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Is surgery necessary for a hole in the heart?

Q: My four and a half years old son has a small VSD (ventricular septal defect, hole in his heart) of 3-4 mm since birth. He is a very active and intelligent child. His growth is fine. The only problem faced by him is cold and cough, which takes a month to get cured. We got two opinions from 2 different heart specialists, which have confused us. One Doctor assured that no surgery/treatment is required in this size, as it will heal in 11 years time. Other doctor said that it will be difficult to control the situation after 11 years so its better to operate now, as little bit heart enlargement is there. The first doctor, based on the second doctor's report, did all the tests again but continues to maintain his earlier diagnosis. Please advise, where to go and whom to believe?

A:This is a common problem, made to look controversial. We do not look at VSDs in terms of mm sizes, but its effect on the heart (whether it is causing enlargement of the heart, the lung pressures etc). If it is so, then it is better to close it now rather than late. Closure of VSDs can never be predicted. The overall data indicates that as the age progresses the chances of closure decrease. If the VSD is truly small (no heart enlargement, normal lung pressures) there is really no indication to close it and then one can wait and watch in the hope that it will close spontaneously. Even if it does not close, it does not seem to cause trouble in life and the majority grow to normal adulthood. There is a very small chance that some of these small VSD may develop infection (infective endocarditis), but this by itself does not warrant closure. There are innumerable examples seen by us of adult patients being evaluated for small VSD, which has never caused any trouble in life. Chest infection, cold etc. is almost never due to this small VSD. Very often this is accused as the cause. The paediatrician should look carefully at allergy or other treatable causes (like lingering sinus trouble) rather than blame the VSD.


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