Right pressure on heart in 2.5 year old

[Damien3981]

Hi Dr,

My son had a large VSD repair(10mm) at 9 months of age. He was diagnosed at 7 months. 3 weeks ago we took him to our cardiologist(we have noticed this for 2-3 months the cardiologist could only get us in at this time) as we could really feel his heart beating and we thought it didn't feel right. Our cardiologist performed an ECO and ECG and said there was high pressure on the right side of his heart. To what extent we are not sure just yet as we are waiting for the catheter to check pressures. We have googled and the only cause of this we can find is pulmonary hypertension.

He is now 2.5 years old I just want to know if you think it's possible that IF we may have got onto this early there is a chance his cells can repair in the lungs if the damage is only mild? Also how accurate is the ECO and ECG for a preliminary diagnosis of Pulmonary Hypertension? Could this be the only outcome for my son or would there be other variables?

Many thanks

[Marie M Gleason, M.D.]

Children with large VSDs (ventricular septal defects) will have high pressure in the right side of the heart until surgery is performed.  The general rule is that repair in the first year of life usually (but not always) results in a return of the right heart pressure to normal.  Children with large VSDs usually develop congestive heart failure symptoms in the first few months of life.  If your child was not diagnosed to have a large VSD until 7 months of age, that could mean that there is something different about the resistance in his lungs.  That could mean a predisposition to ongoing higher than normal blood pressure in the lungs.  The echocardiogram is not definitive for pulmonary hypertension, especially if there is a residual VSD around the patch, but it certainly can suggest that there is a problem.  That is why a heart catheterization is sometimes necessary to determine the true pressure and resistance in the lungs, and see if there are other residual factors present that could explain it.  If the lung artery pressure is high, then it is a question of "how high",  Significant pulmonary hypertension (more than 1/2-2/3 of the systemic blood pressure) is a serious risk for future heart failure and lung failure.  An evaluation by a pulmonary hypertension specialist might be needed to see if your child merits treatment with one or more of the availablable oral medications that can help to "relax" the blood vessels in the lungs and thus could improve the pulmonary hypertension (but not cure it).  

[Damien3981]

Just on this we took my son to ED because he was looking a bit pale and they gave him a chest X-Ray and said his lungs don't look "wet". Is this a good sign?