Treatment of VSD with Repeated Infective Endocarditis and No Significant Left-to-Right Shunt
Not every ventricular septal defect requires intervention on haemodynamic grounds alone. However, when the lesion is accompanied by a pattern of repeated infective endocarditis, the risk calculus changes — and specific management options come into play.
Clinical scenario
The patient has a ventricular septal defect without significant left-to-right shunting, but has experienced repeated episodes of infective endocarditis. Despite the modest haemodynamic burden of the defect, this history of recurrent infection elevates the clinical risk and warrants a targeted management strategy.
Treatment approach
In this setting, closure of the defect is an option that warrants active consideration. The specific approach — and the criteria that guide selection between available techniques — are detailed in the full protocol.
References
DOI: 10.1093/eurheartj/ehaa554
- In patients with no significant LR shunt, but a history of repeated episodes of IE, VSD closure should be considered.
- Surgical closure can be performed with low operative mortality (1–2%) and good long-term results.
- 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.