Is it necessary to get a hole in the heart closed?

Q: I am a 42 years old man having mild ventricular septal defect (VSD) since birth [L->R flow <2:1 and no Ps or pulmonary arterial hypertension (PAH) and normal pulmonary artery pressure (PAP)]. I get echocardiography done routinely to keep track and have no problem in leading a normal life. The doctor has given no treatment for it but has advised regular echocardiography. Now, I have to undergo pre-employment medical check up to join a job. Can the hole in my heart disqualify my medical fitness certificate?

A:The danger of a VSD is endocarditis (infection of the heart). We therefore advise closure, at an early age. There is every likelihood of your rejection if the selection committee is strict. As you are now over 40, they may take a lenient view. You are also over weight and should reduce about 5 kg. I would suggest consultation with a qualified cardiologist/cardiac surgeon before your selection.