Pediatric Cardiology Archive Questions

Below are Dr. Rosenthal’s answers to Pediatric Cardiology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



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Q : 1 09/22/2009

My 10-year-old son has a bicuspid aortic valve and was recently diagnosed with asymmetric septal hypertrophy. He began Xolair injections for uncontrolled asthma and it is currently under FDA review for its cardio effects. Do you have any information? I don't want to continue Xolair if it is damaging his heart. I understand your concern - seems like there are a few health issues for your son, and it is very reasonable to ask the question of whether they are interacting in some way. In children with stenotic or narrowed bicuspid aortic valves, we will sometimes see ventricular hypertrophy develop in response to the blockage. This is usually "concentric hypertrophy", and we would say it is secondary to the obstruction. If the blcokage is relieved, the hypertrophy usually recedes. The term "asymmetric septal hypertrophy" implies a primary abnormality with the heart muscle, one in which the muscle becomes over-developed, even in the absence of obstruction. In either case, the thickened heart muscle in the left ventricle (the main pumping chamber in the heart) may make the ventricle stiff and harder to fill under low pressure. If that is the case, the pressure can become higher than normal in the veins draining the lungs, and in the arteries bringing blood to the lungs. Higher pressure in these blood vessels may cause respiratory symptoms, including wheezing, so this is important to consider when evaluating a child with hypertrophy and wheezing. Regarding Xolair, I have no speciic information that would allow me to speak to the question of cardiovascular safety in children at this time. I know the FDA is considering the cardiovascular safety of this medication in all patients. A link that might help you is: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm172399.htm Also, the FDA's Office of Pediatric Therapeutics may be able to help you acquire additional information on the topic. But to summarize, I would encourage you to work closely with a doctor or team of doctors who you trust - your son's health issues sound complicated, and you really need an engaged and communicative team. Please feel free to contact me if I can be of further assistance. Best of luck, Geoffrey Rosenthal, MD Director, Pediatric Heart Program 410-328-0048

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