Chance of closure 4 mm VSD

[mshanson3121]

I've posted previously, our daughter was born with a moderate VSD and small ASD at birth. She is now 4.5 months old. The ASD is now only a pinhole and her VSD has closed down to being 4 mm. It is restrictive (tissue from triscuspid valve), no signs of leakage, and her pressure differential is 68 mmHg. She has been in heart failure all summer (controlled by meds), however signs of heart failure are now gone. She was scheduled for OHS to repair, but given the size of the hole and the fact that her symptoms were improving, they cancelled surgery and will just follow her up.

Is there a chance that she will require surgery in the future, if the hole doesn't get any smaller? What are the risks of leaving it unclosed? Will she have any restrictions if it stays open and doesn't close completely?

[Marie M Gleason, M.D.]

This sounds like all good news.  We cannot say that surgery will never be required, but it sounds like you have reached a significant level of improvement.  Good luck.

[mshanson]

I also have the echo report:

POSTITION: Levocardia. Abdominal situs solitus. Atrial situs solitus. Atrioventricular concordance. Ventriculoarterial concordance.

Veins/Atria: all normal. Patent foramen ovale noted (small)

AV Vales: all normal.

Ventricles: Mild right ventricular hypertrophy. Mild concentric left ventricular hypertrophy. Restrictive membranous VSD with inlet extension.

Conotruncus: all normal.

Vessels: all normal. PA branches are confluent, however the RPA is more anterior than LAP, unable to obtain both PA's in same plant. No PDA.

Function: normal

Measurements and Calculations:

RVDd: 1.0 cm IVSd: 0.39 cm LVIDd: 2.2 cm LVPWd: 0.40 cm VSD diam: 0.44 cm FS: 54.5% EF (teich): 87.3% LV mass: 14.2 grams MV annu diam: 1.2 cm TV annu diam: 1.5 cm Ao root diam: 1.1 cm asc Aorta: 0.99 cm LVOT diam: 0.81 cm RVOT diam: 1.1 cm RPA diam: 0.45 cm LPA diam: 0.43 cm

Doppler measurements:

MV E point: 84.8 cm/sec MV A point: 68.7 cm/sec MV E/A 1.2 Ao max PG: 2.8 mmHg Lv max PG: 5.8 mmHg LV mean PG: 2.4 mmHg LV V1 VTI: 15.1 cm SV (LVOT) 7.7 ml PA max PG: 7.9 mmHg PA mean PG: 3.5 mmHg VSD max PG: 68.8 mmHg

Chest Xray read: slightly elevated cardiac apex, otherwise cardiomediastinal silhouette is within normal limits. Slightly prominent central pulmonary vasculature with mild increased interstitial marking bilaterally is noted with no evidence of airspace disease or pleural effusion or pneumothorax.

[mshanson]

I wanted to mention that they said that there is tissue from her tricuspid valve making her VSD restrictive.