Patients with ventricular septal defect who have developed Eisenmenger physiology or severe pulmonary arterial hypertension (PVR ≥5 WU) and who desaturate on exercise represent a distinct clinical sub-population requiring a carefully defined management approach.
This protocol applies to VSD with Eisenmenger physiology, or with severe pulmonary arterial hypertension (PVR ≥5 WU), where the patient presents with a fall in arterial oxygen saturation below 90% on exercise. In this setting, the presence of significant PAH fundamentally shapes the management pathway. The full structured protocol defines the evidence-based approach for this population.
DOI: 10.1093/eurheartj/ehaa554
VSD closure is not recommended in patients with Eisenmenger physiology and patients with severe PAH (PVR ≥5 WU) presenting with desaturation on exercise.
There are limited data available for a precise cut-off, but by clinical experience, this would be given by a fall of arterial oxygen saturation <90%.
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