Med Quizzes

Small VSD Management

Small VSD Management Cheatsheet

Key Concept: Well-appearing infant + soft murmur + normal O2 + normal pulses = observation. Echo if murmur ≥3/6, diastolic component, abnormal S2, or symptoms. Medical therapy (diuretics + calories + ACE-I) for symptomatic CHF. Surgery when Qp:Qs >2:1 or symptoms refractory. 50% of small muscular VSDs close spontaneously.

Category	Key Features
Observation	Well-appearing with normal growth and O2 saturation Soft (≤2/6) murmur without thrill No respiratory distress, hepatomegaly, or tachycardia Small muscular VSDs close spontaneously in ~50% by age 2 Outpatient follow-up every 3–6 months No antibiotic prophylaxis required (AHA 2007 guidelines — simple VSD)
Echo + Cardiology Referral	Murmur ≥3/6, with thrill, or harsh quality Abnormal S2 (fixed split, single, or accentuated) Any diastolic murmur component Cardiac symptoms: poor feeding, diaphoresis, tachycardia, hepatomegaly Abnormal EKG (RVH, LVH, or axis deviation) Cardiology referral for large or symptomatic VSD
Medical Treatment	Furosemide + spironolactone for symptomatic CHF from large VSD Caloric supplementation (high-density formula) for failure to thrive ACE inhibitors reduce afterload → decrease L→R shunt magnitude Medical therapy NOT indicated in well-appearing infant without CHF Indomethacin = for PDA closure in PREMATURE infants — NOT for VSD
Surgical / Catheter Repair	Surgical patch closure for large VSD causing CHF or failure to thrive Catheter-based device closure for selected muscular VSDs Indicated when Qp:Qs >2:1 or uncontrolled symptoms NOT indicated for small asymptomatic VSD Elective repair by 6–12 months for symptomatic large VSDs

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Small VSD Management

A Observation

B Echo + Cardiology Referral

C Medical Treatment

D Surgical / Catheter Repair