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Suggest treatment for complex congenital heart disease in an infant

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Posted on Tue, 8 Dec 2015
Question: Gd evng sir, its an urgent case of my male child ( 18 days kid) reporting COMPLEX CONGENITAL HEART DISEASE, AV canal deffect, complete AVSD ,pulmonary artesia have been reffered to ravindranath hospital XXXXXXX under dr. Viswajeet bandopadyay . Where it is being said that heart situation of kid is very complex and intracardiac surgery is impossible now. PDA Is still open for the kid. prostaglandin PGE1 Is being given to keep PDA open. Sir , kindly tell me what is the chances And up to what period thePDA will remain open without prostaglandine PGE1.
Kindly give suitable suggestion to me please.what should be our future action. BT Shunt operation is possible at this time or not. ?? I m sending ECHO TEST REPORT for ur reference.
doctor
Answered by Dr. Pradeep Kumar Jain (24 minutes later)
Brief Answer:
Kindly attach the report

Detailed Answer:
Hello


I have gone through the details and do understand your concern well.
I am sorry but here I could not find the attached echo report.
Conplete AV canal defect can be corrected by surgery.But the problem here is associated pulmonary atresia.
Now the condition in your child is PDA dependent pulmonary circulation.
PDA in neonate is usually gets closed by 4-5days but in such cases where there is PDA dependent pulmonary circulation PDA may remain opened for longer duration.But again it depends on size of the PDA.Larger PDA may not close at all.
Also for surgey the anatomy of right ventricle,coronary artery and size of pulmonary artery should be favourable.
Ravindranath tagore institute is a very good heart institute and Dr Bishwajeet bandopadhyay is also a very good pediatric cardiologist.
I hereby request you to attach the echo report so that I better able to help you out.

Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Pradeep Kumar Jain (32 minutes later)
Sir, yesterday CT angiography has also been done by dr. Bandopadyay . Today report came but dr. Told that surgery is not possible. Pda size is 4.9 mm. Other report i have attached now. Kindly suggest please. What is the chance of survival of this kid up to 4,5 mnths so that surgery can be done in future. Kindly explain me clear future course of action which should be followed by us. Report is not uploaded.
doctor
Answered by Dr. Pradeep Kumar Jain (55 minutes later)
Brief Answer:
The prognosis is very poor

Detailed Answer:
I have seen the reports and I am very sorry to say that prognosis of this congenital cardiac abnormality is very poor.
This is not simple AV canal defect with pulmonary atresia as mentioned in the report done on 12/11/15.The CT angiography report is showing that there is associated infracardiac TAPVC and that too of obstructive type.
The associated obstructive infracardiac TAPVC itself has a very poor prognosis and as there is AVSD with pulmonary stenosis it makes the prognosis more worsened.
For survival patency PDA with help of prostaglandin infusion is must).Prostaglandin can not be given for longer duration and that's why urgent BT shunt is needed.But in this condition BT shunt only will not help.
Infracardiac TAPVC is worst type of congenital heart disease in terms of prognosis particularly if it is obstructive type in your case.This is a kind of inoperable congenital heart disease.
So here I agree with the advice of Dr Bandopadhyay and suggest you not to go for surgery.

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Pradeep Kumar Jain (1 hour later)
Sir, PDA size is 4.9 mm . Is it capable to stretch the life of child for few mnths inspite of all other parallel complication so that some surgery can be done in future ??
2) can Infracardiac TAPVC surgery be done if child able to survive for few mnths with some weight gain ??
3) doctor advised to take the baby at home so obviously PGE1 is not available for baby what should be our POINTS of OBSERVATION for the baby which we should watch carefully??
4) What symptom will be shown in baby before any serious compliction will occure ? And what should be our immidiate course of action ? Any precaution for the baby to be taken ?
5 ) KINDLY GIVE SUITABLE REPLY for all above.
I know survival for the baby is of rare chance still suggest some DOs And DONTs please ??
Thx lot ??
doctor
Answered by Dr. Pradeep Kumar Jain (18 minutes later)
Brief Answer:
Details below

Detailed Answer:
Thanks for writing back

PDA will be helpful to maintain the pulmonary circulation only(blood flow to the lungs).It's Infracardiac TAPVC not the decreased pulmonary circulation which is more worrisome.
Obstructive infracardiac TAPVC is an emergency condition and needs to be operated at earliest.In your case associated AVSD complicates the condition.
So presence of PDA itself would not be of much helpful in prolonging the life.
In infracardiac TAPVC baby gets cyanosed(bluish discoloration of skin).
Watch for worsening of cyanosis,sudden arrest of respiration,respiratory difficulty,excess irritability,persistent crying or cool peripheries and if you notice any consult your nearest pediatrician immediately.Medication usually does not help much in case of life threatening condition but emergency management can be done with help of respiratory support/oxygen depending on the condition.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Pradeep Kumar Jain

Pediatrician, Cardiology

Practicing since :2006

Answered : 2056 Questions

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Suggest treatment for complex congenital heart disease in an infant

Brief Answer: Kindly attach the report Detailed Answer: Hello I have gone through the details and do understand your concern well. I am sorry but here I could not find the attached echo report. Conplete AV canal defect can be corrected by surgery.But the problem here is associated pulmonary atresia. Now the condition in your child is PDA dependent pulmonary circulation. PDA in neonate is usually gets closed by 4-5days but in such cases where there is PDA dependent pulmonary circulation PDA may remain opened for longer duration.But again it depends on size of the PDA.Larger PDA may not close at all. Also for surgey the anatomy of right ventricle,coronary artery and size of pulmonary artery should be favourable. Ravindranath tagore institute is a very good heart institute and Dr Bishwajeet bandopadhyay is also a very good pediatric cardiologist. I hereby request you to attach the echo report so that I better able to help you out. Thanks and regards