Complications
Flow of blood through a restriction causes a reduction in fluid pressure (the Venturi effect). If a Venturi effect occurs through a left-to-right shunt in proximity to the aortic valve, the valve can prolapse, causing aortic insufficiency and regurgitation. In such cases, surgical repair of the ventricular septal defect (VSD) should be considered in order to prevent worsening of the aortic regurgitation.[46]
The surgical procedure may affect the conducting tissue in the heart, thereby resulting in heart block. This may require implantation of a permanent pacemaker.[47]
Cardiac dysrhythmias are a major source of morbidity and mortality for patients. Although rhythm disorders can often be observed with un-repaired or palliated defects, the most difficult cases usually involve patients who have undergone prior intra-cardiac repairs, especially when performed relatively late in life.
Virtually the entire spectrum of rhythm disturbances can manifest in these patients.
Due to the high flow velocity across the ventricular septal defect (VSD), there is an increased risk of infective endocarditis in patients with VSDs compared with the general population. Even small defects that are not haemodynamically significant may cause endocarditis.[43]
A high index of suspicion should be maintained in these patients; infective endocarditis often presents non-specifically and most commonly involves fever with possible physical signs of peripheral emboli (Osler nodes, Roth spots, or Janeway lesions).
Antibiotic prophylaxis is no longer recommended in all patients with VSD, but is reserved for especially high-risk groups: patients with Eisenmenger's syndrome; patients with a previous history of infective endocarditis; patients within 6 months following patch repair or percutaneous device closure of VSD; or patients with a residual defect following closure. Prophylaxis is no longer recommended for routine gastrointestinal procedures.[2]
Three sets of blood cultures should be obtained prior to initiation of antibiotic therapy. A transoesophageal echocardiogram should be obtained in all suspected cases of infective endocarditis. Treatment is guided by presentation, clinical findings, and organism virulence.
Use of this content is subject to our disclaimer