Pediatric Heart Expert Forum
MUSCULAR VSD 4MM
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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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MUSCULAR VSD 4MM

Doctor

What do you think ca be closed????

(FEMALE)

BIRTH DAY 28/02/2011
EXAMINATION DAY 14/04/2011
NEW EXAMINATION 12/05/2011


VSD 4MM MUSCULAR



Echocardiogram:

 Heart Parts (S,D,S)
 Smooth connection of systemic and pulmonary veins
 Very small dilatation left atrium
 Open oval section
 Harmonious  atrioventricular connection
 Physical structure and function atrioventricular valve
 Physical dimension and function ventricles
 High muscular vsd 4mm near the aortic valve
 Dilatation pulmonary valve
 All other parts of the heart is physical

Echo:
Left - Right outflow though open oval section and the vsd with pressure equalizing between two ventricles (PG 22mmHG). High flow through pulmonary arteries and high returns through pulmonary veins


Conclusion:

Medium size muscular vsd near the aortic valve with important Left - Right outflow though open oval section.
Recommended new examination in one month



Doctor concerned about the high pressures and fears of the event to create pulmonary hypertension

As a father I would like to inform you that the child has so far not present any obvious problem.

Best regards

Dimitris Metaxas
(Father)
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773637_tn?1327450515
Dear Dimitris,

Typically a 4 mm ventricular septal defect (VSD) does not cause a moderate-sized shunt.  In fact, the pressure across that defect should be much higher than 22 mmHg, as it should be restrictive to blood flow across it.  Without evaluating your daughter, I cannot say what is happening here.  There are times that certain babies have elevated right sided pressures, such as if they live at altitude, have Trisomy-21 (Down syndrome), or if the defect is LARGER than 4 mm, which is may actually be in this case.  Ordinarily, we like to treat these patients with anticongestive medications, if they need them, and then surgically close the defect prior to about 9-12 months if it remains nonrestrictive and there is evidence of persistently elevated right sided pressures.  You may want to discuss this further with the cardiologist and find out why she has the higher right sided pressure, and what the further plan is.
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