<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .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 36.9C 98.4F, pulse rate is 158min, respiratory rate is 30min, and blood pressure is 9462 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,  <response>: Based on the clinical findings described in the question stem, this infant has a large ventricular septal defect VSD causing significant left-to-right shunting and heart failure symptoms such as poor weight gain, feeding difficulties, and dyspnea requiring medical management. Physical exam reveals findings consistent with a large VSD including a holosystolic murmur, hepatomegaly, and elevated Qp:Qs ratio on hemodynamic studies. Choice A is incorrect because spontaneous closure of a large VSD causing significant symptoms is unlikely. Choice B may help manage heart failure symptoms temporarily but does not address the underlying large VSD. Choice D transcatheter occlusion may be an option for some smaller muscular VSDs but is less likely to be successful for a large membranous VSD. Choice E hybrid approach is not typically indicated as first-line for an uncomplicated large VSD. C: Surgical closure of the defect 