Your child has been diagnosed with a ventricular septal defect. Will he or she require surgery? Sometimes this question has an easy answer, but in other situations it may be more complicated. Many VSD's are small and clearly significant right from the time of diagnosis. It is clear from the start that these VSD's will not require any intervention. A good portion of these small VSD's will spontaneously close over time. Conversely, some VSD's are large and clearly significant. An example of this type of VSD is what is termed a "malalignment" VSD. In this situation portions of the ventricular septum are misaligned - that is, they are like 2 pieces of a jigsaw puzzle that don't fit together and never will. For all intents and purposes these VSD's never close, are almost always large, and typically require surgery.

A coarctation of the aorta is defined as a narrowing of the aorta, which is the main blood vessel that carries blood from the heart to the rest of the body. This type of heart defect is one of the more common ones, as it represents approximately 5% of all congenital heart malformations (with congenital heart defects occurring in approximately 0.8 to 1.2 out of 100 newborns, it still is relatively rare in the overall scheme of things).

B-type natruretic peptide, or BNP, is a hormone that is manufactured by the ventricular muscle in human hearts. The physiologic effects of BNP include the following: Diuresis (increased urination), loss of sodium, and vasodilation. It is expressed in response to either a pressure or volume load on the ventricle. This can be seen in a number of different settings, including valve stenosis (narrowing), an enlarged and poorly functioning heart muscle, or a heart muscle that is stressed by having to pump excess blood.

Heart murmurs in children are very common. A heart murmur just means a sound. Some heart murmurs are sounds produced by actual defects or abnormalities with the heart. For example, a ventricular septal defect (a hole in the wall separating the lower 2 chambers of the heart) makes a very specific noise as blood travels through the hole. Abnormalities with heart valves like aortic valve stenosis can also produce heart murmurs. As blood flows past the defective valve the turbulent flow can produce a distinctive sound. On the other hand, many heart murmurs are what we call innocent heart murmurs. With an innocent heart murmur, the heart is perfectly normal. The murmur in this case is simply the normal sound that blood is making as it flows through the heart.

One question I frequently get from parents is whether it’s safe to travel with their children with congenital heart disease to high-altitude areas. Two considerations immediately come to mind: 1) what type of heart defect does the child have? and 2) specifically what altitude will you be traveling to?

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