Pediatric Heart Expert Forum
Enlarged heart
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Enlarged heart

My child is 5 year old. She went thru open heart surgery when she was 5 months old. The surgery went well and doctors said that she is as normal as other babies afterwards. She was normal for 5 years. Her heart was of normal size when taken ECO and ECG 2 years back.

Recently, due to cough and cold we went to the doctor and he suggested to do X-ray. The x-ray result suggests to have her heart enlarged. Dr. at GP says that it is not very serious. However, he suggested to see Pediatric Cardiologist. I am really very worried. Her appointment is booked for coming Monday.  

I would like to know if heart enlargement is very dangerous? What could be the reasons behind? How long it will take to come to normal size? Will it be treated through medication? Could there be connection with her previous operation? She looks quite normal except that she coughs sometimes in the night. What are dos and don'ts for child so that it does not harm her heart.

Look forward for respose.

worried mother
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773637_tn?1327450515
Dear Worried,

There can be several reasons for enlargement of the heart that we need to keep in mind.  To start with, the reason that your child had heart surgery may actually be important to know—sometimes, there are certain congenital heart defects that can cause the heart to enlarge some time after surgical intervention.  However, without knowing what surgical intervention your daughter had and how it was done, it is hard for me to say.  

A large heart can be seen if there has been an infection of the heart, called myocarditis.  This can occur even after a simple viral syndrome, such as a cough and cold.  Usually, though, these kids are somewhat sicker.

However, the most likely reason that your child’s heart appears enlarged on the X-ray is due to inadequate technique when the film was made.  If your daughter didn’t take a deep enough breath, or she was somewhat rotated when the film was made, it will overestimate the size of the heart.  Unfortunately, chest x-rays are not great studies to estimate heart size.  Since you say that prior echocardiogram and ECG studies appeared normal, it is likely that your daughter’s heart is normal UNLESS you have also noticed some other symptoms over the last years, such as decreased exercise tolerance, getting out of breath easily with exercise as compared to other children, etc.

I personally don’t think it is a good idea to conjecture about treatment plans and some of your other concerns UNTIL we have know for sure IF the heart is enlarged and, if so, why.  Then, discussion of medications, time to recovery, do’s and don’ts, etc., would be more helpful for you so that you can take care of your daughter specifically (and not a hypothetical case).
8 Comments
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Avatar_f_tn
Dear Dr. Boris,

Thank you so much for taking time to respond to my queries. It has been a bit relief after your response and hope things will go well.

Her surgery was for: VSD patch closure (Dacron patch), AP Window division and repair, PDA ligation. EcoCardiography and EcoCardiogram showed normal in 2004 (after the surgery). In 2007 as well EcoCardiogram done - everything was normal.

My daughter does not have any symptons you listed. She is very active and she has been just like other normal kids. In fact it has been difficult to control her activities these days as we feard for her movement after heart enlargement report of X-ray. Her cough too is just once or twice sometimes in the night.

As you said, it might be her movement during X-ray. Her position seem to be slightly slanted. She was not even asked for taking deep breadth while taking X-ray.

I am very hopeful for a good ECG report on Monday. I would like to thank you once again for your kind support.
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Avatar_f_tn
Dear Dr. Boris,

My daughter had an ECG yesterday and the doctor said that her heart is completely normal. As you said, due to some position changes, her X-ray showed heart enlargement. It has been a great relief now.

Thank you so much once again for your response.  
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773637_tn?1327450515
That's excellent news--I'm glad.
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Avatar_f_tn
Dear Dr. Boris,

Thank you so much for your earlier responses. I thought to share the report from Pediatric Cardiologist who had done EKG so as to have more clarity [the medical language is difficult to understand). Please suggest if she needs any precautions or any more tests so that it reduces for any risks with her heart.  

(Note: My daughter had undergone through the following two major operations at the age of 2 days and 5 months old. i) Repair of oesophageal atresia and tracheo oesophageal fistula  ii) Surgical closure of ventricular septal defect and ligation of patent arterial duct.)

The recent EKG done on 9 June (due to heart enlargement shown on X-ray report) and the EKG report says:

There were right thoracotomy and median sternotomy scars, both of which had healed well. Arterial pulses were normal. The cardiac impulse was not overactive. Heart sounds were normal and I could not hear a murmer.

Ecocardiogram demonstrated normal cardiac connections with left sided aortic arch.
The patch closing the previous perimembranous septal defect was stable. There was no residual VSD. Mild tricuspid regurgitation had peak velocity 2.5m/second, indicating that right ventricular and pulmonary artery systolic pressure was 30-35mm Hg. Left ventricular size and function were normal (LVIDD 34mm, normal 27-35; fractional shortening 39%). No other abnormality was seen.

She has had good results from both of her previous operations. Cardiac dimentions are appropriate for somatic size, and her heart can be regarded as normal.

............................................

The doctor suggested to have elective cardiology review in 2-3 years.

I am still not clear whether the enlargement of heart shown in X-ray is due to the size changes in her heart or the rotation of her posture. The doctor did not say clearly the reasons. However, he said that may be some glands or so appearing in X-ray. As she had undergone open heart surgery earlier, it really frightens when anything comes up relating to heart.

I have some other questions such as: how safe it is to do EKG frequently? Are EKG and ECHO the same? How effective is EKG to know about heart condition? Are the readings of EKG in the report fine and normal? or, is there any worrying part?

Look forward for your response.
Kind regards


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773637_tn?1327450515
Dear Worried,

Thank you for posting the information from your doctor's report.  Everything that I see there is quite reassuring.  It appears that the chest X-ray ended up being less accurate as compared to the echocardiogram.  The echo, which is a cardiac ultrasound, is much more accurate in assessing cardiac chamber size and appears to have demonstrated that the heart size is normal.  There is a gland called the thymus which overlays the heart and can cause the heart silhouette to look larger on an X-ray.  However, the thymus is typically gone by now, so I'm not sure what else was making the heart look large.  That said, I am also not worried about it at all, since the much more accurate test was done.

In regard to the EKG and echo:  an EKG (or ECG, as it's an electrocardiogram; EKG is a nod to the German word, as that is where it was first developed) measures the electrical signals coming from the heart.  It is very good for assessing heart rhythm, but only okay at assessing chamber size, sometimes overdiagnosing.  It, like X-rays, are tests that have to be interpreted in the context of the patient.  We treat the kids, not the tests!

What you report as the results of the EKG test is actually the physical examination.  I don't actually see an EKG interpretation in what you have posted, but I'm not particularly worried about it, either, if your cardiologist isn't.  It is perfectly safe to do an EKG and echo--there are no ill effects from either test.  The report suggests that the combination of heart disease and the esophageal atresia with tracheo-esophageal fistula repair may mean that your daughter had VACTERL association (sometimes shortened to VATER), which is a mnemonic short for veterbra, anal (atresia), cardiac, tracheo-esophageal (fistula), renal (or kidney abnormalities), and limb (abnormalitites).  This is an association that we see somewhat frequently, and lists the various problems or locations that problems can occur.  Hopefully your doctor has evaluated your daughter for this and discussed these findings with you.

Overall, it appears that your daughter had an excellent surgical outcome.  She should do very well from a cardiac standpoint.  Don't worry!  Don't let her be a cardiac cripple--treat her normally and let her run around and be a normal little girl.
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Avatar_f_tn
Dear Dr. Boris,

Thank you so much for a detailed information. I can't express - how helpful it is to have this kind of forum and support from Drs like you to medically ignorant people. I have been checking your replies to others as well - it in fact is making me knowledgeous.

Thank you once again for your help.

kind regards
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