Ventricular septal defect
ICD-10 Q21.0 ICD-11 LA88.4

Treatment of Ventricular Septal Defect with LV Volume Overload and No Pulmonary Arterial Hypertension

In patients presenting with a ventricular septal defect who show evidence of left ventricular volume overload — manifested as LV enlargement with increased stroke volume — and in whom pulmonary arterial hypertension has been excluded, a clear interventional pathway is recommended regardless of symptom status.

Clinical scenario
LV volume overload confirmed (LV enlargement with increased stroke volume) with no PAH: no non-invasive signs of pulmonary arterial pressure elevation, or invasive confirmation of pulmonary vascular resistance <3 Wood Units when such signs are present. This specific haemodynamic profile defines the indication for intervention.
Approach (partial overview)
The recommended approach centres on VSD closure — this may be achieved through surgical or transcatheter means depending on defect anatomy and accessibility. Certain anatomical configurations and specific VSD subtypes are particularly suited to one approach over the other. The full structured regimen — including decision criteria, procedural selection guidance, and sequencing — is available via the link below.
Instant Access to Structured Evidence-Based Regimens

References

  1. In patients with evidence of LV volume overload and no PAH (no non-invasive signs of PAP elevation or invasive confirmation of PVR <3 WU in case of such signs), VSD closure is recommended regardless of symptoms.
  2. Surgical closure can be performed with low operative mortality (1–2%) and good long-term results.
  3. Transcatheter closure has become an alternative, particularly in residual VSDs, in VSDs that are poorly accessible for surgical closure, and in muscular VSDs that are located centrally in the interventricular septum.
DOI: 10.1093/eurheartj/ehaa554
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