Your Specialist Report — Hole between the lower heart chambers (perimembranous ventricular septal defect, VSD) in a 4-year-old

Package: Before your surgery · Prepared for: the family of M., a girl, age 4 (sample report, fictional patient) · Location: Atlanta, Georgia · Insurance: employer PPO · Report date: November 2, 2026

1. What this condition is

M.'s cardiologist has told the family that she has a ventricular septal defect (VSD) that has not closed on its own and that she needs surgery to close it. A VSD is a hole in the wall that separates the heart's two lower pumping chambers. The "perimembranous" kind is a hole in the upper section of that wall (CDC, page dated Dec. 14, 2025). Because blood passes through the hole into the lungs, the CDC says a VSD "forces the heart and lungs to work harder." It also says small holes may close on their own, and that a VSD left unrepaired can raise the risk of heart failure, high blood pressure in the lungs and irregular heart rhythms. Surgery to close a VSD is usually one planned open-heart operation: the surgeon sews a patch over the hole while a heart-lung machine does the work of the heart. The national surgeons' registry places "patch repair of ... Ventricular Septal Defect (VSD)" in its lowest-risk group of operations, STAT category 1 of 5 (STS explanation page). Lowest-risk is not no-risk, which is why the questions in Section 7 matter. Your doctors will decide what applies to your child; this report helps you prepare for those conversations.

Questions many families focus on:

• How many VSD closures does this surgeon do in children past infancy, and what happens to the heart's rhythm afterward? No program we checked publishes either number for a single surgeon. You get them by asking.
• Which incision would she have? Duke describes a smaller cut that opens only the lowest part of the breastbone for one child's hole between the upper chambers (Story 3). Ask each program whether that, or a full breastbone opening, would be used for a VSD like hers.
• Is the whole team in our PPO's network? The hospital, the surgeon's group, anesthesia and the heart-lung machine team can bill separately. Section 3, step 3 lists the calls.

2. Specialists to consider

How we compared programs: the public registry. The Society of Thoracic Surgeons (STS), the surgeons' national registry, publishes congenital heart surgery results for programs that agree to it. STS no longer gives congenital programs star ratings. Its congenital pages now show, for January 2022 to December 2025, how many children died within 30 days or before going home, compared with how many would be expected for that hospital's mix of patients (the "observed-to-expected ratio," with a 95% range). STS's own reading rule: if the whole range is below 1, the program had fewer deaths than expected; if the range crosses 1, it performed as expected; if the whole range is above 1, more than expected (STS explanation). STS also warns that its results "are not intended for direct comparison to other participants," because each hospital treats a different mix of patients. MUSC says STS gave star ratings only from 2016 through 2020 (MUSC's statement, MUSC outcomes page).

STS public results, children's heart programs in Georgia and neighboring states, January 2022 – December 2025 (all ages and all congenital heart operations; distances are approximate driving miles from Atlanta):

Read from each program's STS page on November 2, 2026: Children's Healthcare of Atlanta, Duke, Vanderbilt, MUSC, Children's of Alabama, Levine. Children's Healthcare of Atlanta is the only Georgia program listed in STS public reporting. Hospital-published survival and volume figures quoted below are the hospitals' own figures: self-reported, not audited by us, and not comparable between hospitals.

We ranked by experience and public results first, then by distance. Each program has more than one congenital surgeon; we name the surgeon whose page or published work fits this situation best, plus a second name at the same office.

1. Subhadra Shashidharan, MD — Associate Chief, Pediatric Cardiothoracic Surgery, Children's Healthcare of Atlanta (in town)

• Where they practice now: Children's Healthcare of Atlanta, Arthur M. Blank Hospital, 2220 North Druid Hills Road NE, Atlanta. Children's own website refused every automated check we tried on November 2, 2026, so we used two other sources:
• Emory School of Medicine's live faculty profile, checked November 2, 2026 (her Emory profile): Associate Professor; "Associate Chief of Pediatric Congenital Heart Surgery, CHOA"; Director of Quality for Pediatric Cardiac Surgery; Program Director of the congenital cardiac surgery fellowship; publications listed through June 2026.
• Children's own profile page as saved by the Internet Archive on May 19, 2026 (saved Children's profile), and Children's Heart Center page saved September 3, 2026, which lists her as one of four cardiothoracic surgeons (saved Heart Center page).
• Why selected:
• The largest program in the region by the STS count above, and one of two in the table whose whole range is below 1.
• Children's says she performs "more than 200 surgeries per year" (the hospital's own figure, page saved January 19, 2026: Surgical Excellence page). As the program's Director of Quality, she is the natural person to ask about its VSD results.
• Children's reports 100% survival for VSD repair against an STS benchmark of 99.66%, July 2021 – June 2025 (the hospital's own report, page saved June 11, 2026: Volumes and Outcomes). The page gives the rate but, in the text we could read, not the number of VSD repairs.
• Second name, same office: Paul J. Chai, MD, Chief of Pediatric Cardiothoracic Surgery and Co-Chief of the Heart Center. His Emory profile, checked November 2, 2026, lists him as Professor and his interests as complex newborn surgery, aortic valve surgery and heart transplant (his Emory profile; Children's profile saved May 10, 2026). The other two surgeons on the September 2026 list are Joshua Rosenblum, MD, PhD, and Mohan John, MD.
• Accepting new patients: not stated; see "Your first call" (Section 3).

2. Douglas Overbey, MD, MPH — Pediatric Heart Surgeon, Duke Children's (about 380 miles; a short flight)

• Where they practice now: Duke Children's Hospital & Health Center, 2301 Erwin Road, Durham, NC — checked on the institution's own page on November 2, 2026: Douglas Overbey, MD, MPH | Duke Health. The page lists an Associate Professor of Surgery appointment dated 2026 and board certification in congenital cardiac surgery. He is one of four surgeons on Duke's pediatric heart surgery page, checked the same day.
• Why selected:
• Duke's STS range (0.26–0.59) is the lowest in the table, on 1,687 patients.
• Duke's own chart shows 691 lowest-risk (STAT 1) operations from July 2021 to June 2025, the group that includes VSD patch repair (the hospital's own chart of its STS data) (Duke outcomes page).
• A 2024 Duke story describes Dr. Overbey meeting an out-of-town family by video visit and closing an 8-year-old's hole between the upper chambers through a smaller incision that opens only the lowest part of the breastbone; he says, "This surgery isn't offered at a lot of places" (hospital story, Story 3). Ask whether this approach is used for a VSD like M.'s.
• Duke's first-visit page (medically reviewed June 27, 2024) says its heart experts review your child's records, test results and images and may then schedule a consultation, and that "If you live far from Duke, we offer virtual visits."
• Second name, same office: Joseph (Brian) Clark, MD, Professor of Surgery, whose Duke page says he specializes "in the repair of congenital heart defects in newborns, infants, and children" (his Duke page, checked November 2, 2026). The program's chief, Joseph W. Turek, MD, PhD, MBA, lists the Norwood operation, single-ventricle defects and pulmonary valve replacement as his areas (his Duke page).
• Insurance lists on all three pages: Aetna, Blue Cross Blue Shield of NC, Cigna, NC Medicaid, UnitedHealthcare. A Georgia plan is not named; ask (Section 3, step 3).
• Accepting new patients: Dr. Turek's page says yes. Drs. Overbey and Clark: not stated; see "Your first call."

3. Minoo N. Kavarana, MD — Chief, Pediatric & Adult Congenital Cardiothoracic Surgery, MUSC Children's Health (about 300 miles)

• Where they practice now: MUSC Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC — checked on the institution's own page on November 2, 2026: Minoo Naozer Kavarana, M.D. | MUSC Health. MUSC's College of Medicine quoted him in an article dated April 3, 2026, which lists him as Co-Director of the Pediatric & Congenital Heart Center.
• Why selected:
• 1,295 patients in the STS period, performing as expected; 2 deaths among 596 lowest-risk operations.
• MUSC says that from January 2021 through December 2024 its survival rates "meet or exceed STS national benchmarks" in every complexity group, and that it received STS's top star rating in all five years stars were given (the hospital's own statements) (MUSC outcomes page).
• MUSC gives two different yearly counts on two of its own pages: "more than 400 surgeries" (patient page) and "more than 350 operations annually" (division page). Ask for the current number of VSD repairs.
• He has been at MUSC since 2010 and directs its congenital surgery fellowship. The two other active surgeons on MUSC's pages are Lloyd (Mac) Felmly, MD, and Matteo Trezzi, MD (both provider pages live November 2, 2026; same office).
• Accepting new patients: his page shows a "New patient visits" label; the office line is 843-792-3780.

Closer to home (Georgia)

• Children's Healthcare of Atlanta (Specialist 1) is the only Georgia program in STS public reporting. It operates at Arthur M. Blank Hospital in Atlanta.
• Nearest out-of-state program: Children's of Alabama, Birmingham, about 150 miles. STS: 1,232 patients, as expected; 5 deaths among 599 lowest-risk operations, a range that still crosses 1 (as expected). Robert J. Dabal, MD, Chief of Pediatric Cardiothoracic Surgery, is listed on the hospital's own page, checked November 2, 2026 (his Children's of Alabama page; appointments 205-934-2419), and as Division Director on its heart team page.

Leads we checked and did not list

• Kirk Kanter, MD (Children's Healthcare of Atlanta) — chief of the program for most of 1990–2019; Emory now lists him as Professor Emeritus after a 33-year career (1988–2021) (his Emory profile).
• Fawwaz R. Shaw, MD (Children's Healthcare of Atlanta) — still on Emory's cardiothoracic faculty list, but Children's Hospital of Philadelphia announced on April 17, 2026 that he has joined CHOP (CHOP announcement).
• Paul Kirshbom, MD — the surgeon in a 2011 Atlanta family blog (Story 1). He is not on Children's 2026 surgeon list; his Atrium Health (Charlotte) profile now returns "page not found," and a University of Maryland page that appears in search blocked our check.
• Nicholas Andersen, MD (Duke) — named in a Duke article on the program's 2018 results; he is now at Children's Health in Dallas and UT Southwestern (his Children's Health page).
• Scott Bradley, MD (MUSC) — MUSC's College of Medicine lists him as Professor Emeritus, while MUSC's patient directory still shows a profile with a "New patient visits" label. Because the two pages disagree, we did not list him.
• Vanderbilt, Nashville — similar size to Duke (1,684 patients). Its overall range crosses 1 (as expected), but in STAT categories 2 and 5 the whole range is above 1. Neither category includes VSD patch repair. We did not check its surgeons' pages.
• Levine Children's (Charlotte), UF Health Shands (Gainesville), Le Bonheur (Memphis) — in STS reporting, but smaller or farther; not checked at surgeon level. Shands' published period is older (2021–2024).

3. Next steps

How to reach each specialist (from each institution's own page):

• Children's Healthcare of Atlanta: cardiothoracic surgery appointments 404-785-6330 · cardiology 404-256-2593. (Children's site blocked our checks; these numbers come from its pages as saved between May and September 2026. Confirm them when you call.)
• Duke Children's: Pediatric & Congenital Heart Center 855-855-6484 · surgeons' appointment line 919-681-2343. Ask for a video visit and a records review before you travel.
• MUSC Children's Health: cardiothoracic surgery 843-876-0444 · surgeons' office 843-792-3780.
• Children's of Alabama: Dr. Dabal 205-934-2419.

Your first call — three questions (no page we checked answers all three):
1. Is the surgeon seeing new patients with a VSD that needs repair? Dr. Turek's and Dr. Kavarana's pages suggest yes; the others do not say.
2. What is the wait for a first visit, and then for the operation? No page gives a wait time.
3. Is a referral needed? Duke's page says your child's cardiologist will most likely send the referral. The other programs do not say.

Your 3 steps this week:

1. Ask the cardiologist's office for copies of M.'s latest echocardiogram report and images, the note that says surgery is advised, her latest EKG, and any MRI or catheter report. Ask them to write down the size of the hole, whether either heart chamber is enlarged, and whether any valve is leaking. Those lines are what a surgical team reviews first.
2. Call Children's Healthcare of Atlanta and one program out of state. Ask the three questions in the box, and ask whether the surgeon will review the echo before you travel.
3. Call your insurer, using the number on the back of the card, and HR:
4. Is each hospital and the surgeon's group in network? Anesthesia and the heart-lung machine team often bill separately.
5. How does the plan cover a planned operation in another state? (Some plans use a national partner network; ask for its name.)
6. Is prior authorization needed, and who files it?
7. Is there a travel or lodging benefit for surgery far from home?
8. What is our out-of-pocket maximum, and when does the plan year reset? This matters if the date might fall near the reset.

Two federal rules worth knowing. The No Surprises Act protects you from unexpected out-of-network bills for "non-emergency care related to a visit to an in-network hospital" (CMS). It does not make an out-of-network hospital you choose cost the in-network price. Job-based plans cannot set a lifetime dollar limit on essential health benefits (HealthCare.gov).

4. Stories from families who have been there

We found no public account of a 4-year-old's VSD repair at these three programs. The closest real accounts:

1. Family blog, Atlanta (the Jacobs family, Children's at Egleston, February 2011) — Riley, 5 months old and born with a genetic condition (22q11 deletion), had her VSD closed on February 25, 2011. Her mother posted her list of questions for the team before surgery. On the day she wrote that it took about 2 hours of a planned 4 and that the team was "almost 100% sure that she won't need a pacemaker"; the breathing tube came out that evening. On day 4 Riley had fluid in her lungs, a fever, and "a little leakage through or near the patch," which the team had said might happen. Tone: frightened, then relieved. (Her surgeon has since left Children's; see Leads.) January 2011 posts · February 2011 posts
2. Local TV news, FOX 5 Atlanta (August 12, 2015) — Savannah's large VSD was repaired at 4 months at Children's at Egleston in December 2014. Her father had a hole between the upper chambers repaired at age four at the same hospital about thirty years earlier. Eight months later she was "walking, eating and acting like a typical toddler." Article
3. Hospital story, Duke (promotional, 2024) — Giselle, 8, from Winston-Salem, had a large hole between the upper chambers. After a video visit with Dr. Overbey, her parents chose the smaller lower-breastbone incision over robotic or full open surgery. She went home after two nights and started fourth grade weeks later. Duke story

What these stories add: a small leak around the patch can show up early; heart rhythm is checked right after surgery, which is why families ask about pacemakers; incision options differ by program; and a first meeting can happen by video.

5. Ready-to-send messages

Email or patient-portal message to the surgeon's office (copy, fill the brackets, send):

Subject: New patient request — 4-year-old with VSD needing repair — records review
Hello, I am writing about my daughter, [name], age 4. Her cardiologist in Atlanta has told us she has a perimembranous ventricular septal defect that needs surgical repair.
Dr. [name]'s experience with congenital heart surgery is why we are contacting your program. Could you tell us:
(1) whether Dr. [name] is seeing new patients for VSD repair, (2) the current wait for a first visit and for surgery,
(3) whether a referral is needed, and (4) how to send her echo images and reports for review, and whether a video visit is possible before we travel?
We would also like to know how many VSD repairs the surgeon does each year in children her age.
Our insurance is [plan name], an employer PPO. Thank you, [name, phone]

Phone script (what to say in the first 30 seconds): "Hi, I'm calling to request a new patient appointment with Dr. [name] for my 4-year-old daughter. Her cardiologist says she has a VSD that needs surgical repair. Is Dr. [name] seeing new patients for this? What's the wait? Do you need a referral, and how do I send her echo images before a visit? Can the first visit be a video visit? We have a [plan name] PPO; is the surgeon's group in network?" Write down: the person's name, the date, the answer, the next step.

6. One-page summary to bring to the appointment

Print this page and fill it in before each visit.

• Condition: Ventricular septal defect (VSD), type from the echo report: perimembranous / other ______
• Size of the hole (from the report): ______ · Enlarged chamber? left / right / none
• Valve leak noted? aortic / tricuspid / none · Lung pressure (if listed): ______
• Symptoms: tires easily / fast breathing / slow weight gain / frequent chest infections / none
• Weight and height: ______
• Current medications and doses: ______________________________
• Allergies, other health conditions, genetic test results: ______________________________
• Past surgeries or anesthesia, and any problems: ______________________________
• My 3 most important questions: 1. ______ 2. ______ 3. ______
• What we want from this visit: (example: "Know who will operate, which incision, and the date.")
• Insurance: employer PPO, plan name ______, member ID ______

7. Questions to ask the specialist

1. How many VSD repairs do you personally do each year in children over age 1? And your team?
2. What results do you see for children like her: how often is a small hole left around the patch, and how often does it need another procedure?
3. How often do children need a pacemaker after this repair at your center? How is her heart rhythm watched after surgery?
4. Which incision would you use for her (full breastbone opening or a smaller lower cut), and why?
5. Who will do the key parts of the operation? Will a surgeon in training (fellow) take part?
6. Is any valve near the hole affected, and would anything else be repaired at the same operation?
7. How long is the wait for surgery, how many days in the hospital, and when can she go back to preschool and play?
8. Can follow-up visits and echoes be done in Atlanta with her own cardiologist?
9. Who will bill us (hospital, surgeon group, anesthesia, heart-lung machine team), and are all of them in our PPO's network?
10. What warning signs should make us call you or go to the ER, before or after surgery?

8. Your support after this report

• 14 days of email questions about this report: reply to the delivery email.
• Day-30 check-in: we email you. If you could not get an appointment with any listed specialist, we research new options at no charge.
• Not helpful? Tell us within 7 days and we redo the research once at no charge; if it still doesn't help, we refund you in full.

This report is general information to help you find and talk to specialists. It is not medical advice, does not identify or confirm any condition, and does not recommend a treatment. Treatment decisions belong to you and your doctors. No doctor or hospital pays to be included in this report.