Q: My five years old daughter has been diagnosed with a very small restrictive subpulmonic VSD. This was identified when she was three months old and the doctors advised to have a yearly echo check and we were doing it. Yesterday, we got two contradicting opinions from two doctors in this regard. One opinion was since the VSD is very small and there is no leakage in the valve and all other parameters are normal, there is a chance for closure naturally. The second opinion was according to medical theories that small VSDs may generate problems in the future and suggested to close it by an open heart surgery. VSD being restricted by RCC prolapse, no AR. What should we do?

A:Subpulmonic VSD's NEVER CLOSE whatever be the size. The issue here is mainly related to the state of the Aortic valve and this is where the controversy arises. Some authors believe that if there is significant valve prolapse then it should be operated upon in order to prevent further distortion of the valve. Others believe that surgery should be performed if Aortic regurgitation is noticed.I follow the second option. If there is no leakage in Aortic Valve then a yearly echo is done on a regular basis.