Congratulations on joining what I call the “great adventure” of becoming an adoptive parent. You are truly brave and amazing – don’t think otherwise – in taking on the unique opportunity of adopting a child. As I remember our our two “Gotcha days” I think that it is indeed a rare and unique moment when you can change a child’s life forever by bringing them into your home and making them yours!
Here's a little bit about me: I'm a family doctor teaching in a residency program in PA-think TV show "House" without the attitude and drugs. I do all aspects of family medicine- newborns, kids, pregnancy, obstetric deliveries, adult and elderly patients and as a family doctor I get lots of time explaining to patients what the h*** their specialist actually said to them. For fun, on my day off I work in the ER snatching patients from the jaws of death or at least I'd like my friends to think so. (Warning: I will occasionally lapse into funny or strange stories from my experience in the ER and elsewhere- I used to think that the TV show writers made up all the bizarre stuff until I started working in the ER.)
I've adopted two girls (one with special needs) from China, have read research of adoption and given a few lectures on international adoption. With the residency position I have access to look up just about everything in the Medical literature written- a big advantage when trying to figure complex issues like attachment disorders etc.
What I intend to do with this blog is offer my suggestions and advice pertaining to adoption from my personal and professional experience. What I'm not intending is to replace anyone's personal physician's advice or diagnosis. That being said, many families' personal physicians may be unaware of the unique medical aspects of internationally adopted children.
4 comments:
We were given a referral of a child with postoperative congenital cardiopathy (not cyanosis), pulmonary artery stenosis, heart function III. Left ventrical function: EF 65% FS 85%
The CDFI showed the biggest forward flow was 37m/s by CW and PPG was 56mmHg; the local regurgitation could be found in RA; the widely regurgitation could be found in RVOT.
Any thoughts on the severity of this condition? The child is 4 years old and had surgery at 2 years of age.
I'm not a Pediatric Cardiologist and don't read cardiac echos but I will see what i can find out. In general from the people i know who have adopted children from China the pediatric cardiac surgeons are pretty good. I will do some research and get back to you. tom
My search for an answer to your question was very educational and provided me with some resources you and other families may want to get. I spoke to my cardiology colleagues and they were unfamiliar with some of the terminology on the report and there were some confusing items in translation which you wouldn't have realized: 37m/s should be 3.7 cm etc. (37 m/s doesn't make any sense) Part of the issue in interpreting this is we don't know what type of problem was originally diagnosed which can change the interpretation of the echo. For example the original problem was most probably something called a Tetrology of Fallot which involves 4 defects in the heart. One of those is a tight pulmonary valve which itself can be tight or the tissue in front of it may be; this in turn blocks the flow of blood to the lungs and the valve may have been altered in surgery or completely removed.
A valve basically makes the blood flow in one direction - the heart squeezes the blood past the valve and the blood can't get back because the valve shuts- thus blood flows forward. If the valve was removed then blood flows backwards and forwards. Say 20ml of blood flows is pumped out of the right side of the heart past a normal valve and the valve shuts- then 20ml of blood is sucked into the right side of the heart to replace what was just pushed past the valve. In your child's case the blood is flowing back across the valve (seen as regurgitation) so now the right pumping side of the heart (called the right ventricle) has the normal 20ml sucked in + some of the 20ml that came back over the valve (say 10ml). 20+10=30ml more than the right pumping side of the heart can handle. In the long term this will cause the heart to fail. The good news is that the left side of the heart is the strongest muscle with the job of pumping the blood out to the rest of the body. In this echo that part of the heart looks good (EF65%) although the FS tells us that it too is working harder than it is comfortable with.
Enough of the explanations: the bottom line is we can't say for sure but the left side of the heart function looks good but there is a lot of regurgitation on the right side which may be partly expected if the surgery involved removal of the valve or it may show that the valve is tight again and will need further work. Without a doubt this is not normal and there may be significant problems and this child will need complex care best provided in a Western setting. I would also look at how the child is doing overall in regards to growth etc to see if the heart is doing okay at this point. Babies that are sick don't grow well although babies in orphanages living on congee also don't grow well. I know this is a small piece of the puzzle in your very complex decision but I hope it helps. Please let me know how it turns out and if there are any pediatric cardiologists lurking please chime in and flame me or contact me as your mood dictates.
Resources you and others might find helpful.
It's my heart - a great little simple book I just looked at that explains all this anatomy and the surgeries to fix it in a manner that even me a lowly Family Doctor can understand. Available from the Childrens Heart Foundation www.childrensheartfoundation.org
The parents guide to children's congenital heart defects: What they are, How to treat them and How to Cope with them by Gerri Freid Kromer and Shari Maurer which you can get from www.kidswithheart.org
Thank you so very much for all the research you did on our behalf. It is very helpful. We were at a loss as to where to turn for information.
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