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Cardiology update

October 7, 2010

So, after her surgery, we were told to get Princess2 back in to see Dr. I in our town for her follow up care.  Dr. D at Vanderbilt Children’s did a heart ultrasound before releasing us, and he had warned us that he heard 2 murmurs now.  Not totally surprising because any other murmurs would have been covered up by the extremely LOUD PDA murmur.  Dr. D felt that one of them was leakage around the PDA plug he had inserted to plug that hole/opening.

*CLICK HERE to learn what the PDA is*

CLICK here to see what the “occluder” that was put in Princess2’s heart looks like (I think Dr. D went with this one and not the occluder 2.  ;)  and HERE is how it is inserted and how it looks inside the heart.

Okay, in watching those two videos above, I need to tell you that our little Princess’s PDA was SHORT, and the plug he had to use was for a larger size than recommended for her hole because when he tugged on it…it slipped out of place.  Yeah, I’m glad he went with a larger one too.  Anyway, because that opening was so, well, SHORT, the end of the occluder sticks out on the bottom as well.  If you look at the first link, the explanation of the PDA, then you see that it sticking out could hinder blood flow into the veins that go to the lungs, so Dr. D watched and measured the pressures of blood flow before leaving it there and pronounced it okay.

In our initial referral paperwork we knew that her ventricle was enlarged on that side.  Dr. I confirmed that in his initial exam, and Dr. I noticed something funny with the mitral valve.  *Previous post on her initial exam Dr. D saw all of this as well in his pre-op exam, and he looked at it all during surgery and nothing anatomically seemed out of the ordinary to him and he wanted to see what might happen when we finally got that PDA closed.

Yes, it was a LONG surgery…although, I guess, not really…right about 2.5-3 hours.

So, back to the heart ultrasound exam in the hospital that Dr. D had done after he heard the 2 murmurs, with over 140 photos sent to him to review and videos, he said that she does NOT have any other holes.  PtL!  However, she does still have 2 murmurs.  1 of them he is NOT concerned about because it was a slight leakage around the occluder he inserted and to be expected in a PDA of her size (and short squattiness in length).  I remember seeing that blood flow through the occluder, and he told us it could take up to 6 weeks at least to stop, and perhaps even longer.  We should see a significant decrease in it by the time we took her to see Dr. I back home though.

The 2nd murmur was being caused by leakage back through the mitral valve, and it looked like it was leaking to the outside of the heart.  In this, he wasn’t too concerned, but definitely wanted to watch it.  There are explanations that exist, and this “leakage” could be caused by multiple things.

1 – the enlarged ventricle pulled that side of the valve out a little bit and the flap that closes over it doesn’t cover it fully and thus allows blood flow to leak around it.  When the ventricle shrinks back up due to the PDA being closed, it should “fix” itself.

2 – because of her PDA and the extra blood flow back, and the enlarged ventricle, she had a greater volume of blood in her body than normal.  This extra blood volume could be putting pressure on the valve and blood is “leaking” through due to the heart having to pump harder, or because it was used to pumping harder…I can’t remember WHICH way it was described now (heck I couldn’t remember 15 minutes later to tell Dh).  LOL  But, the blood volume will become more “normal” and we might see this leak stop…after a little while.

3 – she has a congenitally malformed mitral valve and it will always leak, but how badly will depend on how things settle out after the PDA closure.

She also has a FLAT mitral valve flap.  It is supposed to be curved, and all 3 of the above apply as well, so more wait and see.  However, given it’s “flatness” it is likely that she will eventually develop Mitral Valve Prolapse.

We were sent home and told to have her seen by Dr. I in 1-2 weeks.  It took me 2.5 weeks (remember we were all sick), and as she had been to the pediatrician I had learned that instead of her LOUD PDA and the “purring” vibration in her chest, she now had a “whistle” sound that accompanies her heart beat.  So, I warned Dr. I that you could indeed hear it with your bare ear pressed up to her chest.  I also told him about the soft flow murmur from the occluder (it had only been 2.5 weeks), and he could not hear it.

The heart ultrasound he did was not quite as clear as the hospitals, but that’s okay.  :)  There was an ITTY BITTY trickle through the occluder still, but so incredibly small and only seen at the right angle that Dr. I thinks it would take about 6 weeks to fully close off.  :)  The mitral valve, though, still had quite a leak to it.  He did not tell us, and we forgot to ask, how it compared to 2.5 weeks prior, but to me it looks about the same.  I also forgot to check on the size of the ventricle to see if it had reduced in size…although I kind of doubt it because both Dr. D and Dr. I said that it could take 6 months or so.   We are in a “wait and see” mode, and we take her back next August for a follow up exam.  Until then, we are to treat her as having a normal heart!  :)  Well, with the caveat that if we notice any heart related issues to call them.  Dr. I did say that she has the body build of a “mitral valve prolapser” and when I questioned it, he said they pretty much all are taller with long legs and arms.  Yep…that’d be our Princess2.

What I got out of all these conversations, is that it’s likely Princess2 will have (or does have or something) Mitral Valve Prolapse.  She has Mitral Valve Regurgitation/Mitral Valve Insufficiency, and because of this she MUST have antibiotics for any dental treatment including teeth cleaning…and for 10 days.

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