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

  • keraeason
    keraeason, SUPPORT NETWORK Member Asks
    Q.

    "I am 50 and about 6 years ago I was diagnosed with BAV. I have been having problems with my bp recently. About a year after diagnosis my bp began to rise and ended up in the er. It has been having episodes of going higher and my Cardiologist has increased my meds and then also prescribed me water pills, which I take when needed. Recently I have been feeling light headed often and very tired throughout the day.. I am active and a physical education teacher. Could this be all because of my BAV? Does all this mean it’s getting worse. I have a yearly echo, but I’m not scheduled for this years until July. Please advise and thank you for your time."

    A.

    I am assuming by BAV, you are referring to Bicuspid Aortic Valve, which is a genetic malformation of the Aortic Valve. The aortic valve is between your left ventricle (lower chamber of heart), and your aorta (large blood vessel leading from your heart to your body). It is the door from your heart to the blood vessels of your body, and regulates the flow of oxygen rich blood. Most people, yourself included, live a normal healthy life with a bicuspid aortic valve. Labile or fluctuating blood pressure is also very common with a bicuspid aortic valve. As you age, one of two things could be going on with your valve, and causing your symptoms, stenosis (narrowing), or regurgitation (back flow). This is best determined by an echocardiogram, which is an ultrasound of your heart structures.
    In your circumstance, if you feel your symptoms are becoming more frequent or more severe, I would suggest calling you cardiologist and asking if you can come in sooner for you echo. Heart valve disease is a condition that does not require treatment until symptoms are frequent or severe enough to impact your quality of life. There are many treatment options for both aortic valve stenosis and aortic valve regurgitation, and that area of cardiac medicine is constantly growing. There are now less invasive options that offer the same relief and results and even 10 years ago would have required full open heart surgery.
    I hope that you’re able to find answers to your symptoms, and find a great team capable of the latest technology when the time is right.
    Be well, Tessa

  • Othmania
    Othmania, SUPPORT NETWORK Member Asks
    Q.

    "Hello, I'm a father of new born boy, today he has 2 months and 13 days old, he is 58 cm and 5.5 kg. We made an Echocardiogram one month ago and it shows as main results Aortic Area was 0.19 cm2 ; speed of blood flow 5 m/s and average gradiant of 65 mm hg. Yesterday we made a 2nd Echo and we found that Aortic area is 0.3-0.4 cm2 (means increased) ; speed of blood flow is about 5,3 m/s and average gradiant of 53 mm hg. Is the increase of the Aortic Area a sign that it's better to not do any surgey now and wait to see the evolution os status by time better? Is the Aortic Surface by itself a reliable input to say that status isn't severe aortic stenosis ? How much the normal Aortic Area should be for a normal baby similar to my boy (Body Surface of 0,309 m2) ?? Please your help and advice for a worried father. Thank you in advance."

    A.

    The gradient across the valve is what will drive the decision-making. With that gradient, there will likely be interest in intervention. The choices are a transcatheter balloon valvuloplasty or surgery. Which is the better option will depend on what the valve looks like (3 leaflets vs 2, etc). The aortic area will probably not be the primary determinant in when an intervention takes place. Thank you Dr. Breinholt

  • 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

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