Patient handout

Adult ventricular septal defect (chronic ACHD)

PRODUCTION

1. Your condition

This handout is for adult ventricular septal defect (chronic achd). Your care team identified this based on: harsh holosystolic murmur (llsb) ± thrill.

Other reasons your team may use this plan: echo: vsd with lv volume overload / left-to-right shunt; new/progressive ar (aortic cusp prolapse — outlet/perimembranous); history of vsd-related infective endocarditis.

3. When to call your provider

Contact your care team if any of the following happen:

Severe PAH/Eisenmenger → STOP closure pathway, PAH therapy + Eisenmenger route — 2020 ESC ACHD
Progressive AR → expedite surgery — 2018 AHA/ACC ACHD
Active IE → IV antibiotics + surgical evaluation — 2018 AHA/ACC ACHD

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe PAH / Eisenmenger physiology (high PVR, bidirectional/R→L shunt) — VSD closure CONTRAINDICATED; PAH-targeted therapy + Eisenmenger precautions — 2020 ESC ACHD(life-threatening)
Qp:Qs ≥1.5 + LV volume overload + acceptable PVR, or prior VSD-related IE — closure indicated — 2018 AHA/ACC ACHD
Outlet/perimembranous VSD with progressive AR from aortic cusp prolapse — surgery to halt AR (timing AR-driven, not shunt-size-driven) — 2018 AHA/ACC ACHD
Prior VSD-related infective endocarditis — closure indication + IE prophylaxis + low fever-workup threshold — 2018 AHA/ACC ACHD
Rising PA pressure / borderline PVR on serial assessment — RHC + reassessment of closure window before Eisenmenger develops — 2022 ESC/ERS PH
Pregnancy with VSD — well-tolerated if small/no PAH (mWHO I–II); Eisenmenger = very high maternal mortality (pregnancy contraindicated); cardio-obstetric — ESC 2018 Pregnancy

5. Follow-up

Lifelong ACHD; pregnancy + transition planning; IE education

6. Sources

Guideline: 2018 AHA/ACC Adult Congenital Heart Disease Guideline (Stout) + 2020 ESC Adult Congenital Heart Disease Guideline (Baumgartner) + 2022 ESC/ERS Pulmonary Hypertension Guideline