baby with 20 months has 4mm peri-membranous vsd

ihave a daughter at age of 20 months weighted 10kg. she suffer from moderate size peri- membranous with left to right shunt vsd about 4mm with tendency to close with septal leaflet of tricuspid valve maximum pg across it 60 mm hg.  first will she need to carry out surgery operation or can be treated by catheter or she can live with this hole withoutany side effects knowing  that she is in good health only little poor in weight tell me if she needs operation or catheter what is the suitable age to carry out any of them. where can she carry out the catheter because it is not exit in my country

[Jeffrey R Boris, M.D.]

Dear Nour Hassan,

Without fully evaluating your daughter, I cannot say exactly what she needs regarding her ventricular septal defect (VSD).  These defects often close by the septal leaflet of the tricuspid valve partially or completely covering it.  As long as the defect remains restrictive to blood flow (and a gradient of 60 mmHg would be considered restrictive) and the aortic valve doesn't prolapse or leak, it is likely that your daughter should do just fine without surgical or transcatheter repair.  You should look for symptoms of congestive heart failure, including getting out of breath easily or sweating sooner than her peers with activity.  If she does not have these, and she is otherwise growing reasonably well, your cardiologist most likely should be able to observe her.  There are plenty of children who grow to have VSDs remain open as adults.  Besides routine cardiology follow-up, it is most important to ensure that she has good dental hygiene to reduce the risk of getting an infection of the heart.