Second Opinions on ASD

My teenage son was recently seen by a cardiologist he was diagnosed with two small atrial septal defects after an echocardiogram.  We decided to seek a second opinion.

The second doctor performed another examination and an echocardiogram.  He was unable to detect any defects, and further mentioned that he didn't find anything remarkable in my son's physical presentation.

He then scheduled a TEE to better determine if indeed my son had an ASD.  They also performed a "bubble test" and determined that there was no communication between the two sides of the heart, and that there was no ASD.  He did however, mention that the septal wall was thinner than normal, and that should be monitored.  

My question is, now that we have seen two cardiologists both of whom we respect, whom do we believe?  Could this thinning septum have been what the first doctor believed to be an ASD?  Is the TEE that much more sensitive than a traditional echocardiogram?

Thank You,

Tim Powers

[CCF-M.D.-RCJ]

Tim Powers,

Sorry to read of your family's recent troubles.  Transthoracic echocardiography (tte) is the intial test of choice when looking for an ASD.  A tte is usually quite sensitive for detecting ostium primum or ostium secundum ASDs, but much less sensitive for the detection of a third type of ASD (sinus venosus ASD).

In difficult cases, such as in patients with a thin or mobile septum, a TEE is a more definitive test and should be thought of as the more accurate test for detection of ASD.

It should be remembered, however, that the accuracy of any of these tests critically depends on the skill of the operator performing and interpreting the test.  Furthermore, the accuracy of any test depends on the pre-test probability that a person has a specific disease.  In lay terms: why did your son see a cardiologist in the first place?  Were the cardiologists really suspicious that your son had an ASD or did they conduct the tte to "cover all the bases"?

The only way that I think your going to feel that the issue has been laid to rest is if you see a third cardiologist and let him personally review the actual films.  An alternative would be to contact the echo referral center at the Cleveland Clinic and let one of our echo specialists review the films.  The contact person is Fran Yanak at toll free 1-866-289-6911.  The general number at the Cleveland Clinic is 1-800-CCF-CARE if you live in the area and wish to see us here.

Hope that helps.