management of a child who had heart surgery

My Son was only 5 days old when he underwent an open heart surgery due to Pulmonary Valve Atresia. He was taking propranol for a year and stopped till he was 3yo. He is perfectly doing well, healthy and energetic. However 2D echo shows he has an enlargement of the heart. He's medication was continued on a 5mg propranolol once a day to control heart beat. My pedia cardio was mentioning about surgery to open the narrowing valve, I am scared for another operation. My son is perfectly well so I want to ask what could be the obvious symptoms that could manifest if my son really needs a second operation?

[Jeffrey R Boris, M.D.]

Dear Jannie Mae,

I cannot tell exactly what is happening with the enlargement of the heart that you are describing.  I would guess that, if he needs repeat intervention to open the valve, the right ventricle is getting either thicker or more dilated.  I will tell you that, with pulmonary atresia with intact ventricular septum, he will likely need at least 1-2 more surgeries, if not more.  However, in experienced centers, these patients typically do well.  As well, it is important not to wait for symptoms before the surgery.  Symptoms can indicate that the heart is SO sickthat it may potentially be too late.  We have certain thresholds of estimated pressure in the right side of the heart and across the pulmonary valve that we look for (as well as other findings) that can give us an indication that it's time to have the procedure performed.  Your cardiologist should be able to discuss this further with you so that you understand the indications for timing of the next intervention.