Six months with scVSD, open-heart surgery or intervention

Hi All,

My son was born with scVSD(Subconal ventricular septal defect, 5.1mm).Now He is six months and doing great(70cm/11Kg).

So far, we have done 3 times of ultrasonic cardiography to track the problem(as below comment).

The specialist in China says he need to have open-heart surgery as soon as possible(8~10 months) to avoid AP and AI.

I would like to know, in this case, whether open-heart surgery is the only way to deal with the hole?Is it possible to use intervention?

[Marie M Gleason, M.D.]

From what I can see by this report, your child has a ventricular septal defect that is located in the wall just underneath the pulmonary valve, called by a variety of names (supracristal, subpulmonary or conoseptal hypoplasia).  These VSDs generally do not close completely on their own, although they can become smaller due to abnormal positioning of the aortic valve cusp into the hole.  This can distort the aortic valve and cause it to leak.  If that is seen, then surgery is indicated.  By the report, your child does not have leakage of the aortic valve.  From what I am reading the first 2 echo studies showed a high pressure difference across the VSD (good) that shows that the lung artery pressure was not high.  I think the reason for concern by your doctor now is that the gradient through the VSD is less, and that makes them concerned that the pressure in the lungs is increasing. That would be unusual if the gradient was low in the beginning and the heart chambers are not enlarged.  Before embarkign on surgery you may be wise to have the echo test repeated and then get a second opinion if the concern is the same.

[bzdk]

[1.5 months]
LVDd25 RVDd /  IVSd / LVPWd3 Ao11 LVEF 75%
LVDs15 RVDs /  IVSs / LVPWs7 LA15 LVFS 41%

AAo1.2 DAo1.44 MPA1.2 RPA /  LPA /
MV 0.9 TV 0.7  LVOT / RVOT /

MR 0   TR 0    AI 0   PI Trivial
Atrial value: no shunt
Aortic valve: no shunt
Ventricular value: 4.34m/s(left To right)

Comments
-No enlargement.
-Valves are normal.
-Atrial Septal is intact.
-Aortic is normal, Pulmonary is widened a little.
-The aortic arch is left sided.
-VSD(under Pulmonary) measuring 5.09mm with left to right shunt.

[4 months]
LVDd25 RVDd /  IVSd / LVPWd3 Ao11 LVEF 67%
LVDs15 RVDs /  IVSs / LVPWs7 LA15 LVFS 35%

AAo1.18 DAo1.4 MPA1.0 RPA /  LPA /
MV 1.2  TV 0.7  LVOT / RVOT /

MR 0   TR Trivial,2.13m/s    AI 0   PI Trivial
Atrial value: no shunt
Aortic valve: no shunt
Ventricular value: 4.24m/s(left To right)

Comments
-No enlargement.
-Valves are normal.
-Atrial Septal is intact.
-Aortic and Pulmonary are normal.
-The aortic arch is left sided.
-VSD(under Pulmonary) measuring 5.86mm with left to right shunt(1.85mm).
-Aortic right coronary valve is embedded in position of defect.

[6 months]
LVDd26.7 RVDd /  IVSd 3.6 LVPWd3.6 Ao14.5 LVEF 67%
LVDs17.3 RVDs /  IVSs /   LVPW s / LA14.8 LVFS 35%

AAo1.1 DAo1.4 MPA1.72 RPA 1.26  LPA 1.0
MV 1.1 TV 0.6 LVOT /  RVOT /

MR Trivial   TR Trivial,2.13m/s    AI 0   PI Trivial
Atrial value: no shunt
Aortic valve: no shunt
Ventricular value: 3.3m/s(left To right)

-Comments
-No enlargement.
-Valves are normal.
-Atrial Septal is intact.
-Aortic is normal, Pulmonary trunk is widened a little.
-The aortic arch is left sided.
-VSD(under Pulmonary) measuring 5mm with left to right shunt(2.5mm).
-Aortic right coronary valve is embedded in position of defect.

[bzdk]

Thank you doctor.We will take echo test again before operation in local hospital.

Leo