This case study focuses on a baby boy who was born with
a problem with his heart. The story is based on a real
scenario, though some of the names have been changed,
and the parents gave permission to include photos of the
infant. Students will read about symptoms that occur
when a baby is born with stenosis, or a narrowing of the
artery. Students consider treatment options and compare
the circulation of a fetus to that of an adult. Finally, the
Ross Procedure is described where a valve from the
pulmonary artery is moved to the aorta.
3-Do an internet search to find out what a normal fetal heart rate is? At what point in the graph would the doctor have become concerned
(circle) https://www.ncbi.nlm.nih.gov/pubmed/23761161
A cardiologist is brought in to determine what is wrong with Lucas’ heart. Doctor Brady performs an electrocardiogram to test for arterial stenosis, which
he suspects due to the clicking sound of the heart. The sound is often caused by a thickened valve. The electrocardiogram shows an enlargement of the left
ventricle and restricted blood flow in the aorta. The ECG shows no evidence of a ventricular septal defect, a common heart defect seen in newborns.
Aortic stenosis is a term used to describe congenital heart defects that obstruct blood flow from the heart to the body. Significant aortic stenosis is
relatively uncommon, affecting about 6 of every 1000 babies born, occurring more often in boys. Aortic stenosis is narrowing of the aortic valve, impeding
delivery of blood from the heart to the body. Since the left heart has to work much harder to pump blood to the body,aortic stenosis is diagnosed as either
mild, moderate or severe. If the problem is not treated, this overwork causes a thickening of the heart muscle called ventricular hypertrophy.
1-What is causing the “click” sound in Lucas’ heart? Compare with normal Lub-Dup.
https://www.sharecare.com/health/circulatory-system-health/causes-the-sound-of-heartbeat
2-What is an electrocardiogram(ECG)?
3-Define ventricle septal defect.
4.Discuss the symptoms for ventricular hypertrophy and arterial stenosis.
You may use the links below for extra help
https://www.mayoclinic.org/diseases-conditions/left-ventricular-hypertrophy/symptoms-causes/syc-20374314
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis
Part III - Lucas Needs a Procedure
After several days in the I.C.U, (Intensive care unit , is a special department of a
hospital or health care facility that provides intensive treatment medicine.)
Lucas’ vitals are stable, but the blockage in his aorta needs to be repaired. Doctor
Brady suggests a minimally invasive procedure called a balloon angioplasty, a
balloon dilation, a procedure done in the cardiac lab. During the procedure,
catheters (thin plastic tubes) are placed into the large blood vessels in the legs and
gently guided to the heart.
The catheter tip is placed across the aortic valve and the balloon tip is inflated. The balloon gently dilates the narrowed area.
With minimal side effects Doctor Brady thinks that this procedure can cause relief of Lucas’s symptoms for several years. The
doctor does warn Kelly and Chris that as Lucas grows he may need another procedure to open the valves again, or potentially
need a new heart valve.
Lucas remains in the hospital for another week and Doctor Brady confirms that his vital signs have become normal. Lucas is
finally allowed to go home!
1-Define balloon angioplasty
2-Sketch a diagram of the arterial system to show how Lucas’ procedure will be performed, include the aorta,and the
balloon.
https://www.heart.org/-/media/data-import/downloadables/pe-abh-what-is-coronary-angioplasty-ucm_300437.pdf
Part IV - 10 Years Later
Lucas grew up as a normal child, and many of his teachers never even knew he was born with
such a major problem with his tiny heart. Lucas would see many cardiologists over the years
and is constantly monitored for problems with his heart. Kelly and Chris knew that eventually,
they would need to have another surgery.
. When Lucas was 11 years old, his parents received the news they had been dreading: the
valve was no longer open enough to provide enough blood flow. They had performed a what is
called a Ross Procedure, where the valve is replaced entirely.
1-What is Ross procedure? What are the advantages and disadvantages of the
procedures?
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatmentoptions/ross-procedure
2-“Patient Choice” is somewhat controversial given then many patients do not have a full understanding of
anatomy to make the correct choice.
Do you think the doctor should just tell Chris and Kelly what to do, or do you think it is better for patients (or
parents of patients) to make the choice? Explain your position.