The child in the previous question undergoes cardiac catheterization confirming a VSD with Qp/Qs ratio of 2.0 and right ventricular systolic pressure half of systemic pressure. The following is/are true:

a. If aortic insufficiency is detected, the defect is likely to be subpulmonic in location

c. The cath data indicate a restrictive type of VSD

d. If pulmonary vascular resistance falls with tolazoline administration, it is safe to close the VSD

e. Operative closure of VSDs is possible without ventriculotomy

The finding of aortic insufficiency in a patient with VSD suggests prolapse of the aortic valve due to a subpulmonic or supracristal defect. Associated aortic stenosis, mitral stenosis and coarctation are common with VSDs. The finding of a moderate left-to-right shunt and a right ventricular pressure well below systemic levels indicates a restrictive VSD. If elevated pulmonary vascular resistance is found, the ability to respond to a vasodilator like tolazoline indicates that the resistance is not fixed and operative repair is possible. Operative repair of VSDs is frequently possible via atriotomy or through the pulmonary artery.