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Heart Disease (Expert Forum)
Question about pulmonary valves and arteries?
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Question about pulmonary valves and arteries?
by heartmom95, Oct 02, 2005 12:00AM
I have a 10yo daughter who has a complex CHD(absent pulmonary valve syndrome,TOF, and non-confluent PA's). She is doing well. I have 2 questions though~First, because her PA's were not conflunet at birth(her left PA was conected to her ductus and hypoplastic)her RPA has been reduced in size several times,her left PA is a gortex graft. She had an MRI in April that again showed RPA is increasing in size-2.3cm but her left PA is only 8mm. Her cardiologist feels that this is "normal" for her and that since her blood flow(via MRI) shows 70/30 relative blood flow that she is fine. My concern is long term. How is this going to effect her as an adult??? We already deal with moderate-persstant asthma(which everyone assures me the two are not effecting each other?).
Secondly, Can you explain this statment that was in her MRI FLOW report~"the right PA was interrogated,there was a forward flow of 40ml. which was 68% of total forward flow though the right ventricle. Reversal flow was 12ml indicating that there was some reversal flow out of the right PA, so the regurgitant fraction of the right pulmoanry artery was 30% which was higher than the total through the RVOT."
I know you don't specialize in CHD but just hoping you can shed some light on this for me. Thanks, Cheryl
Secondly, Can you explain this statment that was in her MRI FLOW report~"the right PA was interrogated,there was a forward flow of 40ml. which was 68% of total forward flow though the right ventricle. Reversal flow was 12ml indicating that there was some reversal flow out of the right PA, so the regurgitant fraction of the right pulmoanry artery was 30% which was higher than the total through the RVOT."
I know you don't specialize in CHD but just hoping you can shed some light on this for me. Thanks, Cheryl
Doctor's Answer
by CCF-M.D.-MJM, Oct 02, 2005 12:00AM
Hi Cheryl,
I am glad to hear your daughter is doing well. As a parent, I can only imagine how hard this is at times and how you are hanging in there. Let me also so that congenital heart disease is one of the most challanging topics to learn and understand. Make sure you are seeing a doctor you trust and make sure that he is a congenital specialist with a high congenital volume of patients. Experience is very important in this field. The American College of Cardiology recently notified its members of the importance that congenital heart disease patients receive frequent life time follow-up.
1. How is this going to effect her as an adult???
It is difficult to say. Some people do very well after a single surgery, but others require multiple surgeries as they grow. We are in a much better position today compared to 30 years ago, but we are still learning.
2. Can you explain this statment that was in her MRI FLOW report~"the right PA was interrogated,there was a forward flow of 40ml. which was 68% of total forward flow though the right ventricle. Reversal flow was 12ml indicating that there was some reversal flow out of the right PA, so the regurgitant fraction of the right pulmoanry artery was 30% which was higher than the total through the RVOT."
I will do my best.
Blood enters the right ventricle and is pumped in the main pulmonary artery. The main pulmonary artery consists of a left and right pulmonary artery. In your daughters case it sounds like she doesn't have a main pulmonary artery. Her right and left pulmonary artery originate from seperate positions in the right ventricle.
The right pulmonary artery receives 68% of the total forward flow out of her right ventricle. I assume the remaining 32% goes into the left pulmonary artery.
The forward flow in the right PA is 40 ml. Of that forward flow. 12 ml leaks back into the right ventricle. They are saying that 12 divided by 40 is roughly 30% ... in other words, of the 100% of blood that initially moves forward, 30% enters the RV again leaving the remaining 70% to move into the lungs.
Because I do not understand the exact anatomy, I cannot tell you what they mean by "which was higher than the total through the RVOT."
I hope this helps a little and wish you the best.
I am glad to hear your daughter is doing well. As a parent, I can only imagine how hard this is at times and how you are hanging in there. Let me also so that congenital heart disease is one of the most challanging topics to learn and understand. Make sure you are seeing a doctor you trust and make sure that he is a congenital specialist with a high congenital volume of patients. Experience is very important in this field. The American College of Cardiology recently notified its members of the importance that congenital heart disease patients receive frequent life time follow-up.
1. How is this going to effect her as an adult???
It is difficult to say. Some people do very well after a single surgery, but others require multiple surgeries as they grow. We are in a much better position today compared to 30 years ago, but we are still learning.
2. Can you explain this statment that was in her MRI FLOW report~"the right PA was interrogated,there was a forward flow of 40ml. which was 68% of total forward flow though the right ventricle. Reversal flow was 12ml indicating that there was some reversal flow out of the right PA, so the regurgitant fraction of the right pulmoanry artery was 30% which was higher than the total through the RVOT."
I will do my best.
Blood enters the right ventricle and is pumped in the main pulmonary artery. The main pulmonary artery consists of a left and right pulmonary artery. In your daughters case it sounds like she doesn't have a main pulmonary artery. Her right and left pulmonary artery originate from seperate positions in the right ventricle.
The right pulmonary artery receives 68% of the total forward flow out of her right ventricle. I assume the remaining 32% goes into the left pulmonary artery.
The forward flow in the right PA is 40 ml. Of that forward flow. 12 ml leaks back into the right ventricle. They are saying that 12 divided by 40 is roughly 30% ... in other words, of the 100% of blood that initially moves forward, 30% enters the RV again leaving the remaining 70% to move into the lungs.
Because I do not understand the exact anatomy, I cannot tell you what they mean by "which was higher than the total through the RVOT."
I hope this helps a little and wish you the best.
Member Comments (2)
by EchoTech, Oct 06, 2005 12:00AM
They will probably monitor the size of the right PA to see if it is still dilating. If it stabilizes, they'll most likely do nothing. If it keeps dilating, then they would do surgery. With her left PA being a gortex graft, and depending on how old it is, it is a possibility that she might need another one put in to be the proper size. I am not positive, because i've seen mostly left sided grafts that kids have either outgrown, or they have gotten blocked up over the years. keep in mind that if she had real young, like within the first couple year of her life, that the graft does not grow with the body. Surgeons will typically try to oversize it as much as possible whenthe they are younger so that there will be room to "grow" into the graft. I hope this helped and didn't confuse you more.
