Ventricular septal defects (VSDs) account for around 20% of congenital cardiac defects. For selected muscular and perimembranous defects, transcatheter device closure is a viable, less invasive alternative to surgery, with fewer complications and faster recovery, while perventricular hybrid approaches (combining surgical access with device closure) help with high anterior or apical defects.
The most challenging scenario is post-myocardial-infarction ventricular septal rupture, which carries very high mortality: surgical repair in contemporary registries still shows in-hospital mortality around 35%, worse with cardiogenic shock and the need for mechanical support. Transcatheter closure offers a valuable alternative or bridge in unstable patients, and mechanical circulatory support (including ECMO) is used for stabilization. Pharmacological management of heart failure in infants with VSD has historically included digoxin, with variable benefit.
Further reading: clinical presentation and therapy of VSD (Haas et al., 2024); ventricular septal rupture after MI (Cubeddu et al., JACC 2024); postinfarct VSD repair outcomes (Moumneh et al., 2025).