congenital heart defect

Thank you fo your help doctor , I  sent to you last month a question about my nephew now he is 2 months old , weight=10 pounds, he is taking  lopril +  digoxin he has VSD peri membaranous + ASD 4mm

here is the last echodoppler result VSD=7mm,   DAo=1,05 ( I think it is aortic dilatation, it"s writting in french)
VL 18 / 27 mm (velocity?)            ejection fraction=63%    Qp / Qs =2,3  (pulmnow   debit / systhemic debit ?)

the pediatric cardiologist said that he does not need a surgery but the surgent said 80% of chances he will be schedule for surgery when he gain more weight (16 pounds at least) what do think doctor , this contradiction is bothering me and his parents , thank you.

[Jeffrey R Boris, M.D.]

Dear Louai,

The ventricular septal defect (VSD) measures 7 mm, which is still sizable.  The descending aorta (DAo) measures 1.5 cm, so the VSD is half the size of the descending aorta.  I'm not sure what the VL numbers are, but I can say that the Qp:Qs numbers obtained by echocardiography are notoriously inaccurate, and not helpful.  That said, his defect will likely require surgical repair.  In experienced hands, he should not have to wait until he is 16 pounds, though.  A weight of 10 pounds (4.5 kg) should be more than adequate.  As well, if he is having congestive heart failure symptoms, waiting till he gains more weight will actually put him at a disadvantage.  He will be relatively undernourished and have gained mostly water weight, which will potentially make him a much higher surgical risk.

With respect to his chest X-ray (CXR), infants normally have a combined cardiac and thymic silhouette, so this is likely a normal finding. . It would be more helpful to know if he had increased pulmonary vascular markings on the CXR, as this would be more proof of too much recirculation of blood from the left to the right side of his heart.

[louai]

++ chest Rx hypertrophy of thymus? what does it mean ,is it normal at this age ,does it have any relation with his VSD or genetic abnormalities.

[louai]

does the fact VSD=1/2 DAo  is in favoror of  a surgery?

thank ypu.

[louai]

does the fact VSD=1/2 DAo  is in favor of  a surgery?

thank ypu.

[louai]

does the fact VSD=1/2 DAo  is in favor of  a surgery?

thank ypu.