Pediatric Heart Expert Forum
VSD size
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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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VSD size

My baby is three weeks old. When he was 2 days old the Dr. diagnosed him to have a murmur which was then diagnosed with echo as a VSD (two holes) each sized at roughly 1.2 mm. We are scheduled to repeat this exam every two months and the cardiologist said 1.2 mm is very small and is very likely to spontaneously close within the first year or two. My question is: what VSD sizes are considered small, what sizes are considered medium and what constitutes "big"? The Dr. seems very calm and tells me to not worry at all and that my child will have NO syndromes associated with VSD such as pulmonary or respiratory deficiencies. Should I really just disregard the risks associated or at 1.2 mm (two holes) I should be concerned and be weary of complications? He is now 3 weeks old - are there any "age brackets" when I should be specifically attentive to changes? Thank you so much for your educated answer...
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Dear Capribex,

Ventricular septal defect (VSD) is a hole in the wall between the two lower chambers of the heart, the ventricles.  Without evaluating your child myself, I cannot say for sure what is happening and what his prognosis is.  However, it appears that he has 2 VSDs that are quite small.  These likely have an excellent chance of spontaneously closing by age 1 year.  As well, he is likely to have no symptoms associated with them.  But, sometimes echocardiography can underestimate the size of the defects, so we like to have the patients come back at least at age 2 months for another examination.  Typically by that time, there have been some changes in the heart and lungs that can unmask symptoms, if the baby has defects that are large enough to allow them to happen.  These symptoms, which are symptoms of congestive heart failure (CHF), include getting out of breath or getting sweaty with feeds.  If your son is not having these symptoms, it is likely that these defects are small enough to limit the amount of blood recirculating across these holes.  We typically do not see symptoms of CHF until the defects are at least 4 mm, or more, in diameter, although this also depends on the size and age of the infant (such as if they’re premature).

Thus, if he remains without symptoms, he should do well.  Finally, even if the defects do not close but are small, he should do well and not have complications.  There would be a slightly increased risk for an infection of the heart, so good lifelong oral hygiene would be important to prevent this.  As well, if one or both of the defects is just below the aortic valve, he will need continued observation to make sure that the valve does not get distorted and start to leak.
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Forgot to mention... He was born exactly on the due date (full pregnancy) and with weight 3.336 kg.
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