American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the treatment for a significant ventricular septal defect (VSD) when accompanied by endocarditis?

Close the VSD immediately
Monitor without intervention
Medicate with anticoagulants
Perform routine follow-ups

The correct answer is: Close the VSD immediately

When a significant ventricular septal defect (VSD) is accompanied by endocarditis, the primary treatment approach is to close the VSD. Endocarditis can complicate the condition, as the presence of a VSD creates a turbulent flow of blood that increases the risk of infection on the heart's interior structures. Closing the VSD addresses this mechanical problem and reduces the risk of further complications from endocarditis, including further embolic events. In cases of significant VSDs, simply monitoring or medicating without surgical intervention does not adequately manage the risk associated with endocarditis. Anticoagulation therapy may not be beneficial in this scenario, as it does not address the underlying issue of the defect or the potential for further infection. Routine follow-ups may be necessary for other conditions, but in the case of significant VSD with endocarditis, prompt surgical closure is essential for the patient's safety and overall health. Therefore, closing the VSD immediately is a necessary and effective treatment strategy in this context.