Treatment of ventricular septal defects depends on cardiac failure, development of pulmonary hypertension and the presence of Eisenmenger syndrome.
Initial management
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Small ventricular septal defects require no specific treatment.
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Cardiac failure in infancy is initially treated with digoxin, diuretics and sometimes angiotensin-converting enzyme inhibitors.
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Persisting cardiac failure is an indication for surgical repair.
Closure of the defect
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Percutaneous closure devices are suitable in selected circumstances, including a residual defect after surgical closure or certain muscular ventricular septal defects.
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Surgical repair should be performed if serial electrocardiography and echocardiography suggest that pulmonary hypertension is developing.
Eisenmenger syndrome and prognosis
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Surgical closure is contraindicated in Eisenmenger syndrome; heart–lung transplantation is the only effective treatment.
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Long-term prognosis is generally very good unless Eisenmenger syndrome develops.
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With Eisenmenger syndrome, death occurs in the second or third decade, although a few individuals survive to the fifth decade without transplantation.