Pediatric Heart Expert Forum
General Cardiologist or Pediatric Cardiologist
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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.

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General Cardiologist or Pediatric Cardiologist

Dear Doctor,

I have a two year old who has been completely healthy. At his two year check, his pediatrician heard a murmur and referred us to cardiology. We live in a very rural area, so we were set up for a general cardiologist who does a clinic in the closest town to our house.

The cardiologist diagnosed him with a small VSD and said that he would want to see him yearly, but otherwise he should be just fine with monitoring. However, he did say that he is not a pediatric cardiologist and that if we wanted, we could see a pediatric cardiologist.

Our issue with that is that it would require a great deal of travel, and since we do not have health insurance, a great deal of expense. He understood that and left it up to us.

I have a copy of the echocardiogram report and the x-ray report. With these findings, would you consider it important to find a pediatric cardiologist for a second opinion, or just follow up with the general cardiologist in a year?

ECHO CONCLUSIONS:
small perimembranous ventricular septal defect (8 mm) with L to R shunting 4.6 m/sec
Probably ruptured sinus of Valsalva with diastolic flow from ascending aorta into right ventricle
Moderate left heart enlargement with mildly decreased systolic function
mild-to-moderate aortic valve regurgitation (RCC prolapse)
Trivial to mild mitral regurgitation
Normal right heart size and function

ECG: NSR, 98, Normal Axis, LVH

X-Ray:
Findings: Cardiomegaly is present with prominent central pulmonary vascularity. No pulmonary edema or effusions. Lung volumes are normal.
Related Discussions
773637_tn?1327450515
Dear Mommy,

Please consider that while an adult cardiologist gets 1-2 months of training in congenital cardiac disease, a pediatric cardiologist gets 36 months of training.  Adult cardiology is VERY different from pediatric and congenital cardiology, and adult cardiologists are not board certified in the practice of congenital cardiology.  Therefore, regardless of the severity of the defect, all children and adolescents as well as any patient with a congenital cardiac defect of any age should be evaluated by a pediatric cardiologist.
4 Comments
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Avatar_m_tn
Dr. Boris,

Thank you for your reply. I didn't realize that pediatric cardiology and adult cardiology would be all that different? I don't want to press you into being specific, but based on the findings I gave above, can you can a recommendation on how soon he should be seen by a pediatric cardiologist? As I said before, we are not insured so we pay out of pocket for these things. Financially we would be in the best position if we could save for at least the next six months, but I don't want to risk his health either. The general cardiologist who saw him said we could wait a year. Looking at his echo results as a pediatric cardiologist, could you give some guidance on whether that would be wise?  

Thank you for being willing to answer questions.
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773637_tn?1327450515
The problem is that without evaluating him as well as the actual images, it's difficult to say how urgent this is.  Often, though, a ruptured sinus of Valsalva aneurysm is a more urgent diagnosis in general, as it can extend and cause more significant problems for the heart.  I understand your financial situation, although they may be able to get you connected with a social worker to help find various sources of support for you.
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Avatar_m_tn
Thank you for responding so quickly. If I were to have all his results send to a pediatric cardiologist, would they then tell me when they would recommend an appointment, or do I just need to try and make an appointment?

I'm sorry to ask so many questions, and I promise these are the last ones.
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This Forum's Experts
773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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