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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.



Now displaying records 1 to 15 of 18.

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Q : 1

07/20/2013
I had a severely leaking aortic valve that I discovered at the age of 60. My surgeon surmised it may have been congenital. My daughter is now expecting a baby and she wonders if it would be prudent to have a fetal heart scan. Thank you for any advice!

Great question. Some causes of aortic valve leakage run in families. The best way to know whether the fetus is at risk is to explore with the obstetrician, who can take an extensive family history and consider the utility of a prenatal test.


Q : 2

05/19/2012
My granddaughter was born premature at seven months and weighed 4 lbs. The doctors said she has pulmonary sternosis and tricuspid regurgitation, an infection and her intestine burst and she is using a bag. What are her chances for a normal life?

Assuming that her care team can relieve the obstruction across her pulmonary valve, and that her gut heals, and that nothing else is going on, she could come through all this fine.


Q : 3

05/01/2012
My daughter is 8 years old and has a cholesterol level of 288 and LDL of 209 (we tested her when she was 5 and re-tested her just recently). Her HDL is 67 and Triglyderide is 60. Her doctor wants to start Zetia (10mg) now and potentially start statins (Zocor or Crestor) later on. He doesn't want to start with a statin drug due to the possible effects on her development. Does this sound like an appropriate treatment plan?

I agree that your daughter's cholesterol is elevated and requires treatment. The most recent guidelines from the American Academy of Pediatrics state that statins can be started as early as 8 years old. The initial studies have evaluated the the effects of Lipitor and Zocor on small groups of children with high cholesterol and there has so far been no evidence of growth failure in these children. Zetia would not be my first line drug.


Q : 4

12/06/2011
My daughter has PDA. Presently she is 10 years old and not having any problems. Is any treatment necessary to close the PDA?

If the PDA can be heard when the doctor listens to the chest, the current recommendation is to close the PDA to reduce the lifetime risk of bacterial endocarditis. We usually close such a defect in the cardiac catheterization laboratory using a small implantable device to plug the connection. If a PDA is present but is too small to hear when listening to the chest, we usually do not recommend closing it.


Q : 5

09/08/2011
My cousin, 37 years old, is 19 weeks pregnant. Her most recent report says- "duration with intracardiac echogenic focus in the fetal left ventricle." What does that mean?

An isolated echogenic focus in the left ventricle of a 19 week fetus usually means nothing. We believe these are caused by a small spot of calcification. We do recommend an echocardiogram after the baby is born though to be sure nothing else is seen. In the past, some thought this finding might be associated with Down Syndrome. But more recent observations do not strongly support this association. Your cousin should discuss the finding with her doctor, who will consider whether it is important in the context of all the available information.


Q : 6

08/25/2011
My daughter was diagnosed with a VSD (3mm or 0.3 cm). She is currently 8 years old. She does not have any noticeable negative systems, but you can hear the shunting noise and we are able to feel it with our hands. It might be an unreasonable question, but should this defect be corrected with surgery? Are there any long term effects if this is not corrected?

It is important to follow up periodically with a pediatric cardiologist. Usually there are no measurable effects of very small VSD, but there can be for some patients. Depending upon the position of the VSD, some can cause the aortic valve to leak. Others can be associated with the development of obstruction below the aortic valve or in the right ventricle. And for some people with VSD, infection in the blood stream can result in infection in the heart. If there is concern about any of these associated problems, then even small VSD should be closed surgically. Otherwise, if all is going well, many do not require surgical closure.


Q : 7

06/06/2011
My granddaughter who is 4 years old just got diagnosed with dextrocardia. Why would it take the doctors this long to diagnose her? Isn't the heart the first thing checked at a check up?

It can be missed in small babies because the heart sounds can be transmitted across the chest. A chest x-ray for a different indication is often the way isolated dextrocardia is diagnosed.


Q : 8

05/26/2011
My daughter is 13 months old and was diagnosed with PDA. What is the right age to close the PDA and is there any chance that the PDA will reopen after the procedure?

If a doctor can hear the murmur caused by a PDA, the current recommendations are that it be closed (usually in the cardiac catheterization lab). The timing depends upon how the child is doing clinically, how the heart is handling the extra blood that it must pump, whether the person has had an infection in the walls of the blood vessel or heart, and other factors. Your doctor should consider all of these things in formulating a recommendation.


Q : 9

04/21/2011
An acquaintance has told me that her 1-year-old daughter requires surgery to fix a heart murmur, but that because she is young, they can go in via her back. Is this possible?

There are procedures performed in the cardiac catheterization suite that gain access to the inside of the heart through the large veins and arteries in our bodies. The neck is one place these blood vessels can be accessed. Some of these types of procedures can treat some of the causes of abnormal murmurs. One example is closing a hole in the wall between the two collecting chambers of the heart (an atrial septal defect). There are many others. So yes, procedures which gain access through the neck are used to treat some of the causes of abnormal heart murmurs.


Q : 10

02/22/2011
My 20-month-old son has has a bicuspid aortic valve with no stenosis. When we saw the cardiologist last week, he said the valves are fused together (since birth), but they are well functioning. He also said that aortic root is a little dilated, do all people with a bicuspid valve have a dilated aortic root? How fast does the root or the arch become dilated? The doctor said my son should live a normal life, but I am concerned.

The clinical course for bicuspid aortic valve is highly variable, but in general, bicuspid aortic valves are not as durable as ones that formed normally. Additionally, the aorta does become dilated for some people with bicuspid aortic valve. Depending upon how dilated, this may or may not evolve into an additional problem. For children like your son, I recommend follow up on a yearly basis, so that changes in aortic diameter and/or valve function can be identified early.


Q : 11

01/19/2011
When my son was born in 2008, he cried a lot especially during feedings (he wouldn't eat and would sweat). We thought it was acid reflux but now we're wondering if it's something more. He is still underweight, pale, breathes heavy and has a hard time sleeping. We have had a rough few years with him and my gut it saying that it's not reflux problems and thinking that it's ALCAPA? Should I have him seen by a pediatric cardiologist?

Poor feeding, shortness of breath, poor weight gain, pallor, and sweating (especially with feeds) are all signs that may be related to heart disease. I recommend that your son be seen by a pediatrician or family practice physician, with the specific question of whether a referral to pediatric cardiology, or for diagnostic testing for heart disease, is indicated. If it is easier to see a pediatric cardiologist than a primary care doctor, then you could just start with the pediatric cardiologist.


Q : 12

10/19/2010
My 14-year-old son has been diagnosed with aortic insufficiency and has had a slight heart murmur for many years. He is obese and we were told that there were no physical activity limitations. Isn't a heart condition a reason to limit certain physical activities?

We will often limit isometric exercises (weight lifting of heavy weights) when patients have aortic valve insufficiency. I would encourage you to work with your physician to determine what restrictions, if any, are indicated.


Q : 13

07/10/2010
My 15-year-old son has pectus excavatum. He has just had an echocardiogram and pulmonary function tests (PFT's). I am thinking my son will need a specialty hospital for evaluation. He is not limited by shortness of breath, but doesn't really run a lot etc. Cleveland Clinic says they offer the Nuss procedure on their Web site. Does University of Maryland have the expertise for this abnormality?

Prior to coming to the University of Maryland School of Medicine and the University of Maryland Hospital for Children, I worked as a pediatric cardiologist at the Cleveland Clinic. I know surgeons in both places, and have taken care of many teenagers with pectus excavatum over the years. In general, the first question to be answered is whether there are any associated issues--things like Marfan Syndrome--that might have greater impact than the pectus itself. If there are no associated conditions, the next question is whether the pectus is impacting the function of the heart and/or lungs. For a small proportion of people with pectus excavatum, chest wall mechanics can be altered in such a way that respiratory function is compromised, especially with exercise. PFT's help us sort this out. For some people with pectus, the bone can cause compression of the cardiovascular structures below and compromise filling or emptying of the right ventricle. The echocardiogram helps us here. If there is no associated condition, and if the heart and lungs work well, then the only other reason to intervene pertains to the cosmetic impact of the chest wall deformity. This impact can be great in some people, and correcting the shape of the breast bone can have dramatic effects on the way people perceive themselves. So there is much to consider. We have very talented pediatric surgeons at the University of Maryland Hospital for Children. Dr. Roger Voigt is the Chief of Pediatric Surgery here. He would be the best reference regarding the Nuss procedure.


Q : 14

05/10/2010
Who performs the procedure for device closure of ASD, a surgeon or a pediatric cardiologist? Are there any risks?

Pediatric Cardiologists with expertise in interventional cardiology usually place ASD occlusion devices. There are always risks involved in any procedure that involves the heart, but in capable and experienced hands, the risks are usually very low.


Q : 15

04/29/2010
My 7-year-old son was recently diagnosed with a bicuspid aortic valve with no stenosis and trivial/trace regurgitation. What concerns me the most right now is his ascending aorta was considered mildly dilated. In the top half of the echo where the measurements are, his ascending aorta was 2.6 cm (normal upper range of 2.2cm) with a z-score of 3.6. In the report summary findings, the ascending aorta was noted at 27 mm (just about the same), but, his z-score was 2.17. This seems like a big difference to me. All other measurements are normal. The doctor said there weren't any restrictions and not to worry and come back in a year. But, why the difference in z-scores on same report for the aorta? Which one is correct?

Aortic dilation is not uncommon among people with bicuspid aortic valve. One reason for the discrepancy in Z-scores may have to do with where the measurements were taken. There are 4 standard points at which the aorta can be measured using echo between its origin and the first branch point. Each point of measurement has its own reference range, so each would have its own standard for calculating Z-scores. Regarding activity restrictions, at this age and aortic size, the general approach is often to avoid conditions that might reduce the durability of the aortic valve or put undue wall stress on the dilated (weakened) ascending aorta. Avoiding weight lifting in teenage boys is one such strategy. In some cases of progressive aortic dilation (increasing Z-scores) we consider using medications intended to relieve some of the stresses on the aortic wall.


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