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Infant having hole in heart. Treatment other than surgery?

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Practicing since : 1981
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My boy was born on14th December. Now he is 17-days old. He weights 3.7 kgs. When how was born he was diagnosed with ahold in the heart -os ASD of 6mm. Shunt from left to right shunt 2:1. Mild TR

My email I'd is YYYY@YYYY

I will be very grateful for your valuable advise. Thank you for your time.

Posted Thu, 24 Jan 2013 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 9 hours later

Treatment of ASD secundum is simple and most cases it can be closed with umbrella device insertion under local anesthesia at suitable time if closing is indicated.
However, 17 days is rather unusual age of presentation of ASD secundum. Can you please describe why the echo was done (as examination of heart is usually not does not indicate neither EKG is suggestive)? And please write down the detailed report of echocardiography and who did echocardiography (Qualifications of echocardiographer) so that I can answer your question with honest advice it deserves. Good Luck.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Infant having hole in heart. Treatment other than surgery? 13 hours later

Thanks for your reply. To answer you more information, when my boy was born, the gynaecologist said baby passed motion&urine in the mother's womb. He was born on 14th December at 8:00pm (evening). Then I took him to the Pediatrician for check-up. As he tested him with steth, he suspected a hole in the heart. He suggested an echo scan for the boy besides the treatment he did for the baby for 4-days as he suffered infection from the swallowing in the mother's womb. On the next afternoon (15th December), we took the baby to the Cardiologist. The doctor did the echo. The report says:

IVS: Intact
IAS: Moderate sized os defect with LT - RT shunt 2:1. ASD size: 6.0m
Good LV/RV function
No AS/MR. Mild TR
No pericardial effusion
Intact IVS. No PDA
Normal pulmonary venous drainage
mitral valve: normal
Aortic valve: normal
Tricuspid valve : normal
Pulmonary valve: normal
Left Atrium: 0.9cm
Left ventricle: Normal size
Right Atrium 0.9cm

Right Atrium : dilated
Right ventricle: dilated
Other findings: NO MR/NO AR/TR 2+/ NO AS E/A:59. /74 CM/SEC dt:74 SEC

Oop/colour/study:PJv:101 CM/SEC. MVF: EPericardium. : normal

Sir, it is said that some holes in the heart of the infants get closed on their own. Kindly advise us in this. If it is so how long they take to get closed ? If treatment is needed to the baby, at what age a surgery or of that kind is necessary ? In the man time Is there any immediate dangers to the baby from this condition ? The baby's daily activity is normal - he is feeding, sleeping, motion and urination is normal. However, he is feeding from the bottle- the mother's milk is not sufficient.

Kindly advise and help the baby. Thanking so much for your time and care.

Yours sincerely,

Answered by Dr. Anil Grover 7 hours later
Thanks for writing back.
The details are more informative. Pediatric echocardioography is a little more sophisticated that is why we base most of the decisions on that.

Apparently, the echocardiography is competently done. As it was done on one day old baby who has had neonatal distress (as you have written the newborn had infection due to swallowing) so it would have to be repeated before comment on ASD can be made. You are right some holes do close but those are ventricular septal defects(VSDs) and closure can occur in these VSDs until child's age of 48 months. ASDs those who persist say now (when the child is 3 weeks old) do not close like VSD. But these generally do not cause problem and we wait for child to grow to beyond one year before balloon closure is done. That is usual story. But in a given patient, like your child, an opinion can be given by a pediatric cardiologist after examining the child and doing a repeat echocardiography. Usually from ASDs there is no danger in waiting before closure is done if the child is otherwise well. But ASDs do not have murmur at birth and these per se do not cause problem in early days after birth. My personal feelings are that your child had persistent fetal circulation (as ASD is normal before birth and it can persist if child has a situation like your child did have). Therefore, no long term decision is possible on that count.
I find Delhi is the nearest place to you, please get your child seen by either of the two pediatric cardiologists(both are equally competent, world renowned in Pediatric Cardiology). There is one pediatric cardiology clinic run by All India Institute of Medical Sciences(DR S S KOTHARI) and other is in Escorts Fortis (DR XXXXXXX SRIVASTAWA). Please take an appointment with either of the two. If you have any question for me I shall be happy to answer. Good Luck.

Best Wishes

(Dr Anil Grover)
Above answer was peer-reviewed by
Follow-up: Infant having hole in heart. Treatment other than surgery? 20 hours later

Thank you so much for your much informative and advise answer. In your reply, you wrote :

" My personal feelings are that your child had persistent fetal circulation (as ASD is normal before birth and it can persist if child has a situation like your child did have). Therefore, no long term decision is possible on that count."

Kindly explain the above. I understood ASDs dont close on their own as it happens with VSDs. And also you said ASDs generally dont cause danger in waiting for their close say one year after the birth. Please explain : Therefore, no long term decision is possible on that count. Does this mean there is an emergency and we need to take the baby to the Paediatric Cardiologist without any delay ?

I will be grateful for your advise. Looking forward to hear from you.

Thanking you,

Answered by Dr. Anil Grover 4 hours later
Thanks for writing back with a pertinent question. Let me explain certain connections are present in heart before birth as child draws blood for its survival from mother therefore these have to close for normal heart after birth. ASD can persist after birth in birth asphyxia and neonatal infection (which your child had). So, ASD present on day 1 specific to your child can not be basis of a decision.

Whereas ASD is present at 3 weeks a treatment should be planned. There is no need to panic as ASD in first year of life is rather benign condition. And above all your child does not have any cardiac symptoms. Yes, as its presence has been documented (with a rider as above) therefore, a pediatric cardiologist ought to see - not on emergency basis but with the idea of planning treatment if it is there. So, echocardiography will have to be repeated. There is no emergency as echocardiography has shown only ASD as abnormality. The advice would be different if there was VSD (which I had written has tendency to close). Thus my comment was child had neonatal asphyxia and day 2 echo had shown ASD, we want to see what is the situation now. One can not take decision on basis of that echo hence was my comment. An abnormality was seen and we want to see what is the situation now and take a decision that constitutes a necessity not an emergency. If I have still not made myself clear you can write to me on YYYY@YYYY , I will be happy to answer further. Good Luck.
Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
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