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Is operative closure of a small ventricular septal defect required after an episode of infective endocarditis?

      Surgical closure of an isolated, small, ventricular septal defect (VSD) after recovery from infective endocarditis (IE) has been recommended for children and adults.
      • L'Ecuyer T.J.
      • Embrey R.P.
      Closure of hemodynamically insignificant ventricular septal defect after infective endocarditis.
      • Therrein J.
      • Webb G.D.
      Ventricular septal defect.
      L'Ecuyer and Embrey
      • L'Ecuyer T.J.
      • Embrey R.P.
      Closure of hemodynamically insignificant ventricular septal defect after infective endocarditis.
      made their recommendation based on 3 patients who had initial episodes of IE, asserting that there was an “increased incidence of endocarditis in patients having experienced a single episode.” Therrein and Webb
      • Therrein J.
      • Webb G.D.
      Ventricular septal defect.
      relied on that statement to recommend surgical intervention for adults who developed a VSD after a single episode of IE. Backer et al
      • Backer C.L.
      • Winters R.C.
      • Zales V.R.
      Takami H, Muster AJ, Benson DW Jr, Mavroudis C Restrictive ventricular septal defect: how small is too small to close?.
      went so far as to recommend that all small VSDs be closed surgically regardless of any history of IE on the grounds that postoperatively these patients would have a lower risk of IE.
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