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Suggest treatment for hole in heart of an infant

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Cardiologist
Practicing since : 1989
Answered : 42 Questions
Question
Hi!
My son was borned on 19-03-14.
On 02-08-14 he need to be admitted in hospital for pneumonia (a xray report is enclosed please refer.)
After two days were told he has got other issues too, that is VSD in heart. (an echo report is enclosed)
Please suggest me the best treatment for him as he is in ICU from 5-08-14.
Waiting for an early reply.
Thanking you in anticipation.
Posted Wed, 27 Aug 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Satish Kumar 6 hours later
Brief Answer:
Small hole. Let the pneumonia settle first.

Detailed Answer:
Hi XXXX
I can understand your concerns. Your little son XXXX has a tiny (about half a cm) hole between the two lower chambers of the heart. As of now, this is not of much concern as the pressure recordings in his lung vessels are not high and there is no mixing of impure (deoxygenated) blood with pure (oxygenated) blood.

More important is his current chest infection. I am sure he is going to be alright with antibiotics and supportive measures.

He may require a follow-up Echo after some 3-6 months to see any changes in his cardiac status. Many a times, these small holes close on their own.

If they remain to be persistent and cause complications like recurrent chest infections, poor growth of the child etc they may be surgically closed after the child assumes sufficient weight and is free from any infection.

So, don't worry...XXXX would be alright.
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Follow-up: Suggest treatment for hole in heart of an infant 1 hour later
Thank you very much for your reply.
I am told here that a hole of size 5.6 mm is moderate and fall in bigger side.
There are less chances of getting closed on its own of a hole of this size.
I am much worried and tensed so its my wife.
XXXX is our first child.
Further the infection seem not to be going.
Till now he is getting the following medicines
1. Inj. Tazomac PS 1.125 gm 1/2 vail i/v TDS
2. Inj. Merotrol 250 mg 1/2 vail i/v TDS
3. Asthalin 1cc + NS 2cc 4 hrly
4. Crocin syrup
5. Pedic Drops
6. Furoped Syrup
7. Dixin Syrup ( 0.8 ml OD)

Please suggest.
I am much stressed and confused.
Thanking you in anticipation.
 
 
Answered by Dr. Satish Kumar 3 hours later
Brief Answer:
Well..size is just above the 'small VSD' category.

Detailed Answer:
Dear XXXX
Normally, we categorise the VSDs as Small (1.0 cm). Depending upon the location of the defect, it may be Membranous or Muscular.

In XXXX case, as per the report provided by you, it is a membranous VSD of 5.6 mm with Left to Right shunt and a pressure gradient of 25 mm of Hg with no significant Pulmonary Hypertension.

Other than the size of the VSD, the pressure in the right and left ventricular chambers and pulmonary resistance are factors that influence the hemodynamic significance of VSDs. In Rushank's case, as of now they do not appear alarming.

One may be right in saying that membranous defects compared to the muscular variety of small sizes getting spontaneously closed over a period of 2 years is less (40% vs 60%). But, absolutely ruling out the possibilities is not correct.

One thing should be taken into consideration that a single Transthoracic echocardiography may not be very accurate in size measurement of the defect. More accurate methods could be a Trans-Esophageal Echo or newer 3D Echocardiographic examination.

In any case, one should wait and re-think for a surgical correction particularly when there is an overwhelming infection. But, also remember, the treating physician is always the best judge. He would definitely think the best possible remedy for his/ her patient.

The treatment that XXXX is getting seems appropriate, and God willing everything should be okay.

My prayers and best wishes are always with you and your family.

- Dr. Satish.
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Follow-up: Suggest treatment for hole in heart of an infant 25 minutes later
Ok..thanks once again for your answer....
Let me ask a few more things and I hope you would not mind.
XXXX takes very short and fast breaths, is it due to the hole that he has in his heart.
Also let me know what remedial steps should I take for his good.
I now know he is not all well and have heart problem, I don't know its minor or major, what precautionary steps should I follow in future.
And should I wait for the narrowing of the hole or go for immediate surgery.
Please suggest.

Thanks for your answers and positivity in them brought hope and happiness.
Thanks again.

Antisupating and waiting for your answers and suggestions.
 
 
Answered by Dr. Satish Kumar 45 minutes later
Brief Answer:
It is due to pneuminia

Detailed Answer:
Rushank's breathing problems are due to his bad lung condition, at the moment.
As per his Chest X-Ray report, he has infection in both the lungs. Is he able to maintain proper oxygenation with inhaled Oxygen by mask or nasal cannula (reflected by SpO2 % in blue in the monitor, more than 90% may be taken as satisfactory.)

Has the attending doctor talked to you regarding possibility of ventilatory support through Endotracheal Intubation?

As far as follow-up is concerned, he will have to undergo follow-ups with a paediatric cardiologist with repeat echocardiography at regular intervals, measures to prevent repeated chest infections etc.

Normally, an uncomplicated VSD patients do exceddingly well. But, the present problem is mostly related to his lung condtion.

PS : There were a few corrections in my previous response, which I can see have not appeared due to some technical reason.

1. The first sentence in the first paragraph it should read ..."Normally, we categorise the VSDs as Small (less than 0.5 cm, Moderate (0.5- 1.0 cm) and Large (more than1.0 cm).

2. The first sentence in the fourth para should be..."One may be right in saying that membranous defects....... is less (40% vs 80%).

I am providing you a very nice reference web link below for patient / care giver education on this topic by the XXXXXXX Heart Association....they are very authentic and reliable. Pl go through them and you will get answers to most of you querries.

- http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Ventricular-Septal-Defect-VSD_UCM_307041_Article.jsp

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Follow-up: Suggest treatment for hole in heart of an infant 19 hours later
He is in oxygen by nasal canula (@ 0.50)
What should I do after the infection is cleared.
Shall I wait or shall I immediately go for the surgery.
Please do suggest.
 
 
Answered by Dr. Satish Kumar 1 hour later
Brief Answer:
After this, first visit Paediatric Cardiologist.

Detailed Answer:
Dear XXXX

After few days (or may be a week or two) of recovery from the current illness you may take your son to a Paediatric Cardiologist at a high volume centre of repute at XXXXXXX or XXXXXXX for more detail assessment of his cardiac anomaly.

There definitely is no urgency of a corrective surgery at this point of time.

I hope I could explain the things, as they are.

Feel free to contact me, any time.

You may rate my responses if you desire as expected at this website.

...again wishing speedy recovery of your son.

- Dr. Satish.
Above answer was peer-reviewed by
 
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