Pediatric Heart Expert Forum
congenital heart defect
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congenital heart defect

hello doctor,my nephew louai  20 days old has ASD type secondum 4mm restrective and VSD membranous (beneath aortic valve)  large 6 mm non restrective ,debit pulm/debit systemis= 1,3 doctor gave him captopril and digoxin  until his next appointment for echodoppler (i think ), pulmonary artery dilated and heart enlarged but no pulmonary hypertension does he need surgery?, what is the pronostic and the complications : could he develope heart failure and failure to thrive , he is breast feeding does he need formula?, please give me some advices and explications,and does the surgery  best for him , thanks
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773637_tn?1327450515
Dear Louai,

A secundum atrial septal defect (ASD_is a hole between the upper chambers of the heart, and a membranous ventricular septal defect (VSD) is a hole between the lower chambers of the heart just below the aortic valve, as you mention.  I typically don’t characterize a 6 mm VSD as large, however.  As well, membranous VSDs often have a good chance of spontaneously closing, or at least becoming smaller so that they are restrictive to extra blood flow.  I’m not sure how your nephew’s doctor ascertained that the ratio of pulmonary to systemic blood flow was 1.3:1, unless it was done by cardiac catheterization.  There are methods of doing this with echocardiography, but they are notoriously inaccurate, so we do not use them.  As it goes, if it truly is an accurate measurement, this level of pulmonary blood flow is typically not a problem.  Overall, though, we manage these babies clinically.  If they are eating well without getting out of breath or getting sweaty with feeds, we typically do not need to treat them with medications.  However, if they do have these symptoms, we say that they are exhibiting signs of congestive heart failure (CHF), in which their heart is not able to meet the body’s needs.  In these circumstances, we do treat with medications.  

The decision to perform surgery is based upon continued CHF and poor growth despite appropriate medical management.  There is no evidence that drinking formula from a bottle is any better for these babies than drinking breast milk by nursing.  However, if the baby has CHF, we will sometimes switch these babies to formula that is more concentrated than typical breast milk or formula.  I cannot say for sure whether he will develop CHF, or not.  His cardiologist will have to observe him serially, discuss signs and symptoms of CHF with his parents, and examine him to assess whether he is developing CHF, or not.
6 Comments
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Avatar_n_tn
thank you so much doctor, the ratio of pulmonary to systemic was doing by echocradiography,  what about valve complications in case of membranous VSD? , I forget to mention the location of VSD is beneath aortic valve thanks
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Avatar_f_tn
Our daughter's VSD is VERY close to her aortic valve, actually involves her aortic root, and there is the risk of developing valve problems, depending on how close the hole is (our daughter is at risk). In our daughter's case, she has a very strong shunt, so our doctor told us today that there's the risk that the valve almost gets "sucked into" the flow, which can eventually lead to a leaky valve.
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773637_tn?1327450515
As stated above, the big risk of a perimembranous VSD is the ability of the aortic valve leaflets to be distorted and to cause valve leakage.
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Avatar_n_tn
thank you doctor for your help, my nephew (case above) recently in chest Rx  doctor has mentionned hypertrophy of thymus? what does it mean ,is it normal at this age ,does it have any relation with his VSD or genetic abnormalities.
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773637_tn?1327450515
Without viewing the study, I am not sure why hypertrophy of the thymus is mentioned.  However, the chest X-Ray in infants typically demonstrates a shadow of both the heart and the thymus, which is a normal finding.  Therefore, this may be a normal finding, although I do not know specifically if his thymus is truly hypertrophied (thickened) or just normal.  It has nothing to do with his VSD, and its presence is a normal finding.
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773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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