Ventricular septal defect ACC/AHA guidelines

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
Ventricular septal defect ACC/AHA guidelines On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ventricular septal defect ACC/AHA guidelines All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ventricular septal defect ACC/AHA guidelines
CDC on Ventricular septal defect ACC/AHA guidelines
Ventricular septal defect ACC/AHA guidelines in the news
Blogs on Ventricular septal defect ACC/AHA guidelines
Directions to Hospitals Treating Ventricular septal defect
Risk calculators and risk factors for Ventricular septal defect ACC/AHA guidelines

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

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) 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)

”