Question
When should a very large ventricular septal defect (VSD) be surgically corrected?
| A. |
In school-going age
|
| B. |
Only if congestive heart failure (CHF) is uncontrolled
|
| C. |
Before six months of age
|
| D. |
Soon after birth
|
Show Answer
|
Correct Answer » C
Explanation
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|
- Large VSDs produce a significant left-to-right shunt, leading to:
- Pulmonary overcirculation
- Congestive heart failure
- Progressive pulmonary vascular disease
- If left untreated, irreversible pulmonary hypertension (Eisenmenger syndrome) may develop.
- Therefore, large VSDs should be surgically closed during infancy, ideally before 6 months of age, particularly if there is uncontrolled heart failure, failure to thrive, or significant pulmonary hypertension.
Why the Other Options Are Incorrect
A. At school-going age
- Incorrect.
- Delaying surgery until school age increases the risk of developing irreversible pulmonary vascular obstructive disease and Eisenmenger syndrome.
B. Only if congestive heart failure (CHF) remains uncontrolled despite optimal medical therapy
- Incorrect.
- Persistent CHF is an indication for early surgery, but even infants whose symptoms are controlled medically may require early repair if the defect is hemodynamically significant.
- Surgical timing is determined by the size of the defect, pulmonary blood flow, pulmonary artery pressure, and risk of pulmonary vascular disease, not solely by symptom control.
D. Soon after birth
- Incorrect.
- Most infants are initially managed medically because pulmonary vascular resistance is high at birth.
- Definitive repair is usually performed during early infancy, not immediately after birth, unless associated with other complex cardiac lesions requiring neonatal intervention.
