Pediatric Heart Expert Forum
3 year old with 3mm 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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3 year old with 3mm VSD

Hi. My son is 3 years old. He has VSD since birth. He has been developing normally (95% in height, 75% in weight) and is generally healthy and active (except for a couple of respiratory infections this winter). We have done color doppler 3 or 4 times. The size of the hole has been decreasing very slowly (from about 4mm to 3mm now). While his physician recommends that we wait for a couple of more years to give the hole a chance to close by itself, some other people suggest we should have it fixed ASAP because the hole will unlikely close on its own. What's your opinion?  Thanks very much. TJ
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Dear TJ,

Without seeing the study or getting all of the information from the echocardiogram, I cannot tell for sure what the risks are for your son.  Most likely, though, since he sounds as if he has been healthy and has been growing well, the hole would probably considered small, or as we refer to it, hemodynamically restrictive.  This means that only a small amount of blood is going across the hole.  This assumes that there is no heart chamber enlargement.  These defects can continue to shrink in size, and may even close.  The most important thing to know is, except for a slightly increased risk for endocarditis (a serious infection of the heart), a small VSD does not cause a problem and does not need to be closed.  In fact, if it is a muscular VSD, a surgeon may not even be able to find it.  That said, there is one more circumstance that changes my statement.   I don’t know where the hole is in the ventricular septum.  If it is NOT a muscular defect, but is in a perimembranous (also referred to as conoventricular)location, this means that it is just under the aortic valve.  These defects occasionally can cause the aortic valve above it to deform, where one or more of the valve leaflets gets pulled down into the defect.  This can cause the valve to leak and not function correctly.  Therefore, these patients do require continued observation if the defect remains open.

Overall, I can’t tell who else is giving you opinions besides your cardiologist.  If you are not comfortable with the management plan for your son, I would consider a second opinion evaluation for him.
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