Pediatric Heart Expert Forum
ASD II: indication for closure or not?
About This Forum:

Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

ASD II: indication for closure or not?

Hello there,

my name is Richard and I live in Zurich, Switzerland. My wife and I have two children, a daughter of 10 and a boy with Down syndrome, Jamie, who will be turning 7 in December.

Jamie has an ASD II, size 4x5mm (0.15x0.2 inch), with slight left to right shunt, without right heart enlargement, but - at least according to our own judgement - with light symptoms as short breath and daytime sleepiness. His sleepines is so bad at times that he needs to take a nap at school or after returning from school we can keep him awake only by placing him in front of the tv which is not something we like to do. We've already ruled out iron deficiency and hypothyroidism, so we're left with the ASD as only thinkable culprit just now.

My wife and I had an appointment with Jamie's paed. cardiologist in the children's hospital yesterday afternoon.
He's been having an ultrasound done every year and each time we were told that the ASD might close on its own and if it didn't until he's six- or sevenish, there would always be the option of closing it with an Amplatzer device. But yesterday the same cardiologist told us that they never close an ASD II like this if there are no severe symptoms and no measurable heart or lung problems. On the other hand, if we'd want to go for it he'd do the operation to set our minds at ease, even though there is still a slight risk (anesthesia and perforation).
The information on the net somewhat conflicts with what he said, as I read that life expectancy is decreased with an untreated ASD. I also know of other parents whose children had similar sizes of ASD II that were eventually surgically closed. Still, I tend to listen more to an experienced specialist than unsolicited information on the internet...

I'd be very grateful to hear a second opinion, thanks in advance! This is a great service here by the way, thanks also for devoting your time and energy for answering questions like this.

Richard
Related Discussions
773637_tn?1327450515
Dear Richard,

Without evaluating Jamie, I cannot say for sure if he needs to have this defect closed specfically, or not.  I can say that a 4x5 mm defect MAY be large enough to cause enough cardiac recirculation to cause some symptoms.  As well, with Trisomy-21, he is absolutely at greater risk of pulmonary hypertension, or irreversible high blood pressure across the lungs, so we do tend to take a more aggressive stance toward closing defects like this.  It is interesting that he doesn't have any right ventricular enlargement.  And, it is often difficult with these kids to ascertain the reason of exercise intolerance, sleepiness, etc.  He could be obstructing his airway, snoring, and having sleep apnea, which is a common finding in these kids.  That said, unrepaired moderate and large ASDs can lead to pulmonary hypertension.  If he meets criteria for placement of an Amplatzer device by transcatheter means, he should actually do well with it; the success rate for this is quite good, and the long term outcomes are excellent, as well.  You may want to consider a true second opinion, to include an evaluation, and not just this advice, however.
2 Comments
Blank
Avatar_m_tn
Dear Jeffrey

thank you so much for taking time to reply. I think I will get a second opinion in our local children's hospital.

Thanks again,
Richard/Zurich, Switzerland
Blank
Continue discussion Blank
This Forum's Experts
773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
Blank
Request an Appointment
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank