Last month we took Lizzie to her 1st Boston Children's Hospital Pediatric Cardiology appointment. Today we received a letter in the mail (a copy of what had been sent to Lizzie's primary care doctor). We had quite the time decoding it, what with all the medical jargon used. Thought we would share it not only to inform, but to give you something to do if you are bored (or really curious like us).
Dear Dr. Lenhardt
We had the pleasure of seeing Elizabeth in the pediatric cardiology clinic at Children's Hospital Boston on October 30th, 2007. As you know, she is a 2-year old girl who was born with Tetralogy of Fallot/pulmonary atresia, which was repaired at one week of age with a transannular patch and placement of a monocuspid valve. She also had her VSD closed at that time. She had been followed at Doernbecher Children's Hospital but is transferring care here as the family is settling in the Massachusetts area for Dad to finish his schooling.
Elizabeth had an uncomplicated postoperative course and has been doing well since her operation. She was negative for FISH 22Q11 deletion. She is growing along her projected growth curve and has a normal activity level. She is currently on no medications. Her only other medical history is left sided hydronephrosis. She has had a normal VCUG and normal renal function.
Her family history is negative for congenital heart disease and sudden unexpected death. Dad has a history of sinus arrhythmia and an innocent murmur. There is also a family history of Type 2 diabetes and asthma.
On exam, Elizabeth is a well appearing young girl in no apparent distress. Her weight is 11.8 kg with a height of 84.7 cm. Heart rate was 102 with oxygen saturation of 92% on room air. Her chest was clear to auscultation bilaterally. Cardiovascular exam revealed a normal active precordium with a normal S1 and a single S2. She has a 3/6 to-and-fro murmur heard loudest at the left sternal border but it can be heard throughout her precordium and radiating to her back. Her abdomen is soft, non-tender, and non-distended with normal bowel sounds and no hepatosplenomegaly. Her extremities are warm and well perfused with pulses 2+ and capillary refill less than 2 seconds.
An EKG done in clinic shows a normal sinus rhythm of 102 beats per minute. She has a complete right bundle branch block and has a right axis deviation. QRS duration is 120 milliseconds. Echocardiogram done which showed a PFO with bidirectional flow. No significant mitral or tricuspid regurgitation. She has severe pulmonary regurgitation and mild pulmonary stenosis with a 20-25 mm Hg maximal instantaneous gradient. She has good biventricular function. The aorta is slightly dilated with no aortic stenosis or regurgitation. There is no residula VSD flow. Her branch pulmonary arteries were not well seen.
Our assessment is the Elizabeth is a young girl with Tetralogy of Fallot and pulmonary atresia, which was completely repaired with a transannular patch, monocuspid valve, and closure of her VSD. She is clinically doing well and there has not been any significant change in her echocardiogram from her last echo done in May of 2007. We will continue to followup with Elizabeth on a yearly basis. We advised the parents to contact us sooner should they have any concerns or notice any worrisome symptoms including failure to gain weight, shortness of breath, dizziness, or syncope. We also discussed with them the possiblity of doing an MRI in the future (when she is able to undergo an MRI without sedation) that would help us better assess her right ventricular size. Although this will not play any acute role in her management, it may help with future decisions when she gets older in terms of pulmonary valve replacement.
Thank you for allowing us to participate in the care of this patient. Please do not hesitate to contact us in the future should you have any questions or concerns.
Sincerely,
Douglas Mah, M.D.
Cardiology Fellow
Lisa B. Bergersen, M.D.
Associate in Cardiology
