Pediatric Heart Expert Forum
2 week old baby with large vsd
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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2 week old baby with large vsd

my daughter born at 34 weeks is now 2 weeks old and has a large peri membrane vsd. she is in failure now and on special care unit. they are trying to manage her condition with drugs and high cal formula. they are talking about letting her come home on tube feeds until she requires surgery though they havent said when this will be.
im very woried about the thought of bringing her home. the docs are very suprised she is symptomatic of the vsd so soon - does this mean she will need surgery sooner rather than later? she is starting to lose weight now - she is just under 5 pounds - do you think her overall prognosis is good as she is so young and premature?
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A perimembranous ventricular septal defect (VSD) is a hole in the wall between the 2 lower pumping chambers, immediately underneath the aortic valve.  They can be small, moderate or large in terms of their size and shunt.  The development of "failure" occurs when the lungs relax and then alot of blood flows from the left side of the heart to the lungs, through the VSD.  This makes extra work for the heart and lungs, so the child can have difficulty feeding and growing.  Premature infants who have immature lungs are at even higher risk for symptoms because the extra blood makes extra work for lungs that are already working hard.  It sounds like your doctors are doing the correct things: medications and high calorie feeds.  The use of an NG tube allows the baby to get nutrition without burning up calories, so that is a common treatment.  On the positive side, VSDs in this region CAN get smaller with time, and that is why they cannot tell you for sure if surgery will be needed.  It all depends upon if they can get the baby to grow, in which case the hole could get smaller. So if they can get the baby to the point of discharge to home, that is the correct thing to do. Surgery is indicated for babies whose symptoms and growth cannot be adequately controlled with medications and/or who have high pressure in the lungs during the first 6 months of life. Good luck!
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Marie M Gleason, M.D.Blank
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The Children’s Hospital of Philadelphia
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