Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
One-third to one-half of all small VSDs close spontaneously (on their own). This seemingly miraculous event occurs most often before the baby is
1 year old, almost always before age 4 (75% by 2 years of age). The closure is due to the small VSD being located between heart fibers that increase in size in time, thus encroaching upon the opening in the ventricular septum.
Even if a small VSD does not close spontaneously, surgical repair is usually not recommended. However, long-term follow-up is required.
What if the VSD is large?
With a large VSD (usually one greater than 1 cm2), there is significant shunting of blood from the left ventricle into the right ventricle. Thus extra blood volume puts a strain on the right ventricle and causes an increase in the blood pressure of the lungs called "pulmonary hypertension." The child may have labored breathing, difficulty feeding, grow poorly, and have pallor.
How is a large VSD treated?
Ultimately, the patient with a large VSD will need surgery to "patch the
hole" in the ventricular septum. The timing of the surgery is an
individualized decision based upon several factors. These include
The extent and duration of increased pulmonary artery pressure. Chronic pulmonary arteriolar pressure may become irreversible and put a strain on the right ventricle. These side effects may be treated with medications until surgery is appropriate.
A child with a large VSD often will not grow as robustly as his peers. The work of increased metabolic demands often requires additional calories when compared to children without such a cardiac defect. High-calorie dense supplements may be added to formula. Some infants may require nighttime continuous feedings using a tube that is passed through the nose to the stomach (nasogastic tube) to maximize growth. It is very rare to restrict fluid volumes in these children.
Infants with iron-deficiency anemia should receive iron supplements to maximize the oxygen carrying capacity of their blood. Blood transfusions to address such an anemia are rare.
A heart murmur is the sound generated when blood flow within the heart is not smooth. Causes of heart murmurs can be functional, congenital, or caused heart valve conditions. Symptoms of a heart murmur may be none, or may include chest pain, shortness of breath, and arm, leg, and ankle swelling. Treatment of a heart murmur depends on the cause.
Birth defects have many causes and currently, are the leading cause of death for infants in the first year of life. Some of the causes of birth defects include genetic or chromosome problems. Exposure of the mother to rubella or German measles during pregnancy, or using drugs or alcohol during pregnancy. The treatment for birth defects depends upon the condition of the effected child.
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