Pediatric Heart Expert Forum
what should i do?
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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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what should i do?

My two year old daughter was born with TGA, ASD, VSD and pulmonary stenosis. I am now pregnant with my second child and my doctor put in a referral for a scan with the pediatric cardiologist to check the baby's heart, but my insurance denied the referral and now I no longer have time to dispute it. How should I go about making sure that if my baby does have a heart defect that I know about it? Should I ask him to try for another referral? I am really concerned.
773637_tn?1327450515
Dear Tam,

That's really strange that a fetal echocardiogram would not be approved, because a known indication for fetal echocardiography is having had a prior child with a congenital cardiac defect.  The typical incidence of a recurrent congenital cardiac defect after you have already had a child with a defect is about 2-5%.

The major concern is that your second baby would have a defect that would require immediate intervention or therapy at birth.  Although the likelihood of this is quite low, it is not zero.  I don't know how far along in your pregnancy you are at this point, so it is difficult for me to say what should be done next.  At minimum, when your baby is born, a good cardiac evaluation should be performed in the newborn nursery.
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I am currently 29 wks pregnant. I have read about when the time to find cardiac defects and I think I'm past that point. I didn't find out with my first one and I had five ultrasounds with her due to being high risk. I am really worried it will happen again.
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773637_tn?1327450515
Dear Tam,

Typically we do our fetal echocardiograms about 18-22 weeks gestational age.  That said, it can certainly be done after that.  The biggest issue is knowing whether there is something with your baby's heart that needs to be addressed immediately after birth.  If a fetal echcoardiogram, not a targeted anomaly scan, is performed, this should assess for the vast majority (though not all) congenital cardiac defects.
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Thank you for all of your answers. I really appreciate your time.
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773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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