Pediatric Heart Expert Forum
Seeking help to take decision for my cousin VSD operation
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Seeking help to take decision for my cousin VSD operation

My cousin has been suffering with VSD. His old is 18. We met doctors in two different hospital and one doctor said, his heart lunch is getting worse so it will not curable in order to that surgery might unsuccessful and another doctor want to do surgery . We got really confuse about doctor their different comments.. Please visit the below link and see the PDF file there is all of diagnosis reports.

https://www.sugarsync.com/pf/D250506_79_935558646

Looking forward to hearing your comments

thanks
palash
Tags: VSD
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773655_tn?1340656399
After looking at the information, including a cardiac catheterization, it appears that your cousin, unfortunately, has a very serious problem that does not appear to be fixable with surgery.  He has a large ventricular septal defect (VSD) that has led to very high pressure in his lungs (due to 18 years of extra blood shunting to his lungs).  The cardiac catheterization reported high pulmonary vascular resistance that does not drop when he was given oxygen; this means that the lungs are permanently damaged.  Usually we do not recommend surgical repair of such VSDs if the pulmonary pressure and resistance is so high.  If you do close the hole,  usually the patient develops failure of the right sided pumping chamber.  Patients with pulmonary hypertension may get some symptomatic relief with oxygen and oral medications for pulmonary hypertension, such as sildenafil (Viagra) and some others.  Your cousin's family needs to discuss things in detail with the cardiologist, to make sure everyone understands the serious nature of this condition and its impact upon long term survival.
4 Comments
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Avatar_m_tn
Dear Doctor,

I beg oblige could you review the different hospital report.  From this report, doctor recommended for surgery. we really confused which report will correct and what decision we can take?. Please visit the link below, the report had made with PDF document.

https://www.sugarsync.com/pf/D250506_6343964_600592

Looking forward to hearing you again.

Regards
Palash
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773655_tn?1340656399
The second opinion revals the same severe degree of pulmonary hypertension and left to right shunting through the VSD.  The baseline pulmonary vascular resistance measurement is still elevated above normal.  This cath showed some vasoreactivity in the lungs with oxygen, unlike the other cath, so that is why they said surgery was a potential option.   There was a pulmonary function report included that showed severe restrictive lung disease as well, which would make recovery much more difficult after a big open heart surgery.  Overall this is still a very poor situation.  The filling pressures in the heart are very high, and the pulmonary vascular resistance is not normal at rest.  There is certainly evidence of a shunt on both cardiac caths, and if one chooses to close the hole surgically it would have to be undertaken with the knowledge that the risk of death around and after the time of surgery would be extremely high, much above what one would typically expect for a VSD repair.  So the family has to decide what risk they are willing to take:  surgery now with a high risk of mortality and a smaller chance for success, or no surgery now and probable earlier death of natural causes.  
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Avatar_m_tn
Thanks for your helpful suggestion.

regards
Palash
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