Pediatric Heart Expert Forum
Echo results/identical twins
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Echo results/identical twins

My son is 7 and was found to have a slightly enlarged heart on a chest x-ray.  His doctor also heard a murmur and sent him for EKG/echo.  The EKG was normal and the findings on the echo were a patent foramen ovale with left to right shunt and mild pulmonary valve insufficiency. The measurements listed were aorta 2.5cm; left atrium 2cm; LVOT diameter 1.7cm; main pulmonary artery 1.82cm; right pulmonary artery 1.04cm; and left pulmonary artery 9.2mm.  I was wondering if that difference in the size of the left pulmonary artery is normal and if not what it should be measuring.  His identical twin also had a heart murmur at birth but it has only been heard on occasion-if one has a heart defect is it probable the other will?  Thank you.
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A patent foramen ovale is the small hole in the upper heart chamber wall that all children are born with.  Nature usually closes it in the first few years of life and the amount of blood flow crossing the hole is not enough to cause any heart chamber enlargement. Usually we do nothing with these small holes. Mild pulmonary valve insufficinecy is a normal finding in childhood.  I cannot accurately comment on the other measurements of the aorta and pulmonary arteries because size will change with age and body surface area (which takes into account both height and weight).  The echo report will usually provide z-scores that alert us to abnormal values (average z-score is 0, lower normal -2, and upper normal +2).  That being said, the lung arteries do not have to be exactly the same size, and the left may be a bit smaller than the right.  So the echo report is somewhat equivocal, and if the heart is only mildly enlarged on CXR, that could be related to the degree of deep breath that occurred at the time it was taken.  Identical twins may in fact have identical heart problems, but not always. You should check with your doctor as to whether or not they recommend an evaluation of your children by a pediatric cardiologist.
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