Pediatric Heart Expert Forum
4.5 mm VSD
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4.5 mm VSD

Hello doctor,
I am from Mongolia. My daughter was born with 6 mm muscular VSD. Now she is 18 months old and diagnosed with 4.5 mm hole in the heart. Her growth and feedings are quite well. But i am worried about my daughter's safe health.
Can my daughter be treated by her own, or not? Approximately, when should her VSD be treated?
773637_tn?1327450515
Dear Eegy,

Without evaluating your daughter, I cannot say how she is doing.  Typically, a 6 mm ventricular septal defect is large enough that it requires surgical repair in the first 2-6 months of life.  Now that it is 4.5 mm, it is just on the edge of still being a significant problem.  One of the things that can happen with chronic high volume blood flow through a VSD is that the child can develop pulmonary hypertension, or high blood pressure across the lungs.  This can be irreversible.  However, I do not know if there has been too much or limited blood flow across the defect.  

Since you know the name and size of the defect, I would presume that you have access to a pediatric cardiologist.  I would recommend speaking with the cardiologist to get a better sense of what needs to be done next.  Ordinarily, when a defect is what we call restrictive to flow, these defects can either close by themselves or remain open; however, it does not matter, as these typically cause no problems.  If it was not restrictive to flow, and pulmonary hypertension has occurred, this is a serious and potentially life-threatening problem that requires medical as well as some non-medical therapy.
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Hello again, doctor. Thank you very much for your kind advice. I met with our cardiologist recently. The cardiologist explained that now we have to wait for my daughter's VSD to close her own, until she gets two and a half years old. She also tells "Because blood is flowing through left to right shunt restrictively, this means that it is not dangerous for our daughter. If your daughter's VSD doesn't close her own when he reach 2.5 years old, we may repair her heart hole using cardiac catheterization."
Our cardiologist strongly believes that the hole will be closed without any surgical intervention and she recommends that if we need any repair, the best solution will be the cardiac catheterization.
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773637_tn?1327450515
Dear Eegy,

If the blood is flowing through the defect restrictively, then it is not a risk for your daughter's heart.  And, since it is not a risk, then it should not require any intervention, either surgical OR by catheter.  It does not make sense to me that the cardiologist would want to close a restrictive defect if she is telling you that the defect is restrictive and not a risk.  The defect may or may not close by itself, but that is okay.  It does not need to close to be safe for her.  There are plenty of adults who have a small defect remain open without problems.
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