Atrial Septal Defect

My son, now 4yrs, had a 2D echo done last Nov. 2001.  At the time we got the results he was in the hospital for respritory problems.  He is a former preemie, born @ 23wks & did have a PDA ligation (w/ left vocal cord paralisis)and still has quite a bit of BPD.  Anyway we were told at the time by our family physician that he had a small ASD which possed no problem but it was recommended that we follow-up in 8-12mths.  Given his problems I finally found a Pediatrician to handle his care.  I went to the hospital and retrieved a copy of the echo & report which stated basically that there was some mild-moderate regurgitation (PV .6-.9m/sec), Mild left atrial enlargement & small asd/PFO with L-R shunting.  Although there were no measurements on the actual size of the asd/pfo.  We never saw a cardiologist and although we are doing a follow-up echo at my request we still are not seeing a cardiologist.  So my questions are:
1.  Could his PDA have influenced the PFO/ASD
2.  Although I gather from what I have read, many people
    live with no problems, is there a possibility of him having
    complications later into his teens on.
3.  What would cause his left atrium to become enlarged vs his  
    right?
4.  How badly could this effect his already comprimised lungs?
5.  What type of follow-up would normally be recommened.

Thank you so much for any information you can provide.  Also, should I take the video for any comparison?

[CCF-M.D.-RCJ]

TrishK,

Thanks for your questions.  I am not a pediatric cardiologist, so my information comes from what I have read today only.

I am not aware of an association between the two anomalies, but this question would best be posed to a pediatric cardiologist.

There are potential complications associated with ASD, mostly depending on the size of the ASD. In large ASDs in otherwise healthy kids, surgery is often recommended to correct the ASD.

I suspect that the left atrium has been enlarged due to the BPD -- the high pulmonary pressures leading to undetected R to L shunting.

The effect of the ASD on the lungs will be difficult for anyone to determine.

I would see a pediatric cardiologist once, and let that person determine follow-up after the evaluation.

Hope that helps.

[TrishK]

I forgot to add:  two weeks ago he had something going on in his lungs, and in checking to make sure he had good airflow I noticed that his heart would race & slow down but had no real rytham.  The first beat would often split sounding like three beats and sometimes the 2nd beat would split as well sounding like he had two double beats and then it would go back to two? always speading up and slowing down. (this was at rest, laying in bed).

[debra21784]

not a cardiologist but based on your last post I would see a pediatric cardiologist and even get an opinion from a peds cardiac surgeon.I would be concerned about the enlargement taking place in his heart from the increased pressures.Sounds like you need reassurances and direction from experts and would recommend a academic medical center as opposed to a community based hospital and practice

[RTFLY]

I can only agree with what has been posted. If I may ask, where are you located? There are many good academic centers with affiliated children's hospitals that would be of great benefit if you are able to utilize such a source. Again, seek out the professional expertise of a pediatric cardiologist to get the best info possible. Take care and hope all goes well.
                  
                                             JCI, BS RRT

[TrishK]

Thank you all for your responses.  We are located in Northern Ohio but closer to Toledo, however, I grew up near Cleveland.  The frustrating part is this is the second time we are just being sent to an echo department.  The pediatrician really didn't feel that there was any indication of a serious problem, to refer us to a pediatric cardiologist. When I questioned the why the left heart would be enlarged she though maybe the echo was misread?? I also got the impression that she had no intention of repeating the echo until I asked why we were advised to do so.  Leaving my husband and I once again to feel as though we are not in the loop of the "what if's" or any particular possible complications that could occur at some point (very frustrating) since we have always been very involved in his care.

I guess at this point we have another echo scheduled for Tues. the 29th at the childrens hospital.  A friend of mine managed an echo department, and actually did Peds clinic with the Ped. Cardiologist that she told me to request read the echo.  Would it be to bold of me to ask the tech to have him call us directly to explain the results withougt compromisig our relationship with the Pediatrician?  (Since we cannot get a referal).  I am sure we would both have felt better if we could have discussed this hole thing with one to begin with.  Thank you again for your input.

[debra21784]

The peds cardiologist will probably not step in ,Iwould not be too concerned about stepping on the peditrician's toes and make my own appointment for my child with a pediactric cardiologist.Advocate for the health of  your child and peace of mind for you and your husband