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Grown-up Congenital Heart Disease (GUCH): Difference between revisions
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Grown-up Congenital Heart Disease (GUCH) (view source)
Revision as of 15:03, 25 January 2012
, 25 January 2012→1.2.6 Treatment
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With echocardiography the localisation, size and hemodynamic influence of the VSD can be investigated. Dilatation of the left atrium and left ventricle might be present and the pressures in the pulmonary artery can be estimated by means of the tricuspid regurgitation. Invasive measurement by means of catheterization is only indicated when there is doubt about the shunt size and the pulmonary vascular resistance. | With echocardiography the localisation, size and hemodynamic influence of the VSD can be investigated. Dilatation of the left atrium and left ventricle might be present and the pressures in the pulmonary artery can be estimated by means of the tricuspid regurgitation. Invasive measurement by means of catheterization is only indicated when there is doubt about the shunt size and the pulmonary vascular resistance. | ||
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Treatment and prognosis of a VSD depends on the size en localisation of the defect, the pulmonary vascular resistance and possible concomitant defects. Spontaneous closure occurs mainly in small defects, of which 75 percent closes before age 10. In patients with a small defect no pulmonary hypertension develops, however there is an increased risk of endocarditis. | Treatment and prognosis of a VSD depends on the size en localisation of the defect, the pulmonary vascular resistance and possible concomitant defects. Spontaneous closure occurs mainly in small defects, of which 75 percent closes before age 10. In patients with a small defect no pulmonary hypertension develops, however there is an increased risk of endocarditis. | ||
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Repair of VSD has been historically performed surgically. However, percutaneous VSD repair has been growing given the desire of young adults to avoid surgery. Surgical and percutaneous VSD closure should be performed by surgeons and cardiologists with appropriate training and expertise. | |||
Indications for closure of a VSD in an adult are included in the 2008 American College of Cardiology/American Heart Association (ACC/AHA) adult congenital heart disease guidelines as follows. Similar recommendations are included in the European Society of Cardiology and the Canadian Society of Cardiology guidelines. | |||
* Closure of a VSD is indicated when there is a Qp/Qs ≥2 and clinical evidence of LV volume overload. | * Closure of a VSD is indicated when there is a Qp/Qs ≥2 and clinical evidence of LV volume overload. | ||
* Closure of a VSD is indicated when the patient has a history of infective endocarditis. | * Closure of a VSD is indicated when the patient has a history of infective endocarditis. | ||