What are the considerations for a five‑month‑old with VSD?

Question

Hi doctor,

I did an echocardiography of my two-month-old baby last year. First, a ventricular septal defect of six millimeters was found. Then we have done the next echocardiography this year, and the ventricular septal defect increased to eight millimeters.

Baby is now five months old, and his weight is 13.22 pounds. Please suggest the right time for surgery and cost.

Kindly advise.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

A ventricular septal defect usually closes by the age of two years, and even up to ten years.

The ventricular septal defect is not causing left ventricle or right ventricle enlargement. Still, the issue of concern in this echocardiography report (attachment removed to protect the patient's identity) is the significant shunt fraction, which causes pulmonary hypertension.

Does your baby turn bluish while crying?

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.

Answer 2

Hi doctor,

Welcome back to icliniq.com.

I understand your concern.

VSDs (ventricular septal defect) of eight millimeters are considered large. Moreover, pulmonary to systemic blood flow is 2:1, which is significant, and there is pulmonary hypertension.

Indications of surgery are if the infant's growth is compromised or he has shortness of breath, turning blue on crying, or recurrent chest infections. Fortunately, these symptoms and signs are not present, but the size and shunt fraction are significant. So surgery should be done. A good age is four to six months, but it may be delayed up to 12 months if a pediatric cardiac surgeon thinks VSD can not be harmed until that age.

Sir, it is advised to take the pediatric cardiac surgeon's opinion on this. The doctor will assess the patient and will decide accordingly.

As general guidance for large VSDs and significant shunt and developing pulmonary Hypertension, VSD closure surgeries are done at around six months, or maximum, before 12 months of age.

If the VSD is small, less than three millimeters, such VSDs usually self-close, and patients are just observed with repeat echocardiography every one to three years.

I hope this information will help.