VSD and RCC Prolapse

[rpateric]

Dear Sir,
Iam writing this for my 3 month old baby. At the time of birth he was having 5mm perimembranous VSD,ASD and PDA. Later after 10 days VSD was found to be 2mm, ASD 1.6 and PDA was absent. We were asked to do follow-up every 3 months.
Last week we did echo again to get the status.

The Result was that his VSD is now 2.6 partially covered by RCC prolapse, his left atrium and ventricles are dilated, L-R shunt gradient is 70mm .His Mitral  is MR-trivial. There is no AR and PAH.

We are yet to start any treatment. Please let me know how to proceed ? Whether Surgery is the option available ?

Thanks and Regards,
Rupesh

[Jeffrey R Boris, M.D.]

Dear Rupesh,

Without seeing your son and evaluating everything, I cannot tell you how to proceed.  It sounds, based on the information that I have, that there is significant blood flow across the ventricular septal defect, despite its small size.  Ordinarily, these defects close with coverage from part of the tricuspid valve.  When part of the aortic valve (right coronary cusp, or RCC) covers the defect, there is a risk of leakage at the level of the valve, which can cause a problem.  Although there is no aortic regurgitation reported at this time, this can certainly develop if the aortic valve is deformed.  If your son is not feeding or growing well despite these findings or if the aortic valve starts to leak more, it is likely that your son will require surgical repair.

[pillai111]

Respected Sir,

I Am having my Six monthe baby boy born on good friday with Sub aortic VSD measuring 4-5mm now.at hte time of Birth it was 6-8mm measure. Furoped and Dixin pead is given regurarly to him. There is no feeding problem with him.weight is 6.1 kgs and age is Six Months 5 days. Doctors have sugested to go for Surgical.  as it is restricted by tricuspid septal valve aneurysmal tisue.left to rightinterventcular shunt.
can I wait for 2 to 3 months my ID is ***@**** pls. sugest
Thanking you.

[Jeffrey R Boris, M.D.]

I cannot say whether your waiting 3 months is okay or not without evaluating him.  It is true that as the hole gets smaller, the gradient gets higher, but only to a certain point--it is dependent upon how much pressure is generated by the left ventricle.  Therefore, even if the defect gets smaller, a 70 mmHg gradient may be all you have (which is often plenty).  This is not specifically high or low for this sized defect, per se--again, it depends on the systemic blood pressure at the time.

With regards to aortic valve prolapse, there are typically no symptoms unless there is at least moderate aortic valve regurgitation.  When this happens, there may be some exercise intolerance and exercise-associated chest pain, and the heart may be hyperdynamic in its function.

[rpateric]

Dear Sir,
Thanks for your kind response. My Baby's birth weight was 2.85 kg, and when he was 2 months 21 days, his weight was 5.4 kg. He is feeding properly, his gestures and responses are just like other normal babies and is getting good and sound sleep .
We have decided to wait for another 3 months and do a routine checkup before going for any treatment. Hope this is fine.

His report also says that his left atrium and left ventricles are dilated. Is it true that as the hole size comes down, the L-R shunt gradient will increase ? as is the case with my baby. Is this high gradient normal for 2.6 mm VSD ?

Also can you please let me know the symptoms of valve leakage or deformation and development of AR ?

Thanks and Regards,
Rupesh