Download 23 January 2013 Re: Emma Chu MRN: 1138650 DOB: 31/8/2012

23 January 2013
Re:
MRN:
DOB:
Diagnosis:
Emma Chu
1138650
31/8/2012
Moderate perimembranous ventricular septal defect
Emma Chu was first reviewed on 7 November 2012. Clinically, she had signs of heart
failure. She was tachypnoeic, pink, saturation 99% on room air, heart rate 149/min,
systolic murmur grade 3/6, liver 3cm, femoral pulses well felt. On cardiac assessment,
CXR showed cardiomegaly with lung congestion. Echocardiography showed dilated left
atrium and left ventricle. Small patent foramen ovale, moderately large
perimembranous ventricular septal defect, 4.3mm, left to roght sunt, pressure gradient
across the VSD 32mmHg, no left or right ventricular outflow tract obstrution, no patent
ductus arteriosus, no coarctation of aorta, good left ventricular function ejection fraction
82%. She was started antifailure therapy, syr frusemide 4mg tds, syr aldactone 6.25mg
bd.
Emma was reviewed again on 5 Deember 2012. Clinically, she was better. Although she
remained to have subcostal recession, she had less tachypnoea. Liver 2cm.
Echocardiography showed dilated left atrium and left ventricle, mild tricuspid
regurgitation gradient 30mmHg, moderate perimembranous VSD, 3.4mm, left to right
shunt, pressure gradient across VSD 40mmHg, good left ventricular function, ejection
fraction 75%. Syr frusemide 4.5mg tds and syr aldactone 6.25mg bd were continued.
6 week later, she came for third review today. Clinically, she was fairly comfortable with
mildl tachynoea. She remained to have subcostal recession. Echocardiography showed
dilated left atrium and left ventricle, mild tricuspid regurgitation, gradient 33mmHg,
moderate perimrmbranous VSD, 3.6mm, left to right shunt, pressure gradient across
VSD 38mmHg, no coarctation of aorta, good left ventricular function, ejection function
71%.. She was on Syr frusemide 5.5mg tds, syr aldactone 6.25mg bd.
In view of persistent signs of heart faiure (although improved) despite anti-failure
therapy with significant shunt and potential risk of progressive raised in pulmonary
pressure, she was recommended for early closure of VSD.
Yours sincerely,
Dr. Choo Kok Kuan
Consultant Paediatrician & Paediatric Cardiogist
Sime Darby Medical Centre Subang Jaya
Sime Darby Medical Centre Ara Damansara