Congenital acyanotic heart disease.

Hello, My nephew ' Preet' who has Congenital acyanotic heart disease. He is currently in INDIA and I need some consultation
before he undergoes open heart bypass.

2 D ECHOCARDIOGRAPHY AND COLOUR DOPPLER STUDY
Congenital acyanotic heart disease.
Moderate ostium secondum ASD ( 7 mm) with left to right shunt.
Moderate restrictive subaortic VSD ( 3.3 mm) with left to right shunt.
Good LV systolic function at rest. (LEVEL 61 % )
No evidence of coarctation of aorta or PDA or aortic egurgitation.
No pericardial effusion / clots / vegetation
Abdominal situs solitus.
IVC is connected RA.
Pulmonary veins are connected to LA.
Intact IAS.
Moderate sizes subaortic VSD -  partially closed by the septal tricuspid
leaflet & low velocity left to right flow.
Left ventricular volume overload.
Good systolic LV function.
Normal other chambers
Grade II tricuspid regurgitation.
Trivial mitral regurgitation.
Severe pulmonary hypertension (estimated systolic PA pressure - 84 mmHg.)
Normal pericardial
No PDA /coarctation.
M MODE MEASUREMENTS: NOT TAKEN
VSD SIZE - 5 mm
Doppler measurements Peak gdt.mmHg
Mitral valve :  7/1.36
Aortic valve :  4/1
Pulmonary valve :  6/1.29
Desc Ao :  6/1.23
VSD Gradiant :  31 mmHg
TR : 74/4.32
Please help. Suhas Aligave 973-430-6473

[CCF-M.D.-CRC]

Dear Suhas,

How old is your nephew?  The most concerning thing about the numbers reported here is the severe pulmonary hypertension.  Oftentimes pulm0onary hypertension is irreversible if the condition has gone untreated for too long.  However, if he is still young there is a possibility that the surgery will help to reduce the pressure.  I would tend to agree that closing the atrial septal depfect (ASD) and the ventricular septal defect (VSD) are probably a good idea at this point.  There will be some risk to the surgery and the surgeon can give an estimate of the risk of mortality during surgery.

[Preet Aligave]

HI,

Preet is 10 months old.

[Preet Aligave]

Previous report when Preet was 21 days old.
VIEWS - PSLx, PSSx, APICAL 4CH, APICAL2CH
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MITRAL VALVE AORTIC VALVE
AML APPEARANCE Apperance : tricuspid
D-E      08     (15mm-26mm) Root Dimension      09 (20-37mm)
EF Slope 48  (70mm-150mm/sec) Cuspal separation    07 (15-26mm)
EPSS    05    (<10 mm) Closure line     thin and central
PML Apperance : other
Motion Paradoxical POLMONARY VALVE
Mitral valve area        cm2 Annulus
Sub valvular apparatus :  3+ Appearance
Other EF slope
Wilkins Score     06  (< 9) A wave

DIMENSION M- MODE : Other
RVID 20 (9-26mm) TRICUSPID VALVE
IVS 04 (6-11mm) Appearance
LVIDD 26 (35-57mm) Slope
LVIDS 18 (24-42mm) Other
EDV 24
ESV 10
PW   05 (6-11mm)
EF   61 (64-83 %)
FS 31 (28-44 %)
LA   11 (19-40mm)


DOPPLER STUDIES pulsed, continuous, Hight, PRF, Color Doppler
(A = adult,  C = child.  Figure in the bracket indicates normal Peak Velocities in M/Sec)
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VALCE VELOCITY M/Sec GRADIANT  mm.hg
Mean Max Mean Max

MITRAL - 0.87   A(0.8-1.3) - 3.1
          C (0.6-1.3)

A0RTIC - 0.71   A(0.8-1.3) - 2.1
          C (0.6-1.3)

TRICUSPID - 0.87   A(0.8-1.3) - 3.1
          C (0.6-1.3)

PULMONARY- 1.03  A(0.8-1.3) - 4.3
          C (0.6-1.3)