<s>[INST] l am a 51yrs old sudanese schoolteacher 5 ft six inches of height 55kgs weight diagnoesd in Kuwait chest hospital in 1989 as a vsd sevesre pulmonary hypertension and not indicated for surgery i got married in 1998 with three duaghters 12_10_8 .l know my case very well and l ve heart disease history a younger brother had died of heart failure and four youger brothers died in their baby hood they were likely have the same disease .my parents are close relatives and they still alive with reasnable health according to thier age.l was hospitalised in1986and 2006 for haemoptasis. I have been suffering recently from feet swelling and neck and shoulders stiffness specially when l carry any something over ten kilos of weight accompanied with a high fever and l feel the area very hot a two days ago echo showed that the case is normal a chest xray showed in the day that heart is not enlarged but not in good health other lab results 2days ago esr 8 mm/h.hb119.5percent uricacid 6.0 my question is what are the exepected symptoms and comlications in this case and how to deal with them.email: YYYY@YYYY cell 0000 [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. You are having pulmonary hypertension (PH) due to valvular heart disease (VSD). Surgical correction is the best treatment at the time of diagnosis. I am still surprised why surgery was not advised in 1986. Anyways, future complications for PH with VSD are 1. Right sided heart failure 2. Congestive heart failure 3. Arrhythmia 4. Uncontrolled hemoptysis. So to prevent all these, you should definitely get done 2D echo regularly. Avoid excess salt and water in diet. Start Tadalafil or Bosentan for PH. Do chest physiotherapy and deep breathing exercises. Start low dose diuretics. Hope I have solved your query. I will be happy to help you further. Wish you good health! Thanks. </s>