VSD symptomatic?

My son (25 months) had a moderate unrestrictive mid muscular vsd as well as a pfo that was diagnosed a few days after his birth. They originally thought he was septic due to tachypnea and poor feeding. They seemed very relaxed about it, he had an echo and some chest x-rays initially as well as a follow up echo and x ray when he was a couple of months old. He has been followed by a cardiologist and they have not done any further echos. He did have some chest x rays when he had pneumonia. He is growing well and they seem to have the "wait for it to close" game plan. He still has an audible murmur. I feel he gets short of breath on exertion and that he gets respiratory infections more than normal. I have mentioned my concerns. If his vsd was causing problems would it be obvious? Is it normal to not have a follow-up echo at certain intervals? Thanks!

[Jeffrey R Boris, M.D.]

Dear TJ,

Without evaluating your son, it is difficult for me to tell exactly where he was.  It sounds to me as if he had some aspect of congestive heart failure, which sounds consistent with a moderate sized unrestrictive VSD.  However, it also sounds as if he did not fail to grow and has been able to make it to 25 months without needing surgery.  This means that his defect is likely relatively smaller than before.  Certainly, if he gets short of breath easily with exercise and he gets LOWER respiratory infections easily (e.g. pneumonia), that may be an indication that the defect is still a bit too large.  However, if he is otherwise growing and doing well, it may not be necessary to close the defect.  WIth respect to the use of echo, some cardiologists feel quite comfortable using clinical evaluation to assess these kids and don't feel that the echo images will change their management.  Others like to have the images to back up their treatment plan, as another piece of information. Certainly, the fact that the murmur is still there tells us that the defect is still open, but what you describe doesn't necessarily give me any hints about its size.  In the end, it's not whether the defect fully closes, but whether it closes enough to limit the blood flow and become "restrictive", so that there's no congestive heart failure findings.  He can live like that without any appreciable effects on his life.