation chart
A large ventricular septal defect in an infant can cause congestive heart failure and growth retardation, especially of weight. Note the decrease in weight from birth at the 25th percentile to age four months below the 5th percentile. Most such patients require closure of the defect.
VSD surgical closure
The following video of surgical closure of a large ventricular septal defect was obtained through the courtesy of Dr. Redmond Burke, and it was carried out at the Miami Children’s Hospital in Miami Florida.
This is a 4-month old baby who has a large ventricular septal defect. The defect was completely covered with tricuspid valve tissue.
We’ll start at the apex of the VSD, and this is the pericardial patch. The smooth side goes on the left. Put this down inside.
You can see we have finished the inferior margin of our VSD repair. Okay, so now we’ll repair the tricuspid valve leaflet. We use a single 8.0 prolene and run it from the top down.
You can see where we repaired the tricuspid valve annulus.
We tested the valve leaflet and it looks perfect.
By filling the right ventricle with saline, we can see that the tricuspid valve is competent.
Okay, these are the de-airing maneuvers. The patient has been head up and head down. We’re trying to keep air out of the coronaries, and out of the aorta here, so that no air bubbles can go to the baby’s brain. We infuse CO2 through this cannula into the operative field. That displaces air. CO2 is highly soluble in blood, and we’ve inflated the lungs to get any air out of the pulmonary veins. Reduce your flow. (Response: “Flow is down.”) Clamps off. Now you will see the heart will start to turn pink… And here is the first beat.