A 3-year-old child has a loud pansystolic murmur at the lower left sternal border, no cyanosis, and echocardiography confirms a perimembranous VSD with left-to-right shunt and Qp:Qs of 2.8:1. The child has recurrent respiratory infections but no Eisenmenger changes. Regarding the risk of infective endocarditis (IE) prophylaxis, the CURRENT recommendation for this uncorrected VSD is:
- A No prophylaxis required for uncorrected VSD without prior IE ✓
- B Prophylaxis required for all dental procedures
- C Prophylaxis only if prior IE episode has occurred
- D Prophylaxis for 6 months after transcatheter device closure
Correct answer: A. No prophylaxis required for uncorrected VSD without prior IE
Explanation
Current AHA/ACC guidelines restrict IE prophylaxis to high-risk lesions: prosthetic valves, prior IE, unrepaired cyanotic CHD, certain repaired defects with residual shunts near prosthetic material, and cardiac transplant recipients with valvulopathy. An uncorrected perimembranous VSD without prior IE does not qualify for routine dental prophylaxis. Prophylaxis is however recommended for 6 months after complete device closure with endothelialization of the device.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.