question: Q:Cardiac surgery is consulted on a newborn with a large ventricular septal defect. The child has poor weight gain and feeding difficulties. He requires furosemide and captopril to avoid dyspnea. On physical examination his temperature is 36.9°C (98.4°F), pulse rate is 158/min, respiratory rate is 30/min, and blood pressure is 94/62 mm Hg. Chest auscultation reveals a holosystolic murmur along the left lower sternal border and a mid-diastolic low-pitched rumble at the apex. Abdominal examination reveals the presence of hepatomegaly. An echocardiogram confirms a diagnosis of a membranous VSD while hemodynamic studies show a Qp:Qs ratio of 2.8:1. Which of the following is the best management option?? 
  {'A': 'Continue medical treatment and provide reassurance about spontaneous closure of the defect', 'B': 'Addition of digoxin to the current medical regimen with regular follow-up until spontaneous closure occurs', 'C': 'Surgical closure of the defect', 'D': 'Transcatheter occlusion of the defect', 'E': 'Hybrid surgery using both transcatheter device and surgical repair'},