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baby with PMVSD 4-5mm
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by norwaridah, Jun 27, 2013
hi doc, pls help to ease my worry. my baby diagnosed with PMVSD measuring 4-5mm, left to right shunt. her birth weight is 3.3kg and she's now 6kg (I guess) at 5mths old. she can't hold her head up, but she can control her head very well while lying on bed. she doesn't seems have an urge even to turn to her side yet (or i need to encourage her to do so?). i have to support her neck and back while lifting her up or put her in a sitting position. but she's already making sounds, playing with her hands, interacting well with me and strangers. is it normal for babies with this defect have a slower growth rate? below are details of her last echo at pead cardio clinic. pls do interpret these for me as i went to the hospital alone and my baby constantly throw her tantrum thus i can't speak to the doctor much. thank you.

current status : heart failure
slow weight gain with sweating during feeding
o/e mildly tachypnoeic
murmur : PSM 3/6 LLSE
atrial status : atrial solitus

measurements (mm) and LV fucntion :
EF (%) : 66
IVS : 4
LVFWD : 4
LVEDDd : 26
LVEDDs : 17

moderate PMVSD, peak PG 68mmHg
LA and LV mildly dilated
No AR
No prolapsed RCC
No other intercardiac lesion seen
Good function
Started anti-failure
SBE prophylaxis as required

medications :
frusemide 5mg (1ml, twice daily)
spironolactone 6.25mg (1ml, once daily)
Answer:
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by Marie M Gleason, M.D.Blank, Jul 07, 2013
First my advice to you is never leave any doctor's appointment until you understand what has been told to you, and you have your questions answered.  Second, from the report it sounds like your child has mild congestive heart failure from a moderately restrictive VSD with a significant left to right shunt and left heart enlargement.  that is why the doctor prescribed 2 diuretic medications to help the fast breathing and sweatiness with feedings.  These VSDs can get smaller over time, so you should try the medication and maximize the amount of nutrition the baby gets so it can grow.  Sometimes motor development is a bit behind if the child is weak.  If the baby can grow and gain weight the hole may get smaller with time and surgery may not be needed.  Good luck.
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