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The American College of Cardiology/American Heart Association (ACC/AHA) classification of the recommendations for patient evaluation and treatment (classes I-III) and the levels of evidence (A-C) are defined at the end of the "Major Recommendations" field.
The American College of Cardiology/American Heart Association (ACC/AHA) classification of the recommendations for patient evaluation and treatment (classes I-III) and the levels of evidence (A-C) are defined at the end of the "Major Recommendations" field.


Clinical Features and Evaluation of the Unoperated Patient
Clinical Features and Evaluation of the Unoperated Patient


Recommendations for Cardiac Catheterization
Recommendations for Cardiac Catheterization


Class I
Class I


*Cardiac catheterization to assess the operability of adults with ventricular septal defect (VSD) and pulmonary arterial hypertension (PAH) should be performed in an adult congenital heart disease (ACHD) regional center in collaboration with experts. (Level of Evidence: C)
*Cardiac catheterization to assess the operability of adults with ventricular septal defect (VSD) and pulmonary arterial hypertension (PAH) should be performed in an adult congenital heart disease (ACHD) regional center in collaboration with experts. (Level of Evidence: C)


Class IIa
Class IIa
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Recommendation for Medical Therapy
Recommendation for Medical Therapy


Class IIB
Class IIB
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Recommendations for Surgical Ventricular Septal Defect Closure
Recommendations for Surgical Ventricular Septal Defect Closure


Class I
Class I
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**Closure of a VSD is indicated when there is a Qp/Qs (pulmonary–to–systemic blood flow ratio) of 2.0 or more and clinical evidence of left ventricular (LV) volume overload. (Level of Evidence: B)
**Closure of a VSD is indicated when there is a Qp/Qs (pulmonary–to–systemic blood flow ratio) of 2.0 or more and clinical evidence of left ventricular (LV) volume overload. (Level of Evidence: B)
**Closure of a VSD is indicated when the patient has a history of infective endocarditis (IE). (Level of Evidence: C)
**Closure of a VSD is indicated when the patient has a history of infective endocarditis (IE). (Level of Evidence: C)


Class IIa
Class IIa
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*Closure of a VSD is reasonable when net left-to-right shunting is present at a pulmonary blood flow/systemic blood flow (Qp/Qs) greater than 1.5 with pulmonary artery pressure less than two thirds of systemic pressure and PVR less than two thirds of systemic vascular resistance. (Level of Evidence: B)
*Closure of a VSD is reasonable when net left-to-right shunting is present at a pulmonary blood flow/systemic blood flow (Qp/Qs) greater than 1.5 with pulmonary artery pressure less than two thirds of systemic pressure and PVR less than two thirds of systemic vascular resistance. (Level of Evidence: B)
**Closure of a VSD is reasonable when net left-to-right shunting is present at a Qp/Qs greater than 1.5 in the presence of LV systolic or diastolic failure. (Level of Evidence: B)
**Closure of a VSD is reasonable when net left-to-right shunting is present at a Qp/Qs greater than 1.5 in the presence of LV systolic or diastolic failure. (Level of Evidence: B)


Class III
Class III
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Recommendation for Interventional Catheterization
Recommendation for Interventional Catheterization


Class IIb
Class IIb
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Recommendations for Surgical and Catheter Intervention Follow-Up
Recommendations for Surgical and Catheter Intervention Follow-Up


Class I
Class I
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Recommendation for Reproduction
Recommendation for Reproduction


Class III
Class III

Revision as of 19:52, 7 July 2011

Ventricular septal defect Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Ventricular Septal Defect from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Treatment

Medical Therapy

Surgery

Ventricular septal defect post-surgical prognosis

ACC/AHA Guidelines for Surgical and Catheter Intervention Follow-Up

Prevention

ACC/AHA Guidelines for Reproduction

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]and Leida Perez, M.D.

Associate Editor-In-Chief: Keri Shafer, M.D. [2],Atif Mohammad, M.D., Priyamvada Singh, MBBS


Ventricular septal defect ACC/AHA guidelines [1]


Major Recommendations (DONOT EDIT)


“


The American College of Cardiology/American Heart Association (ACC/AHA) classification of the recommendations for patient evaluation and treatment (classes I-III) and the levels of evidence (A-C) are defined at the end of the "Major Recommendations" field.


Clinical Features and Evaluation of the Unoperated Patient


Recommendations for Cardiac Catheterization


Class I

  • Cardiac catheterization to assess the operability of adults with ventricular septal defect (VSD) and pulmonary arterial hypertension (PAH) should be performed in an adult congenital heart disease (ACHD) regional center in collaboration with experts. (Level of Evidence: C)


Class IIa

  • Cardiac catheterization can be useful for adults with VSD in whom noninvasive data are inconclusive and further information is needed for management. Data to be obtained include the following:
  • Quantification of shunting. (Level of Evidence: B)
    • Assessment of pulmonary pressure and resistance in patients with suspected PAH. Reversibility of PAH should be tested with various vasodilators. (Level of Evidence: B)
    • Evaluation of other lesions such as aortic regurgitation (AR) and double-chambered right ventricle. (Level of Evidence: C)
    • Determination of whether multiple VSDs are present before surgery. (Level of Evidence: C)
    • Performance of coronary arteriography is indicated in patients at risk for coronary artery disease. (Level of Evidence: C)
    • VSD anatomy, especially if device closure is contemplated. (Level of Evidence: C)

Management Strategies

Recommendation for Medical Therapy


Class IIB

  • Pulmonary vasodilator therapy may be considered for adults with VSDs with progressive/severe pulmonary vascular disease (refer to the National Guideline Clearinghouse [NGC] summary of the ACC/AHA guideline, Pulmonary Hypertension/Eisenmenger Physiology). (Level of Evidence: B)

Recommendations for Surgical Ventricular Septal Defect Closure


Class I

  • Surgeons with training and expertise in congenital heart disease (CHD) should perform VSD closure operations. (Level of Evidence: C)
    • Closure of a VSD is indicated when there is a Qp/Qs (pulmonary–to–systemic blood flow ratio) of 2.0 or more and clinical evidence of left ventricular (LV) volume overload. (Level of Evidence: B)
    • Closure of a VSD is indicated when the patient has a history of infective endocarditis (IE). (Level of Evidence: C)


Class IIa

  • Closure of a VSD is reasonable when net left-to-right shunting is present at a pulmonary blood flow/systemic blood flow (Qp/Qs) greater than 1.5 with pulmonary artery pressure less than two thirds of systemic pressure and PVR less than two thirds of systemic vascular resistance. (Level of Evidence: B)
    • Closure of a VSD is reasonable when net left-to-right shunting is present at a Qp/Qs greater than 1.5 in the presence of LV systolic or diastolic failure. (Level of Evidence: B)


Class III

  • VSD closure is not recommended in patients with severe irreversible PAH. (Level of Evidence: B)

Recommendation for Interventional Catheterization


Class IIb

  • Device closure of a muscular VSD may be considered, especially if the VSD is remote from the tricuspid valve and the aorta, if the VSD is associated with severe left-sided heart chamber enlargement, or if there is PAH. (Level of Evidence: C)

Key Issues to Evaluate and Follow-Up

Recommendations for Surgical and Catheter Intervention Follow-Up


Class I

  • Adults with VSD with residual heart failure, shunts, PAH, aortic regurgitation (AR), or right ventricular outflow tract (RVOT) or left ventricular outflow tract (LVOT) obstruction should be seen at least annually at an ACHD regional center. (Level of Evidence: C)
    • Adults with a small residual VSD and no other lesions should be seen every 3 to 5 years at an ACHD regional center. (Level of Evidence: C)
    • Adults with device closure of a VSD should be followed up every 1 to 2 years at an ACHD center depending on the location of the VSD and other factors. (Level of Evidence: C)

Recommendation for Reproduction


Class III

  • Pregnancy in patients with VSD and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. (Level of Evidence: A)
 ”

References

  1. ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.


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