American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is an additional indication for VSD closure beyond left ventricular volume overload?

Significant pulmonary hypertension
History of endocarditis
Familial history of heart disease
Adverse effects of medications

The correct answer is: History of endocarditis

Ventricular septal defect (VSD) closure is typically indicated when there is significant left ventricular volume overload due to the left-to-right shunt created by the defect. However, a history of endocarditis is a crucial additional indication for VSD closure. Patients with VSDs have an increased risk of developing endocarditis due to the turbulent blood flow and potential for bacterial colonization on the heart structures involved. If a patient has already experienced endocarditis, this indicates a heightened risk for recurrent infection, making it essential to close the VSD to prevent further complications and protect the heart from additional inflammatory damage. Other factors may contribute to clinical decision-making regarding VSD closure, but the presence of a history of endocarditis stands out as a strong, specific indication for intervention beyond just volume overload considerations.