Remmy’s Story: Repairing Patent Ductus Arteriosus
When seven-year-old Remmy had occasional shortness of breath and seemed more tired than usual, it never occurred to his parents that he might have a problem with his heart.
“The first time we were told about a potential heart issue was in 2014 by our pediatrician,” says Imad, Remmy’s father. “My wife took our two kids for their regular checkups, and the pediatrician told her he heard a murmur in Remmy’s heart. We thought maybe it was just a one-time event and were not immediately concerned.”
A month later, Remmy was back in the pediatrician’s office with the flu, and after hearing the murmur again, the doctor referred the family to a pediatric cardiologist for further evaluation. “When the cardiologist told us there was no problem, we decided to seek a second opinion,” Imad says. “A second doctor diagnosed patent ductus arteriosus and suggested we wait a year to see if the hole would close spontaneously.”
Patent ductus arteriosus (PDA) is a birth defect that occurs when the baby’s blood vessel known as the ductus arteriosus remains open instead of closing properly during pregnancy. The opening allows oxygen-rich blood to flow from the aorta to mix with oxygen-poor blood from the pulmonary artery. The excess blood causes the heart and lungs to work harder, which may lead to fluid in the lungs and an enlarged left heart if left untreated.
After bouncing back and forth between the two physicians, Imad did some research online and asked doctors he knew and trusted for a recommendation, which led him to the office of John Breinholt III, M.D., chief of pediatric cardiology at Children’s Memorial Hermann Hospital and director of the division of Pediatric Cardiology at McGovern Medical School at UTHealth. Dr. Breinholt first saw Remmy in December 2015.
“Remmy was doing well,” Dr. Breinholt says. “But it was clear he was tiring more easily than normal. For the most part, Remmy was active and could keep up with his friends; but, like many children with patent ductus arteriosus – which occurs in about five out of every 1,000 births – if the defect is large enough to cause the heart to dilate, it should be closed.”
The family quickly felt comfortable with Dr. Breinholt. “Immediately when he did the first exam he could hear the murmur. He did diagnostic testing and after explaining the issue in depth, he advised us to have a minimally invasive procedure to repair the hole,” Imad says. “Dr. Breinholt was very thorough, down to earth and eased our concerns. We set the date for Dec. 23, 2015.”
Dr. Breinholt repaired the defect through a minimally invasive procedure called a transcatheter device closure via cardiac catheterization (cath), which occurred in the cardiac cath lab – different than a traditional operating room. During the procedure, a collapsed closure device, or a catheter, is threaded to the site of the abnormal blood vessel near the heart using the leg vein and artery. After being placed in position, the device is expanded to close the PDA.
Remmy was placed under general anesthesia and slept during the procedure. Like most children who undergo the procedure, Remmy went home the same day. After a few days of rest, children can resume normal activity.
Remmy went back to school in January and was looking forward to returning to his favorite sport – jumping on his trampoline. “We as parents were concerned about his heart, so we didn’t want him to do anything too active until after he saw Dr. Breinholt six weeks later,” Imad says. “Remmy’s teacher and classmates put a countdown clock up on the wall of the classroom with the follow-up visit date of Feb. 18.”
In February, Dr. Breinholt assured the family that all was well and Remmy was back on his trampoline soon after. Remmy had waited weeks before he was able to jump and even did a practice jump in the clinic to show Dr. Breinholt.
“We have a great appreciation for Dr. Breinholt and his wonderful work,” Imad says. “He makes everything very clear and straightforward for parents and the kids. It was a big relief for us that everything went so smoothly.”
Dr. Breinholt remembers the family – “They were very concerned about their child having a heart procedure. We understand that parents are scared when there’s concern that their child has heart disease, so we get them into the clinic as soon as possible to either ease their fears or address the problem. We want to make the process and experience pleasant and easy. At the end of the day, we are all about the children we treat and their families. When a surgery or catheterization needs to be done, we want families to know they’re receiving the most advanced and thorough care available.”