Pediatric Heart Expert Forum
continued heart problem after PDA closure
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continued heart problem after PDA closure

My 5 month old granddaughter saw a pediatric cardiologist at 3 weeks of age for a heart murmur and was diagnosed with moderate PDA. She had no sx at that time.  Her parents were told to return in 3 months for follow-up to look at the PDA again and see if it was closing on its own.  At the follow-up appt the baby was found to have an enlarged heart with a large PDA.  She was scheduled for cardiac catheterization the following week where she underwent closure with no problems.  Follow up 2 weeks later showed the PDA to be closed but no improvement of her enlarged heart.  She was admitted to the hospital for a close investigation via echo with no additional problems found. She was started on Lasix and Captopril and discharged 2 days later with repeat echo showing that her heart was beginning to improve.  Doctor's appt 5 days later showed a bit more improvement.  The doctor said this was a very unusual course for a PDA.  I'm worried that she hasn't responded to the repair the way the doctors anticipated.  Could you offer any information?  I'm sick with worry.  Thanks.
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Dear Pmgr,

We certainly do see patients who have patent ductus arteriosus (PDA) have evidence of congestive heart failure during infancy.  However, as you were told by your cardiologist, it should resolve after closure of the PDA.  In the absence of improvement, then there has to be thought given to primary problems with the heart muscle itself, such as a dilated cardiomyopathy (a genetic disorder of the heart muscle) or myocarditis (a viral infection of the heart muscle).  Another possible cause could be an anomalous origin of the left coronary artery.  Much less likely is some other shunt lesion outside the heart that hasn't been found yet that is causing heart failure; again, this is MUCH less likely and would have probably been found by now.  Without evaluating your granddaughter, I cannot tell what is going on and what needs to be done next.  Your cardiologist may be able to do further testing studies of the heart to be able to get a sense of where the problem lies.  Or, if there is concern that you are not getting the answers that you need, you should consider a second opinion.
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