ASD vs. PFO

[golfdesperado]

I am the proud father of a baby boy.  He was born at 28 weeks, 3 days.  He was 2 lbs 10 oz at birth and is now 7 weeks old.  He is currently 4 lbs 3 oz and was recently moved into an open crib and is no longer on a nasal cannula or oxygen.  Bottle feedings are going well at two trials per day and sometimes he finishes his bottle of 33 cc.
Now, he has been diagnosed with a heart murmur which has been noted by at least two echoes as ASD vs. PFO with left to right shunting.  This is significant and treatment has been with diuretics.  The current path has taken him to fluid restrictions and now this has led to a weight gain of only 2.5 oz in the past 10 days (keeping in mind the fluid restriction).  We have been made aware of the possiblility of this hole closing but we are concerned about the minimal weight gain.  We have not consulted with a pediatric cardiologist, only with our neo at this point.
Would you suggest that we consult with a pediatric cardiologist at this point, or at least ask the echo be sent as a second opinion?
Thank you so much in advance for your response.

[golfdesperado]

Thx for answering my post. We will ask that a ped card review it. I forgot to mention that he does still have immature lungs. This could be the primary reason for treatment.
This forum is a great resource for people. Thx for giving me some of your time. God bless.

[Jeffrey R Boris, M.D.]

Dear Golfdesperado,

Although many neonatologists learn how to read echocardiograms, they typically (though not always) do not have the experience to determine whether a congenital cardiac finding is what we call "hemodynamically significant" or not.  A significant defect would be one that affects the blood flow so much that it is causing problems for the heart and/or the rest of teh body.  Without evaluating your son, it is difficult for me to tell whether this defect is significant, or not.  I can recommend a couple of things, though.  The echocardiogram should be read by a pediatric cardiologist, and NOT an adult cardiologist.  If it is truly the size of a "patent foramen ovale vs. atrial septal defect", this means that it is small and NOT hemodynamically significant.  If the diuretic and fluid restriction has been instituted because of this hole, it would be appropriate to have a pediatric cardiologist to see your son, because this kind of therapy for a small defect may not be appropriate.  There may be other reasons (such as immature lung development) that the diuretics may be needed, though.