Which of the following is/are true of the surgical treatment of VSDs?

B. Intracardiac repair is advisable for patients with intractable symptoms and for asymptomatic infants with evidence of increasing pulmonary vascular resistance.

DISCUSSION: The right atrial approach is preferred for the repair of most perimembranous VSDs. Prompt intracardiac repair is indicated for infants with large defects, large shunts, and pulmonary hypertension who present with intractable left ventricular failure, recurrent pulmonary infections, severe growth failure, or evidence of increasing pulmonary vascular resistance. In the modern era, complete heart block requiring a permanent pacemaker is a very uncommon complication of surgical closure of a ventricular septal defect. Hospital mortality after closure of a VSD currently approaches zero. While in earlier years younger age was an incremental risk factor for hospital death in some surgical experiences, this risk has been neutralized during the past decade.