What does intact septal defect mean?

Hi,

Welcome to icliniq.com.

Thank you for sharing your wife's history, diagnosis, and pertinent reports (attachment removed to protect patient identity).

1. First of all, your baby has a normal heart and has no heart problems.
2. All fetuses when inside the womb of the mother, they are required to have a small hole in between the top two chambers of the heart. This is called foramen ovale. I call this as a normal hole all fetuses have and after the fetus gets delivered, this normal hole spontaneously closes.
3. In some babies, it might take just a few hours, and in some babies a few days for this to close. So, your baby has a similar normal hole in between the top two chambers of the heart and is a small one. It will close by itself after the baby gets delivered.
4. The ventricular septum is the wall that separates the two bottom pumping chambers of the heart. There is no hole in this wall in a normal heart. In your baby's fetal echo, they mentioned that this wall is intact, meaning that they did not see any problem causing a hole. This is good news.
5. Because your wife has an inflammatory, connective tissue disease called SLE (systemic lupus erythematosus), there will be antibodies in her that can pass to the baby and react with the baby's heart especially the electrical cells of the heart. Hence, the previous baby had a congenital heart block.
6. There are chances for this to reoccur in future pregnancies. Hence, some medications suppress this inflammation. Your wife is appropriately being placed on such anti-inflammatory medicines namely Wysolone (Prednisolone) and HCQ 200 (Hydroxychloroquine).
7. The good news for now is that there is no problem with the baby's heart rate and there is no evidence of heart block in the fetal echo. But, she needs to be constantly monitored for the baby's heart rate as the problem can happen later also.
8. Your baby has just a normal hole and will close spontaneously after delivery. There is no problem with holes in the heart as per the echo report and hence, no surgical intervention is needed.

Hi,

Welcome back to icliniq.com.

Thank you for your positive feedback and I greatly appreciate it.

1. There is no proven evidence of routinely giving prenatal Prednisone to prevent heart block in future pregnancies.

2. According to the echo report, the fetal heart rate is normal. But, I do not see a mechanical PR interval measurement in this report.

3. If this is also normal, then there is no evidence of even first degree heart block, which is an early evidence of damage to the electrical cells in fetal heart due to the antibodies.

4. Assuming that there is no first degree heart block in the current baby, routinely giving Wysolone to mom is of no benefit. Also, this medication is with some side effects to both mom and baby.

5. Please ask the cardiologist if there is a first degree heart block in the fetus, if there is none, then Wyslone is not recommended. But ,if there is evidence of first degree heart block in the fetus, then maybe there is an indication for steroid medicine.

6. Again the picture shows (attachment removed to protect patient identity) the small hole in between top two chambers of heart, which is a normal hole in the fetus. There is nothing to worry about the hole here.

Mr.Hari, Thank you for contacting icliniq again. Great that the mechanical PR interval is normal. Fetal heart rate is also normal. 1. The most vulnerable period for heart block to happen is 18-24 weeks. She is probably already 23 weeks now right and its good that there is no evidence for heart block. 2. Wyslone is started only to prevent heart block in baby by your doctors right? Is this correct? The reason i ask this is because prednisone can be used for any maternal indication but not for the baby. 2.As i mentioned in my earlier answer, prednisone is not recommended for preventing heart block in future pregnancies. It does not cross placenta and does not reach the fetus at all. But it comes with side effects to both baby and mother. Also long term studies have shown neurodevelopmental abnormalities in the childhood for fetuses exposed to steroids for long time. 3. I recommend constant monitoring for fetal heart rate, PR interval atleast every 2 weeks. Recommend stopping prednisone. HCQ may be continued because it is for maternal indication. Hope this helps. Thanks for contacting me again.

Mr.Hari, I am quoting below a journal from rheumatology. Refer to first paragraph in page 2 regarding nonflourinated steroid use. It clearly explains why prednisone is not helpful in prevention of heart block in fetus as it does not cross placenta to reach the fetus. Rheumatology (Oxford). 2008 Jun;47 Suppl 3:iii35-7. doi: 10.1093/rheumatology/ken153. Prevention of congenital heart block in children of SSA-positive mothers. With the above evidence as well as with my clinical experience, I recommend stopping prednisone. however, HCQ has shown to have some benefit and hence it can be continued. Hope this helps.

Dear Hari, Congratulations! That's great to hear about the health of your baby. I looked at the ECGs and its not unusual to have a some what long QTc in new born period. Anyways, better to repeat it in 3 months of age as your doctor had suggested to make sure its not a true long QT syndrome. Once again congratulations and great to hear back from you.

Hi Sinus rhythm is normal rhythm or normal pattern of heart beat. So, your baby's heart is beating normally. Repeat ECG in 3 months to follow up on QTc interval. No other follow up is required if theECG is normal at 3 months. Everything is reassuring so far. Hopefully that clears your concerns. Thanks