A 3-year-old child presents with a harsh pansystolic murmur loudest at the lower left sternal border, with a thrill. Chest X-ray shows mildly increased pulmonary vascular markings. Echocardiography confirms a small perimembranous VSD with a left-to-right shunt and normal pulmonary artery pressure. What is the most appropriate next step in management?
- A Immediate surgical closure to prevent Eisenmenger syndrome
- B Observation and follow-up, as small VSDs often close spontaneously ✓
- C Device closure via cardiac catheterization
- D Prophylactic digoxin to prevent cardiac failure
Correct answer: B. Observation and follow-up, as small VSDs often close spontaneously
Explanation
Small perimembranous VSDs (Qp:Qs less than 1.5:1, normal PA pressure) have a high rate of spontaneous closure, especially in infants and young children; up to 75-80% close by age 10. Surgical or device closure is indicated for large VSDs causing heart failure, failure to thrive, or developing pulmonary hypertension, not for small hemodynamically insignificant defects. Prophylactic digoxin is not indicated in a child with no symptoms of heart failure. Eisenmenger syndrome develops only with large, untreated VSDs over many years.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.