Related to Perimembranous VSD.. 4.9 mm

[vidixit]

Hi All,
I am based in India. We got this shock before our baby was born.

After 8 days she was born in Blore she went through Echo, Cardiologist suggested
wait till she is 2 years old. This should not cause any problem.

Due to job we shifted city.. now we are close to Delhi. She went through another
Echo (She is 11 weeks old now) . now Cardiologist here says that she need to
go through surgery.. we are very worried with this different opinion.

Otherwise she is doing fine, normal weight gain, activities, no sweating.

Her latest Echo reports goes like that.

Situs                               : Solitus
Cardiac Position               : Levocardia
Systemic venous drainage :Normal
Pulmonary venous drainage: Normal
AV Connection                  : Concordant
VA Connection                  : Concordant
Loop                                 : d-loop
Left Atrium                        : Dilated
Right Atrium                      : Normal
Mitral Valve                       : Normal
Tricuspid Value                  : Normal
Left venticle                       : Dilated
Right venticle                    : Normal
IAS                                  : Intact
IVS                                  : Large perimembranous VSD l->R
                                         gradient = 18 mmHg
Aortic Value                    : Normal
Pulmononary Value           : Doming, annulus = 8mm
Great vessel relation          : Normal
Aorta                               : Normal
Pulmonary Artery              : Normal
Arch                                  : Normal    
Ductus                             : Absent
Coronaries                         : Normal
other findings                 : Nil

Please advice what needs to be done.

[cuckoo175]

There is also other ways to repair without open heart surgery. It can be done with an umbrella device that is placed with a catheter across the defect and help in closing the defect. But before doing so your cardiologist will again do an echo to find out if the device can be placed. So if you are somewhere around Mumbai then you are very good chance of meeting Dr Bharat Dalvi who is a very well known pediatric cardiologist around the world. So try and meet him and may be he can help.

[mshanson]

Hi there from Canada. Our daughter has a moderate VSD as well as a small ASD. She is going to require open heart surgery to repair her holes, but she is also in congestive heart failure (not eating well, not gaining well, fast breathing, sweating while nursing), and is currently on 3 different heart medications. When do you see the cardiologist again? I would tend to err on the side of caution, if one thinks she needs it, and one says she doesn't, is there a different cardiologist you can get an opinion from?

[Jeffrey R Boris, M.D.]

Dear Vidixit,

Without having all of the information that I would need, I cannot say exactly what needs to be done here. Certainly, her echo suggests that there is no significant restriction to the blood flow going across her VSD.  However, if she is eating well, not getting sweaty or out of breath feeds, and gaining weight (all symptoms of congestive heart failure, or CHF), it may be able to be observed.  It sounds as if there may be some pulmonary valve stenosis (obstruction), but you do not tell me how much of a gradient, or amount of obstruction, there is.  If the gradient is relatively high, it may be limiting how much blood flow is recirculating through the defect, and thus limit her CHF symptoms.  If this is the case, she can certainly grow and potentially try to close down the VSD.  However, another potential reason that she does not have heart failure is if she has residual pulmonary hypertension, or high blood pressure across the lungs.  This would be a bad thing, and would lead to needing the defect closed sooner than later.  Therefore, I wouldu recommend discussing this further with your cardiologist and finding out why there is a change in plans toward surgical repair at this point.