A 3-month-old infant has a prominent left precordium, harsh pansystolic murmur at the lower left sternal border, and a diastolic rumble at the apex. The ECG shows biventricular hypertrophy. Chest X-ray shows cardiomegaly with plethoric lung fields. The infant feeds poorly and sweats with feeds. Which of the following management decisions is CORRECT?

• A Refer for surgical closure at age 1 year as long as the infant is growing well
• B Start digoxin and furosemide; close the VSD before 6 months to prevent pulmonary hypertension ✓
• C Counsel parents that spontaneous closure is expected by age 5 years
• D Order cardiac catheterisation immediately to measure pulmonary vascular resistance before any intervention

Explanation

This infant has a large VSD with features of congestive cardiac failure (poor feeding, sweating, diastolic mitral flow rumble indicating high left-to-right shunt). Large VSDs with failure require medical management (diuretics, digoxin, caloric supplementation) and early surgical correction before 6 months to prevent irreversible pulmonary vascular disease (Eisenmenger syndrome). Waiting until 1 year or expecting spontaneous closure is inappropriate for a large symptomatic VSD. Catheterisation is not the immediate next step.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.