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Fixing a Hole
In the old days, there wasn’t much anyone could do for babies born with serious heart problems. Today, a baby like John Leslie, born in April 2005 has a chance, given the right medical care. Baby John was born with a hole between the large blood vessels that serve the heart. It was a hole that should have closed in the womb, but never did.

The condition, called patent ductus ateriosus (PDA), can be non-surgically treated. Under a doctor’s care, with the infusion of certain pharmaceutical agents, it sometimes corrects itself. This was the case with Baby John, who did well in his first year of life.

“We had gotten to the point where our son was very normal, and there was no risk of cardiac arrest,” says John’s father, David, who works for GE in Connecticut. “But our pediatric cardiologist warned us of other risks. The hole can gradually reopen after the first year. Then, later in life, something as simple as dental work could cause a dangerous heart infection.”

There were non-health related concerns as well: With the hole left unrepaired, John might be considered by some insurance plans to have a preexisting condition.

“We thought it would be good to have it taken care of. ”PDA can be treated surgically, by sewing the hole closed. There is also another technique that avoids surgery: It allows the physician to thread a catheter (a thin wire) through the blood vessels into the heart. A plug or coil at the end of the wire is inserted into the hole and left there. Blood forms a clot around the plug or coil and that closes the hole.

The baby’s pediatric cardiologist suggested that they try the catheter procedure. David trusted the cardiologist, but thought he should get a second opinion first.

“I wanted to investigate the procedure and consult with as many people as I could,” he says. Getting an independent second opinion about the options available to us was very important to us.

Fortunately, David worked for a company that offered their employees access to Cleveland Clinic’s MyConsult online second opinion service. Just before Christmas, David went online, and followed the MyConsult instructions. These included gathering and sending the baby’s medical records to Cleveland Clinic.

The case was given to Larry Latson, M.D., head of the Section of Congenital Heart Disease at Cleveland Clinic Children’s Hospital, and one of America’s leading pediatric cardiologists.

As part of the second opinion process, the parents were able to present Dr. Latson very specific questions about Baby John’s condition and his treatment. They submitted the information just before Christmas and shortly after New Year’s, they received a detailed medical opinion from Dr. Latson.

“One of the advantages of this service is that you can make your questions very specific and get very specific written answers,” says David. “Dr. Latson gave us a good sense of the risks of each of our options.”

The report offered a thorough analysis of the baby’s condition. Dr. Latson reviewed all the potential treatment options: doing nothing, the catheter treatment, and surgery, giving the pros and cons of each. Finally, he recommended the catheter treatment – assuring David that complications were very rare.

With his MyConsult second opinion in hand, David scheduled the procedure for baby John. David appreciated having Dr. Latson’s detailed comments in writing. “It’s nice to have something to look at later and think about. When the procedure is taking place, you’re tense, you have a lot of questions. Having something written down is a real advantage. Dr. Latson’s report was very easy to understand.”

Baby John is doing very well following the procedure. “He had a follow up a week ago,” says his father, “and everything seems to be healing successfully.”

It is to be hoped that coming years will see John enjoy good health in every way. But if further problems occur, “I would obtain a second opinion from Cleveland Clinic again,” says David. “I recommend the service to others.”

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