Incorrect Diagnosis Results in Heart Failure

This cardiology ultrasound case takes place in Texas and involves a child who died after complications. The child had an ultrasound that showed a thickening of the left side of his heart. The child was admitted to the hospital, at which time he was noted to have a cardiac murmur. An initial echocardiogram indicated that the child had a severely dilated left ventricle with decreased function. The child had significant deterioration in the hours after he was admitted to the hospital. He did not respond to the medical management as would be expected in this scenario. He was on multiple cardiac medications to treat his condition, however the treating physicians had made a mistake when diagnosing the child’s condition, and missed a critical congenital defect that ultimately led to the child’s death.

Question(s) For Expert Witness

1. Please explain your qualifications to review this case. Are you familiar with the proper follow up protocols during pregnancy?

2. What steps should be taken when infant shows cardiac murmur? Please explain.

3. Have you ever reviewed a similar case? Please explain.

Expert Witness Response E-007617

TAPVR is among the few cardiac surgical emergencies. There is no good medical management. It requires surgical intervention to survive. Unfortunately, it looks like pulmonary hypertension, clinically, and often is treated as such initially. The diagnosis is made by echocardiography and it is important that the pulmonary veins are demonstrated returning to the left atrium. If not, you have to suspect this diagnosis. From the brief description, it appears either it was not seen on the initial echo, or it was not shown by the images obtained. The delay in diagnosis was related to the outcome. TAPVR is among the few cardiac surgical emergencies. There is no good medical management. It requires surgical intervention to survive. Unfortunately, it looks like pulmonary hypertension, clinically, and often is treated as such initially. The diagnosis is made by echocardiography and it is important that the pulmonary veins are demonstrated returning to the left atrium. If not, you have to suspect this diagnosis. From the brief description, it appears either it was not seen on the initial echo, or it was not shown by the images obtained. The delay in diagnosis was related to the outcome.