One For the Heart

A UN of doctors saves a little American from ventricular septal defect

Well, damn! That's some great news. We could pretty much put it out of our minds, and we almost did. We moved back to Miami. As I say, Joe was healthy and active. He still is. He's down at Carver Elementary as I write this. And he'll come home this afternoon and climb the frangipani in our yard like he does almost every day, keep going up until we tell him he's too high. Then he'll come in and wrestle with his brothers. The whole regular little-kid routine.

But by last March, we'd scheduled him for surgery.

A token of Joe's classmates' esteem
A token of Joe's classmates' esteem
The heart itself looked like a smallish, wet, red mango; into the ventricle, there was a lot of white tissue, with just a slot through it -- it was all scar tissue, a large obstruction
The heart itself looked like a smallish, wet, red mango; into the ventricle, there was a lot of white tissue, with just a slot through it -- it was all scar tissue, a large obstruction

What happened was that Joe's Miami pediatrician suggested an eminent pediatric cardiologist at Miami Children's Hospital named Anthony Chang (now at Texas Children's Hospital in Houston). We took him for a full checkup. EKG, echo, blood tests, everything. And he looked good.

But Dr. Chang, in his handsomely appointed offices, described a condition sometimes associated with VSD. It involves growth of extraneous muscle that is a kind of scar tissue on the inside of the ventricle. If this tissue grows and keeps growing, it can reduce the volume of the chamber, making the heart year by year less efficient, oblige that ventricle to work harder and thus get bigger and harder, just like it was pumping iron instead of your life's essence. This is called hypertrophy, and it's bad. Or worse, the muscle can grow in a band, toward the center of the chamber from the wall of the ventricle, all around the inner circumference, and eventually choke it off. That will eventually produce heart failure.

At first it was just a possibility, Dr. Chang said. Though he did say he saw on the echo the faint beginning of something that looked like it might become troublesome. We should have an echo done annually, to keep tabs on how this possible condition was progressing.

Joe had had only non-American doctors before. They'd all been from developing countries, except one, the Italian. And he, the sole G7 First Worlder in the lot, was the only bad one. He'd missed by a life.

Chang was right on the money. What he said might happen, happened. A superb diagnosis of something that was hardly there, two years in advance.

The man who called for surgery, Joseph's latest cardiologist (Chang had moved on), also made a favorable impression on us. He's Iraqi. Abdul Aldousany, down in Kendall. I picked Joe up in mid-January after school and drove him there for a routine checkup.

My son knows he's got this little hole in his heart.

"Where are we going, Dad?"

"To the cardiologist. For a checkup."

"To the hospital?"

"No, just the doctor's office."

"Will he give me a shot?"

"No. Nothing will hurt. They'll put those little stickers on you and the machine will draw lines on paper from your heartbeat. Then he'll put some of that jelly on your chest and rub it around with that thing, like a scope, that lets him see your heart."

"To check the hole?"


"Dad, what happens if it gets bigger?"

"Well, I don't think it will. Nobody ever mentioned that. But if it did, I guess we'd have to get it fixed."

That was it on that subject. He saw a limousine or a punchbuggy (VW Beetle) go by, or something else he was interested in, and the subject of having to fix his heart was dropped. It fell completely from my mind, too. I wanted it to.

The nurse did the EKG. Then we went into another room and Joe lay down on another examination table and Dr. Aldousany came in and proceeded with the echo. I'd seen a few of these by now, between cardiograms on Joe and the various sonograms of my unborn sons, and was able to follow them pretty well, visualize what we were looking at. The vertical line of septum separating the ventricles is clear. He switched on the color coding, which shows the blood at varying degrees of pressure in gradients of color, and you could see the pulsing stream shooting through the hole. It looked as tiny as ever, which is what I expected to see. So much so that I wouldn't even say I was relieved. It was status quo. Normal.

But the doctor was quite intent on the screen. Joe is good at this, and was staying still. If he'd shift a little, Aldousany would say, "Easy Joseph, don't move." And he was looking at that right ventricle, the one that pumps deoxygenated blood up into the pulmonary artery, which carries it to the lungs to get recharged with the good O that keeps us going. And I could see clearly the pulmonary artery and the valve at the base of it that was opening to let the pumped blood in. Not far below that valve, about two-thirds of the way up the ventricle, was a white line almost across the chamber, thicker at the ends where it attached to the wall, and thin as a pinstripe in the middle.

As I said, I've seen several of these echocardiograms and was familiar with the basic layout of this miraculous little pump. But I'm no heart doctor, so I still wasn't alarmed, and I pointed to the line across the ventricle and said, "That's supposed to be there, right?"

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