Keely’s Heart Surgery

Hi, my name is Keely Jane and I am 3 yrs old. I went to the doctor and found out I have a hole in my heart so now mommy and daddy  have to take to Seattle for surgery...
Below is a little info to explain my surgery and what they are going to do.

My surgery is in April and we need the money by April 20th when we leave my surgery is the 22nd thank you guys for helping and caring. I know I’ll be ok but mommy and daddy are nervous.

Diagnostic Studies:

ECG: Sinus rhythm, possible right ventricular

hypertrophy, nonspecific precordial repolarization

abnormality

ECHO: Moderate to large secundum atrial septal

defect with left-to-right shunting. Moderate right

heart dilation with normal RV systolic function and

mild interventricular septal flattening throughout

the cardiac cycle consistent with increased RV

volumes. Normal left ventricular size and systolic

function. Normal peak average LV global

longitudinal strain of -23.5%. there is prominent

flow visualized through the pulmonary veins with mean gradient of 2-3 mmHg through the left lower pulmonary vein which is likely secondary to increased flow volume.

Assessment & Recommendations:

Keely's echocardiogram today demonstrates a

moderate to large secundum atrial septal defect with moderate right heart dilation as a result of her intracardiac shunting. I also note some mild flow turbulence through the left lower pulmonary vein with mean gradient of 2 to 3 mmHg although I suspect this is secondary to increased flow volume from her ASD shunt. Clinically she seems to be doing quite well and I think it is unlikely that

her intermittent symptoms of palpitations

represent an arrhythmia although there is a small potential for this. I encouraged her mother to check Keely's heart rate the next time she complains of the symptoms since I would expect if her heart rate is less than 200 bpm it would be quite unlikely she is experiencing an inappropriate tachycardia whereas above 220 bpm would be highly suspicious for an arrhythmia. Given that she is nearly 4 years of age in the setting of a significant ASD with hemodynamic effect I have low optimism that there will be any positive evolution in her ASD and thus feel she warrants intervention to close the defect. Based on the echocardiographic appearance I am optimistic she will be a good candidate for percutaneous device closure of her ASD and the family seems quite interested in this option over surgical intervention.

Given her size I think this could safely be done with low risk for complication at any time and since she is doing well clinically I feel this could be done on an elective basis at the family's convenience.

Since we are in the midst of the winter months

with increased risk for travel the family is

interested in postponing an intervention until the spring which I think is quite reasonable. I told the family I would reach out to the interventional cardiologist at Seattle Children's Hospital to review

her echocardiogram and assuming they are in

agreement with then ask the schedulers to find a time for Keely's procedure which works best for all involved. She requires no restrictions or medications from a cardiac perspective. SBE prophylaxis is not indicated. She should continue routine care with her primary care provider, I will

plan to see her in follow-up at the recommendation of the interventional cardiologist after she is discharged from her procedure. I asked her parents to contact me at any time if they have concerns in the interim although I think this is unlikely to be necessary. I spent an extensive amount of time discussing the etiology and natural history of hemodynamically significant atrial septal

defects as well as cardiac and noncardiac

etiologies of tachycardia, testing strategies,

potential complications, interventional options, long-term health considerations and my expectations for Keely's course with her mother as well as her father via telephone today. They expressed understanding of and agreement with. 

I know it's a lot but thanks for taking the time to read, and thanks in advance for your donations!  ❤️