what is danger of tiny VSD leak after full repair

[fadi75]

My son got full TOF repair 2 months ago "VSD,ASD,Valve" when he was 18months old with no complications on the first visit after surgery the doctors mentioned that there is tiny leak in VSD and valve got degree 1 of leak or narrow "which he mentions he did not open the valve fully to give it chance to grow normally later and give the valve more lifetime "
my question how much the surgery considered successful ? and how much danger my son  still got ? is it possible to do another repair for the VSD ? i mean is it possible that the leak increase so it gets needed to do the surgery again ?

[Marie M Gleason, M.D.]

There is a stent mounted valve called a Melody valve that has been approved for use in the US in specific circumstances to replace the pulmonary valve.  It has been in use in Europe for several years. It is performed in the cardiac cath lab, but not all Tetralogy patients qualify for this treatment. In patients with Tetralogy of fallot, the question of whether or not to replace the pulmonary valve comes up due to valve leakage causing right sided heart chamber enlargement over the course of many years.  there is no set answer as to who will need  a valve replacement or when.  That decision is made on an individual basis.  In most cases, however, we are looking at late teenage years to young adults. Most of these valve replacements are done surgically if the patient does not have an artificial conduit between the right ventricle and the pulmonary artery.

[fadi75]

my understanding now is "narrow or leakage in valve is not a reason to replace it but the right sided heart chamber enlargement is the thing we should keep an eye " .

really thanks .

[fadi75]

Thanks doctor for the clarification,
i heard that in hospital of Philadelphia you add new pulmonary valve for the first time without surgery "just using cath-lab" within 15 minutes  , is it correct ?
another thing is the valve of my son considered in good situation and when usually it needs replacement ?after how long or according to what circumstances ? and is t possible to be done by cathlab without surgery ?

[Marie M Gleason, M.D.]

It is common for small leaks to be seen around the VSD patch after surgery.  If the amount of blood going across that is small, it poses no significant risk to the child.  Rarely the patch can "dehisce" or unravel, but that should have happened already if your child is already 2 months out from surgery.  Some small residual leaks even close up completely over the first year after surgery.  If they do get larger, then a repeat operation would be needed to sew it closed again.  You should discuss this further with your child's cardiologist after the next visit, if you still have questions or concerns.