Najar, Girl is a 2 day old FT female with TEF/EA who I scheduled for surgical repair on 02/19/18. Her echo showed membranous VSD, two secundum ASDs and small PDA, all shunting left to right. Clinically she doe not have signs of increased pulmonary blood flow. Once pulmonary vascular resistance further drops (usually in few weeks, we would expect to see signs of increase pulmonary blood flow such as tachypnea, excessive sweating/ difficulty with feeding and lung congestion. At that point, she will needs to be started on anti HF medications ( diuretics and ACEi) to improve respiratory status and likely will require increased calorie intake to promote adequate growth. Till then, will continue to observe clinically and no need to start cardiac
