Can a VSD PG be too high?

[mshanson]

Well we received excellent news at our daughter's echo on Tuesday and the VSD (membranous with inlet extension) has closed significantly. Our daughter is now 6 months, and they didn't even bother measuring the VSD, saying that it was too small to bother. The pressure gradient was 108 mmHg (up from 64 mmHg in October). They have removed medications, cleared her for a year. We were thrilled, but someone then said to me that sometimes a really high PG can be a problem? Is that true? At first they thought she had trivial aortic regurgitation however, they took a second look and said she had none, and no signs of aortic problems.

[Dani423]

Thanks so much for the responses! She does have mild left sided enlargement but they have not put her on meds for it.

[Marie M Gleason, M.D.]

Crying could explain a different gradient, but either way, the numbers suggest a small VSD.  If there is no enlargement of the left sided heart chambers on the echo, you should be in good shape.

[Dani423]

"pressure gradients will vary from echo to echo depending upon the patients state of activity during the study"      
----- I was just curious about this- My daughter was crying a bit during her last echo and the pg reading was higher than her previous, about 30 higher to be exact. Her dr said the hole was more restrictive based on the higher pg, but could the higher number just have been from the crying and the hole not really more restrictive? Is there any other thing they base how restrictive it is other than the pg? Her dr was not in there during the echo so did not know she was crying.
Thank you so much.

[Marie M Gleason, M.D.]

The only time that a pressure gradient across a VSD would be considered "too high" would be if there is blockage of the aortic valve or narrowing of the distal aortic arch (coarctation) that can raise the pressure in the left ventricle.  Your cardiologist should be able to tell you if either of those things are present in your daughter.  Also remember that these pressure gradients will vary from echo to echo depending upon the patients state of activity during the study.  I would think this is fine.

[Dani423]

At our last appt when our daughter's pg also went up, I asked the cardiologist, "So it's a good thing for the pressure to keep going up right?" and he said, "Today this is good that it is higher and it means it's more restrictive, but also you don't want it too high....if it were to be too high it could mean the left ventricle is working too hard".
I do not know what "too high" is, I assume he meant based on the size of the hole and what it "should be" for that size.
So everything must correspond fine with the size of your daughter's hole and the pg, or they'd have said something right?