5 year old with pressure gradient, VSD, ASD, Coarctation

My 5 year 10 month daughter has a congenital defect.  Born 2 months prem at 3 pounds.  Immediate coarctation repair by end to end anastomosis, PDA ligation.  Large VSD, small ASD.  Recoarcted at 8 mnths. Successfully catheterised at 8 mnths.  She has had the RSV virus, and lots of respiratory infections, antibiotics, feeding problems.  She is now 14.8 kg and has asthma. My main concern is her pressure gradient.  It has gone up to 40.  She has had some chest pain recently.  She used to be hyperactive but is becoming more tired.  We have another echo on Thursday.  Is this pressure gradient significant?  Am i looking at a Stent operation sometime?  I am afraid that another catheterisation will rupture the aorta.  I am also afraid that a Stent op means that we will have to have further operations. I am also concerned that if we do nothing, she is going to fail to thrive even more significantly.  What is the natural progression of things with this heart pressure gradient given that the VSD is about 3mm with some tissue growth restricting the flow around the hole.  If the coarctation is narrowing again, does this put further pressure on the lungs?

[Douglas Bogart, MD]

This is a complicated problem but a gradient of 40 is significant and should be evaluated.  Talk with the pediatric cardiologist.