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The smaller the defect, the greater the gradient from the left to the right ventricle and the louder the murmur
Small shunts: loud, harsh holosystolic murmur in third and fourth left interspaces along the sternum and, occasionally, mid-diastolic flow murmur
Systolic thrill common
Large shunts: right ventricular volume and pressure overload may cause pulmonary hypertension and cyanosis
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Antibiotic prophylaxis recommended for dental work when:
Small shunts do not require closure in asymptomatic patients
Large shunts should be surgically or percutaneously repaired
Surgical mortality is 2–3%, but ≥ 50% if pulmonary hypertension is present
Surgery is contraindicated in Eisenmenger syndrome
Percutaneous closure devices are available and effective in some situations
2018 AHA/ACC Adult Congenital Heart Disease Guidelines
Indication for VSD closure: At least a 1.5:1 left-to-right shunt, PVR is less than one-third that of the SVR, and the PA systolic pressure is more than one-half of the aortic systolic, then the risk of VSD closure despite some pulmonary hypertension is acceptable
Contraindication for VSD closure: If the ...