ASD,PFO,PDA and Mild tricuspid regurigitation

[wasim_rehman]

Dear Doctor/All,

My infant boy was referred for an echocardiogram after the Pead has heard a heart murmer.Following is the echocardiogram report done at 1 month 23 days of infant age:

Situs solitus,levocardia.
Atrioventricular and ventrioculoatrial concordance.
Normal pulmonary venous connection.
Two fenestrations in interatrial septum (total area = 5mm).
Interatrial septum is also intact.
Patent foramen ovale, 3.2mm in size with left to right shunt.
Interventricular septum is intact.
Normal size cardiac chambers.
No left ventricular hypertrophy.
Normal left ventricular function.
Normal cardiac valves.
Normally related great vessels.
Mild tricuspid regurgitation.
Tiny patent ductus arteriosus, 1mm (could be collateral), flowing continuously with peak systolic velocity = 1.8m/sec. EDV = 0.9m/sec.
No coarctation of aorta.
No pericardial effusion.

Cardiologist's explanation and my concerns:
The cardiologist has mentioned the below two points in conclution to be kept in observation and according to her, there is 85% chance that these will self close within an year. She referred no treatment or intervention at this stage and recommends another echocardiogram after an year.

1.Two fenestrations in interatrial septum (total area = 5mm) i.e small ASD according to cardiologist
2.Tiny patent ductus arteriosus, 1mm (could be collateral), flowing continuously with peak systolic velocity = 1.8m/sec

However, in addition to above i am concerend to know about these points as well:

3.Patent foramen ovale, 3.2mm in size with left to right shunt.
4.Mild tricuspid regurigitation

Are these alarming? Should i wait for an year with no treatment? How severe are the problems? Should i take a second opinion? There are no syptoms in my baby boy, he is gaining weight, doesn't sweat, doesn't breath repidly, doesn't have bluish lips etc,in short he looks perfectly normal by the grace of almighty God. Seeking your professional advice.

[Jeffrey R Boris, M.D.]

Dear Wasim,

Without evaluating your son, I cannot say for sure what risks there are for him.  However, in reading the echocardiographic report and what you are saying about the interpretation, it sounds as if the cardiologist's interpretation seems about correct.  The patent foramen ovale may be one of the fenestrations in the atrial septum; however, if it is an additional hole, infants with atrial septal defects typically do not have symptoms.  The ductus arteriosus sounds as if it is small and hemodynamically insignificant.  Mild tricuspid regurgitation is usually a normal finding and does not cause a problem as long as it does not worsen.  Overall, it sounds as if your nearly 2 month-old son is doing well.  The things to look for would be getting out of breath or sweating with feeds.  If he is not doing these, and he is growing well, he will need neither earlier follow-up nor a second opinion.

[shy782]

A related discussion, systolic murmurs/vsd was started.

[wasim_rehman]

Dear Dr.Jaffrey,

Thanks a lot for your prompt answer. It has given me a great degree of satisfaction, I need you to clarify one more thing, if patent foramen ovale (sized at 3.2 mm in report) may be one of the fenestrations in the atrial septum, does that mean the hole would be approximately 1.8 mm? (Since the total area of two fenestrations in interatrial septum is 5 mm according to the report)

Thanks again.