Pediatric Heart Expert Forum
Ecocardiograph
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Ecocardiograph

Hi Dr Boris,
I just want to find out if it is safe to have an ecocardiograph done within two month.  My 5 yr old daughter had one done in June and was diagnosed with mild mitral regurgitation.  I would like to take her to have it redone elsewhere.  
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773637_tn?1327450515
Dear Lystrab,

Echocardiography, or ultrasound of the heart, is very safe to do.  It does not expose patients, parents, or the operator to any significant radiation.  It has no real side effects, and, as you have seen, can be performed relatively quickly and easily as long as your daughter is able to hold still and follow directions.  I would recommend, though, that you make sure that the study is performed in a pediatric echocardiography laboratory.  There is a number of adult cardiologists who say that they manage pediatric patients, as well.  However, unless they are board certified in pediatric cardiology by the American Board of Pediatrics, I would avoid them for two reasons.  The first reason is that they do not really know how to diagnose or to manage children with congenital heart disease.  The second reason is that their sonographers, the people who perform the echocardiograms, are not adequately trained or experienced in assessing kids’ hearts.
10 Comments
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Avatar_m_tn
I am not a doctor.

It is safe to have another echocardiogram in two months, or even the next day for that matter.  As far as I know there is no legal time limit for ultrasound.  There are no permanent bioeffects that have been detected, and the power of diagnostic ultrasound machines is much less than you would find in ultrasound used by chiropractors.  X rays have limits, as do radiopaque dyes, but not ultrasound.
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Avatar_f_tn
I took my 5year old daughter to get another echocardiogram and the report states:
Normal LV size and function. LV EF = 75%
Mild mitral regurgitation with eccentric jet behind the posterior mitral leaflet.  Mild thickening of Anterior mitral leaflet tip.  Normal left atrial size.
Tri leaflet aortic valve with normal function. Normal aortic root size.
Trace triscuspid regurgitation, normal pulmonary valve.  Normal right ventricle and right atrium.
No intra cardiac shunts seen.
Normal pericardial structures.
LVIDD =3.4            LA = 2.8
LVIDS =1.9            AO = 1.8
LVPWD = .5          HR = 83
ISVD = .5
RVIDD = .6

What does this means
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Avatar_m_tn
I am not a doctor.

It would appear that the second echo confirms the findings of the first echo.  Essentially it is normal.  I don't have the z-scores in fromt of me, but I think those are fairly normal values for her age and size. There is no point in fretting about the mild mitral regurgitation, which it seem  like you are. A significant portion of the population has mild mitral regurgitation with no reduction in quality of life.   Your daughter can go out and create mayhem and eat along with other 5 year olds.
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773637_tn?1327450515
Dear Lystrab,

These data appear to be quite normal, with the exception of the mild mitral regurgitation (which we already knew about).  They demonstrate that her heart is the appropriate size and is functioning well.  Although I am not able to evaluate the actual study myself, this information suggests that the mild mitral valve regurgitation is causing no specific effect on the heart at this time.  This will require continued follow-up, as we would expect, but if it remains the same, she should need no intervention for this.  It also means that she should have no restrictions or precautions.  That said, everything that I just wrote here should have been conveyed to you by your cardiologist in interpreting this test.  If you are not getting that feedback, you need to speak with your cardiologist to ensure that you do or obtain a second opinion.
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Avatar_f_tn
my son is a 14 yr old weight 133 lbs, height 5 foot 8 1/2 inches. Has bicuspid aortic valve with root dilation of 3.6. six months ago it measured 3.4. before that it has not changed in 18months. His dr stopped all sports and weight lifting, is concerned about his aortic bursting. He has always had echos down and in 3 months he will get a MRI done. Is he at high risk of it bursting and the dr talks about surgery when it gets to 5.0..I'm concerned it may burst before 5.0. Should we be waiting 3 months for the MRI or should it get done sooner? Can his aorta burst at the size its at?? Should he be wearing a medic alert bracelet? We are very concerned..
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Avatar_m_tn
I am not a doctor, but I will share my experience.

Is he at a high risk of bursting?
  I am not aware of any cases of aortas bursting, especially at 3.6 cm.  How it is usually done at the facility that I work at, is that they also wait until 5.0cm.  After 5.0 cm, I believe that the risk of dissection or ripping on the inner wall of the aorta become a more significant risk.  

Why do they wait?  The reason, as I understand it, is to put off surgery as long as they can while still having the best outcome that they can.  I don't know the specifics about your case, but if we assume that they would have to replace the aortic valve (not saying that they have to in your case, sometimes they can spare the valve depending on some factors) and part of the aorta, it sets the clock ticking as to when the next surgery will have to be.  Usually the part of the aorta that is replaced isn't the problem, it's the prostheitc vavle that they will put in to replace the bicuspid valve.  Even though valves nowadays can last up to 15 years on average , it still has to be replaced eventually.  If you replace the valve now at age 14, then it would be in the realm of possibility that he'll need re-do surgeries at age 30, 45, 60, and 75 on average.  If you medically mamge it as long as you can to put the surgery off,  he might only need one at age 45, 60 and 75.  Three surgeries are preferrable to 5 in any doctor's book.  They balance the desire to have as few surgeries as possible vs. quality of life and the quality of the predicted outcome.
   I will also point out that if they can spare the valve and just replace the section of the aorta that is dilating, that would be a different scenario.  With the limited info and without actually seeing the echo, it's hard to tell and there is some guessing and assumptions on my part.
  They also look at the rate of how fast the aorta is getting bigger.  The change from 3.4 cm to 3.6 cm is of some concern, but not of any alarm.  Echo can estimate the size of the aorta very well, but it is known among cardiologists that there is some variability between echos and between who's doing them.  It is a distinct possibility that though the aorta may have grown in the last 3 months,  it may have not been 0.2 cm, it could very well be less.  I
  I don't see a reason to get the MRI any sooner, but perhaps Dr.Boris may have another perspective that I'm missing.
  Should he be wearing a medic alert bracelet?  I don't know.  The only reason I can think of is that the medicine he is taking now might interact with a drug that might have to be given in an emergeny situation.  giving you the chances of that is beyond my scope.  

I hope this helps allievate some of your concerns.
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773637_tn?1327450515
Dear Ty,

Obviously, without seeing your child's echocardiogram or evaluating him, I can't say for sure.  However, I can say a few things here.  We get concerned if there is a 5 mm (0.5 cm) change in 6 months, which does not sound like occurred with your son.  Also, the difference between 2 millimeters in the different measurements may honestly just be within standard error between the two studies.  Certainly your son is the size of a small adult, and the data that we have for aortic rupture is in adults.  We usually take 5 cm (50 mm) to be the threshold for increased risk of rupture, so I do not believe that your son is at significantly greater risk to wait for the MRI at this point.

In these patients, I do restrict major isometric activities, such as football, wrestling, and weight lifting.  However, I try not to limit their aerobic activities, unless there has been a significant enlargement in the aorta.  Also, despite the lack of any decent research on this, it may be worthwhile discussing with your cardiologist whether a beta blocker, ACE inhibitor, or angiotensin receptor blocker (ARB) could be considered for him.  These medications have been used in patients with Marfan syndrome, which may have some similar biochemical findings and certainly has similar aortic dilation and rupture findings.  

Finally, regarding a MedicAlert bracelet, I can't say for sure regarding his need for this.  This is something that I would discuss with your cardiologist, although it probably would not be a bad idea if he had one if his aorta was at least 4 cm in diameter.
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Avatar_f_tn
Thank you for taking time and answering my questions. I do have one question. When i told you his dr restricted sports, I meant every sport. I understand no football, and no weight lifting. But he told him no basketball, and track. Is this nesessary?? My son feels like he can't do anything. From what I told you before would you be taking basketball from him. You had mentioned you try not to limit their aerobic activities. Does this include basketball?? Thank you sooo much
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773637_tn?1327450515
Dear Ty,

Unfortunately, without more fully evaluating him, I can't really tell if anything else requires restrictions or not.  Your cardiologist will have to be the arbiter of that.
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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