What is the gold standard for treatment of a ventricular septal defect that fails medical management?

Surgical closure is considered the gold standard for treating a ventricular septal defect (VSD) that has not responded to medical management. VSDs are congenital heart defects characterized by an abnormal opening in the ventricular septum, allowing blood to flow between the left and right ventricles. In cases where medical therapy does not adequately control symptoms or reduce the risk of complications such as heart failure or pulmonary hypertension, surgical intervention becomes necessary.

The surgical procedure typically involves closing the defect with sutures or using a patch to prevent the left-to-right shunt, which can lead to volume overload in the lungs and heart. This approach not only alleviates symptoms but also prevents further complications and improves the overall quality of life for the patient.

In contrast, medical therapy generally focuses on managing symptoms, such as heart failure or hypertension, but it does not address the underlying defect itself. Observational management may be appropriate in clinically stable patients with small VSDs, where the defect can potentially close on its own. Cardiac catheterization, while useful in certain cases for diagnostic purposes or less invasive closure techniques, is not the definitive treatment when medical management has failed. Thus, surgical closure remains the most effective and definitive approach in these situations.