There are obviously many factors which will make a cardiologist
recommend and the surgeon decide to close the VSD surgically.  The
factors that they do not want to decide upon are poor weight gain or
congestive heart failure, since if the VSD is causing these, then the
operation is associated with greater risk.  Please understand that
what this means that a baby who is growing slowly because of
inadequate intake of calories does *not* fall into the same league as
a baby whose weight gain is slow because of the VSD (usually
associated with congestive heart failure).

If the VSD is still fairly large at 1 year, it is unlikely to close on
its own, though it still might.

Pediasure is unlikely to be taken by a one year old.  It does not
taste very nice.  It is just as easy to add oil or butter to the
baby's solid food, so that he gets a lot more calories that way.

Jack Newman, MD, FRCPC