VSD closure 적응증(2008 ACC/AHA guideline)

Eisenmenger complex로 알려진 VSD with irreversible chronic pulmonary vascular obstructive disease는 조기에 VSD를 인지하고 closure를 하기 때문에 요즈음은 거의 볼 수 없습니다. VSD가 조기에 확인되지 않으면 Eisenmenger complex가 생길 수 있고 이 환자들은 일반적으로 10대와 20대에 증상을 나타냅니다. 호흡곤란, 청색증, 흉통, 객혈, 부정맥, 실신, secondary erythrocytosis가 빈번하게 됩니다. VSD closure 적응증은 2008 ACC/AHA guideline에 포함되어 있으며 severe irreversible pulmonary artery hypertension 환자에서는 권고되지 않습니다. 
  
! Eisenmenger syndrome(triad)
1. congenital systemic-to-pulmonary communication
2. pulmonary arterial disease
3. cyanosis
  

! VSD closure 적응증(2008 ACC/AHA guideline)
1. Indicated when there is a pulmonary to systemic flow ratio (Qp/Qs) ≥2 and clinical evidence of left ventricular volume overload.

2. Indicated when the patient has a history of infective endocarditis.

3. Reasonable when there is net left to right shunting with a Qp/Qs ≥1.5 with pulmonary artery pressure less than two thirds of systemic pressure and pulmonary vascular resistance is less than two-thirds of systemic vascular resistance.

4. Reasonable when there is net left to right shunting with a Qp/Qs ≥1.5 in the presence of left ventricular systolic or diastolic dysfunction or failure.

REF. UpToDate 2018.03.12