Cardiology>>>>>Adult Congenital Heart Disease and Pregnancy
Question 1#

You are reviewing a 27-year-old male in clinic for the first time. On a routine health check 12 months previously he was found to have a restrictive perimembranous VSD on his echocardiogram. The jet velocity was measured at 5 m/s. There was no evidence of left ventricular dilatation and pulmonary pressures are not raised. He is asymptomatic. The rest of his echocardiogram confirmed a structurally normal heart apart from mild aortic regurgitation. You repeat the echocardiogram in clinic and there has been no change. 

What is the most appropriate follow-up?

A) Advise him that this is an incidental finding which should not cause any problems and discharge him from clinic
B) Advise that there is an increased risk of endocarditis but based on the current guidance there is no role for antibiotic prophylaxis and discharge him from clinic
C) Arrange for follow-up with echocardiography in 12 months
D) Advise him that although there are no problems at the moment it is advisable to close the VSD to reduce the risk of progressive haemodynamic change and risk of endocarditis. This can usually be done transcatheter
E) Advise him that although there are no problems at the moment it is advisable to close the VSD to reduce the risk of progressive haemodynamic change and risk of endocarditis. This is usually done surgically

Correct Answer is C

Comment:

Restrictive VSDs, by definition, have no haemodynamic consequences. There is an increased risk of endocarditis but no role for prophylactic antibiotics based on current guidance. They can cause aortic valve prolapse (usually right coronary cusp) and progressive dysfunction as a result of the Venturi effect of the high-velocity jet and turbulence below the AV. Patients with evidence of any degree of AV regurgitation require close follow-up for progression as surgical repair of the VSD is indicated prior to irreversible valve damage.