Monday, May 10, 2010

Ventricular Septal Defect (VSD)

VSD is the most common congenital anomaly of the heart and it accounts for 15-25% of congenital heart disease. This is described as a "hole in the heart". The heart is made of 4 chambers the right and left atrium on top of the right and left ventricles. Unoxygenated blood comes from all the body and is channeled into the right atrium this then goes to the right ventricle and this gets oxygenated through the lungs then passes the left atrium to the left ventricle and this becomes oxygenated blood that gets distributed through the aorta to the rest of the body. The VSD is basically a hole in between the chambers of the ventricles that result in mixing of the oxygenated and unoxygenated blood.

Usually for the first few weeks of life a heart murmur can be heard by your doctor and most of the babies will be asymptomatic especially when the VSD is small. In some cases when the VSD is moderate or large the babies will not be gaining enough weight. They will be breathing faster than usual and sometimes their color looks dusky from time to time.

Small VSD usually close over time. This will be followed-up by the baby's cardiologist Moderate to large VSDs might need surgical intervention but they do not do the surgery till the baby is about 6 months of age. They want the baby to be gaining enough weight by giving them a high caloric diet at 24 to 26 kcal per ounce and putting some feeding tube to help them gain weight.They also start them on some diuretics or heart medicine to help maintain them and try to control their symptoms.

The great thing about this ventricular septal defects is that most of them resolve on its own and it is easily correctable by surgery.

Tuesday, May 4, 2010

What is Bell's Palsy?

The chief complaint that you would hear most of the time would be "one side of my child's face does not seem to be moving, this is more noticeable when he cries, laughs or screams". The child will be unable to close the eye on the affected side and the corner of the mouth will droop. This is considered a common disorder in infancy to adolescence. Taste on the front of the tongue might be lost but there should be no numbness to the area. The most important thing you want to prevent is dryness of the affected are which will result in keratitis. Your doctor will prescribe some eye drops to prevent this from happening. The facial nerve on the affected side is considered to be swollen thus this symptoms appear.

The most common reason for this palsy is that the child had some type of viral infection approximately 2 weeks prior to the event. Most common cause is the Epstein-Barr virus, Lyme disease (you usually see this in the Northeast area), herpesvirus and mumps virus. This has excellent prognosis because 85% will resolve completely without residuals, 10% with very mild residual weakness and only 5% are left with severe facial weakness.

Steroids do not induce remission and is not recommended but since the pathophysiology is swelling of the facial nerve some people think that this might help a little bit. If palsy seems to be chronic or persistent you need to consider other facial nerve tumors that can impinge on the nerve to present with the symptoms. Physical therapy might help a little bit in the recovery process.