Moderate VSD

[Buffalobill]

Hi, our son had an echocardiogram at less than 48 hrs old due to a murmur and it was found that he has a moderate VSD and small ASD.  We are most concerned about the VSD.  He will see a cardiologist next week.  At this point we don't know the exact size but that is one of our questions.  Right now we only spoke with pediatricians.  He is 5 days old now.

The VSD peak velocity was 2 m/s and VSD peak gradient was 16 mmHg.  Can someone explain what those two measurements mean, and how they relate to size, if at all?  Also, the velocity was termed "low velocity."  Is this something that will increase as he grows older?

Thanks.

[Jeffrey R Boris, M.D.]

Dear Bill,

I agree with most of what was posted above.  A moderate sized VSD is diagnosed by its size, essentially.  The estimated "gradient", or amount of restriction to flow, across a defect is measured by doing some complex math based on the peak velocity of the Doppler wave form of the blood going across the defect.  The one thing about it is that in the first several days to weeks, the resistance to blood flow across the lungs is elevated and naturally falls to normal values by at least 2 months of age.  Therefore, that estimated gradient early on is not necessarily helpful, because it may be falsely low.  In the end, a higher gradient across the defect is good--it means that there is some restriction to flow across the hole.

What will need to be done is what was recommended above:  care for him as you would normally do.  If he has significant sweating or difficulty breathing with feeds, then he may have some congestive heart failure, which can sometimes be improved with medications.  If he fails the medication regimen, then he may require surgery to close the defect.  However, he may also be able to adequately grow enough to close down the hole, which would then restrict the amount of blood flow going through the defect, and thus eliminate his heart failure symptoms.

[mshanson]

Hi there, my daughter was diagnosed with a moderate/large VSD and small ASD when she was 3 days old. By the pressure gradient, your son's VSD is my guess almost a large one: for comparison, my daughter's is a moderate, restrictive VSD and her PG is 68 mmHg.

The pressure just means the force of the blood crossing the VSD. When the pressure is lower it means there's very little resistence, generally indicating the hole is larger and unrestricted, which allows a lot more blood to leak through. My daughter's hole is restricted (now) by tissue from her Tricuspid valve, so it doesn't allow as much blood to leak through.

Do you know where the hole is located? I don't know what the velocity means. How is your son doing? You'll need to watch him carefully for signs of congestive heart failure - our daughter was in heart failure by 2 weeks old. Depending on how he handles the VSD, and the real size of it, I'd guess it's likely he'll end up needing open heart surgery to close it. But I'm not a doctor - just a mom who's been there.

Feel free to send me a message if you have any questions.