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Does my son with heart defects need surgery?

Q: My child was diagnosed with ASD (atrial septal defect) and VSD (ventricular septal defect) at the age of 2 months. He is 1 year 8 months old right now. At the time of diagnosis the VSD size was 8 mm and ASD was smaller but now the size of VSD is 4 mm and ASD is tiny. Does my child need surgery for this or we can wait? Also, is there any risk in surgery as it is an open heart operation? Please suggest.

A:ASD and VSD are normally present in a developing child, that is, when the child is in the mother’s womb and during the process of development, they close. Unfortunately in some, the process may be delayed and may carry on even after birth. Certain types of VSDs, especially muscular VSDs and perimembranous VSDs may close even upto 8 to 10 years of age, while sub aortic or sub arterial VSDs generally do not close after birth. In your case, as the size of the VSD and ASD has becomes smaller and the child is only one year eight months old, I think you can wait, subject to your treating cardiologist’s consent for the same. If the child has no symptoms and echocardiography shows that there are no harmful effects of the VSD, especially on the lungs, then one can safely wait and do serial six monthly Echos and the chance is significantly high, that these may close spontaneously. As far as risk in surgery is concerned, these are relatively simple operations but I do grant, they are open heart surgeries and therefore some finite risk is definitely attached to them. Currently mortality for ASD and VSD closure is under 1%.

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