THIS MONTH’S PROFESSIONALS

Dr. John Breinholt

Dr. John Breinholt

Pediatric Cardiology

Dr. John Breinholt Dr. Breinholt currently serves as Chief of Pediatric Cardiology at Children’s Memorial Hermann Hospital and is the director of the Division of Pediatric Cardiology in the Department of Pediatrics at McGovern Medical School at UTHealth, part of the University of Texas Health Science Center at Houston. He was selected for the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship Program (2013-25) and the American Academy of Pediatrics Young Physicians’ Leadership Alliance (2014-2017).

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This Month’s Questions & Answers

  • TSDK1
    TSDK1, SUPPORT NETWORK Member Asks
    Q.

    "My 6 month old son was diagnosed (echo done after a week) with a 3.4mm * 4mm perimembranous vsd at the time of birth (premature baby - 32 weeks). We did an Echo when he was 2 months old, and was told that the size of the hole had reduced to 2 mm and were asked to repeat the echo after his first birthday. During regular pediatric consultations, his pediatrician mentioned the murmur has become soft and asked us to do an echo as he felt that the VSD must have closed by itself or was about to close. So, we did an echo last week with a senior pedeatric cardiologist and were shocked to hear that the VSD has been partially closed by RCC prolapse and there is a mild Aortic valve (grade 1) leak now. He also told us that there is a mild AR and would need a surgery if the aortic valve leak increases. He prescribed digoxin and asked us to come for a follow up next month. We are struggling to recover from the shock and want to know whether surgery is the only option? Are there any symptoms that would indicate the increase in aortic valve leak? Will this be fixed by a one time surgery or will require life long medication?"

    A.

    It can happen that perimembranous VSDs can reduce in size, and rarely can close spontaneously. It is usually from tricuspid valve tissue that obstructs the defect, although in my experience, it usually only partially closes the defect. When they are small, many cardiologists choose to watch them. The one risk taken with that approach is the development of aortic valve regurgitation. In that setting, many would recommend closure before the regurgitation worsens.
    The VSD will be close with a single surgery. The outcome of the aortic valve is variable. It may not require further intervention, but that is not certain. Your child will require a lifelong relationship with a cardiologist if only to watch for any changes.
    At this stage, surgery is the only option to address this problem.
    Thank you, Dr. Breinholt

  • Bsmall
    Bsmall, SUPPORT NETWORK Member Asks
    Q.

    "My son was recently diagnosed at 12 yrs old with PAPVR. He is scheduled to see a cardiac surgeon soon. Any help with information and connection with parents who have been faced with this would be greatly appreciated. I am scared and I am trying to learn all I can.. in what to expect... If anyone can share their experiences it would mean the world to me."

    A.

    I am unaware of any specific group for this. Most of these patients do very well. It is a relatively straightforward surgery that involves the closure of an atrial septal defect (sinus venosus) and rerouting of the pulmonary vein. The challenges typically involve where the pulmonary vein enters, and complications can involve residual narrowing of the pulmonary vein. Nevertheless, it usually goes well.
    Some centers have begun offering alternative approaches to this surgery that involve a less invasive approach that doesn’t involve a sternotomy (incision in the middle of the chest), but rather in the underarm area. One center is in Sacramento, and the other is the University of Texas HSC at Houston/Children’s Memorial Hermann Hospital where I work. This is a relatively new approach with a better cosmetic result. Thank you, Dr. Breinholt

  • Pfletcher490
    Pfletcher490, SUPPORT NETWORK Member Asks
    Q.

    "What is exactly is congestive heart failure"

    A.

    Congestive heart failure is a broad term that describes the heart's inability to effectively or efficiently handle its function. It might be because the strength of the heart is weakened, or it might be because of a congenital defect that leads to over circulation of blood to the lungs. The definition of CHF is easier to explain depending on the heart being discussed. Thank you, Dr. Breinholt

  • MJH1979
    MJH1979, SUPPORT NETWORK Member Asks
    Q.

    "My daughter is born on 28 th may 2018. on 29 may 2018 she was diagnosed with hypoglycemia. On June 10, 2018 she aspirated twice and admitted in NICU with breathing difficulty. On June 12, 2018 she was diagnosed with two holes in her heart, one asd of 3 mm and PDA of 4 mm. Her pneumonia is still there today on 18 th June 2018 but improving."

    A.

    The hypoglycemia and aspiration are unlikely due to the heart. The ASD is small and may never need intervention. Unless it “grows” as she grows and becomes a size that we would consider closing, it would not be done until she is 3-4 years old at the soonest. The PDA could require intervention. Sometimes the measurements can overestimate, but if she has heart chamber enlargement (on the left side) in addition to the PDA, it may need to be closed. It is also possible that the pneumonia is related, but it would require examining her and having more information to know for sure. I hope she has a cardiologist. That would be the most important next step. Thank you for this question, Dr. John Breinholt

  • parijat
    parijat, SUPPORT NETWORK Member Asks
    Q.

    "My child has Ostium Secundum ASD of 7-8 mm and Large Perimembranous VSD during his first month of age. Now he is 5 months old and the ASD is 5 mm and Moderate VSD. Can you please suggest wheather any surgery will be needed or it will cure itself."

    A.

    Perimembranous VSDs do not frequently close on their own, particularly if they are moderate to large in size. ASDs can get smaller, and even close. If the ASD is only 5mm at 5 months of age, it is possible it will close, or at least not require surgery (or even catheter based closure). The VSD is more difficult to predict. If the child continues to do well clinically, doesn’t require any medical therapy, is growing and thriving, he can wait. We do watch the aortic valve closely because flow through the defect can influence that valve and cause problems. If it does, surgery will be necessary. Sometimes the defect can be partially closed by valve tissue from the tricuspid valve (from the right ventricle). If that happens (or has already happened), sometimes we can close those defects in the catheterization laboratory, without surgery.
    The short answer is the ASD may not need anything or could be closed with a device and without surgery. The VSD is more difficult to predict and hard for me to comment without more information. However, if he is doing well, there is time and surgery may not be necessary.
    Thank you for this question.
    Dr, John Breinholt

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