HPLS - Left heart syndrome

We went for an amnio at 16 weeks due to my age of 38. Our biggest concern was the risks associated with the amnio - so we thought.

nstead we walked out of the clinic with the probable diagnosis that our baby has Hypoplastic left heart syndrome or double outlet right ventricle or both! They can't usually diagnose at this early stage, so would suggest the severity of the condition.

We were advised to have an additional test done as a part of the amnio to rule out any genetic problems which sounded horrific, and the recommendation was termination.

We were told the best case was 3 open heart surgeries before our child is 2 and they probably wouldn't live past 6!

Thank goodness we have two healthy children who have kept our feet on the ground and made us realise how lucky we are, while we wait the two weeks till our 18 week ultrasound to determine a confirmed diagnosis.

We live in regional area with limited support services - and 3.5 - 4 hours from Melbourne.

My frustration was we were handed this "diagnosis" with no further information or access to support services for this 2 weeks. The major focus seemed to be on termination.

Has anyone else been in a similar situation? If I was to find this out later in pregnancy there would be no decisions and we would be going down the operation path to save our child. Instead we have been handed this at 16 weeks - and told we will have a decision to make.

As my husband says, if only someone would tell us what we have to do...

Instead we have another week to wait for the next ultrasound.

Nicolabee my heart goes out to you :hug: I was in the same situation about 6 years ago when my son was diagnosed with Left Heart Syndrome inutero. We were told to terminate, too, but we didn't. He did have two surgeries when he was born (for other congenital heart defects) and today is a healthy and happy boy.

I know how upsetting and awful it is to hear that diagnosis :hug: hope the next scan brings good news for you.

Nicolabee - Yes we have this too - actually our son has Hypoplastic Right Heart plus five other heart defects.

We found out at 20 weeks and were offered termination up to 24 weeks. He has had several heart operations - in Royal Childrens Melb. We are from Adelaide.

Our son is now 4.5 years old and still has issues with his heart - there is no "cure". If you want to chat here you can ask anything (I mean anything) and I will be honest with you. Or you are welcome to PM me if you would prefer.

My heart goes out to you. Is this your first baby? Our son was our first - I am now expecting our second and have just passed the 20 week u/s with a clean bill of health for this ones heart!! Yay!!

Thinking of you and your DH.

Rachel

Hi Rachel

Thankyou for your willingness to share - I really do appreciate it - and understand that it is not easy.

Do you mind me asking if they diagnosed all the problems with your sons heart in utero or did you find out more when he was born?

In response to your question, we have two children, a son 6 (Grade 1) and a 3 year old daughter - they are currently fighting over whether it is a boy or a girl - they have no idea what is going on.

So, we have them to consider in whatever decision we make; and like you we do not live near Melbourne (rather a 4 hour drive)

I guess my big question is - did you at any time consider termination? What was the driving force behind your decision to continue your pregnancy? (a question I am sure that is hard to answer now when you look at your little boy and the joy he has no doubt brought you)

One other question - what is PM? I am new to the forum!

Nicole

Hi Nicole,

All but one of our son's heart defects were picked up in-utero. The only one that wasnt was not possible to see via a scan. We had the initial 20 week scan with a normal technician and then were refered to our major Children's hospital for a scan with a Pediatric Cardiologist within four days. That is what you need, not another technician but a Paed Cardiologist. Do you have private helath insurance?? If you do it means that you can have the same cardiologist and surgeon each time but if not you will still get the best person for the job - just not the same one each time. We went private and I know that helped me cope as we were able to build up very strong relationships with our care givers.

By the way RCH in Melb is the best hospital in Australasia for this surgery. People fly in from not only other states but overseas to go to RCH!

Once we had the (three hour!!) scan with our Paed Cardiologist (Dr Gavin Wheaton) he then spent the next hour talking us through what he had found, what it meant for the baby in terms of surgery and life expectancy and that yes we did need to think about termination. So my DH and I took a couple of days off work and just talked. I really wanted to at least talk about termination just to be sure we were both on the same page and being honest with each other - not trying to hide anything from the other to save an upset. So we considered it and our decision was based on the information gathered from Gavin (and there were phone calls to him as well). We decided to go ahead because while our son's life would start with surgery and need a couple in the first few years it was felt that from that point on he would have a physically limited but otherwise good quality of life. Albeit a shorter one than we had expected. So really it was about how much of an impact this would have on his life - would it mean constant pain or significant limitations or very short life etc.

All did not go to plan (sorry if this is distressing but I would have wanted someone to be honest with me) and our boy was small at birth (unrelated pregnancy complications - 3lb 10oz / 1.6kg birth wt) and his first trip to RCH resulted in not a great outcome with additional complications. That is the ONLY time I have second-guessed our decision about continuing with the preg. I was told that DS wasnt expected to live due to complications and at that point I thought that I had brought our son into the world only to go through surgery and complication and then to die. BUT he didnt.

He has had more surgery than any of us could have predicted and as I said in my previous post has not received a "cure" or in medical terms a "repair".

There are great resources available to you in Vic. Please go to the HeartKids Vic website and find out your local contact or ring the RCH and ask for Leanne Foster who is the head Social Worker attached to the cardiac ward - she often deals with families of children with HL/RHS. Also ask her for the book "There is no such thing as a silly question" it will help you a lot. You can tell her Roman's mum (from Adel) sent you!

PM means Private Message and is an icon next to my details at the top right of the panel with any message from me and I think you can also click on my name to do it??! Not good at that myself yet. Its like sending me an email instead of chatting in the public forums.

Rachel

Nicole a PM is a private message, but this function is not available until you've reached a minimum post count.

:hug::hug:

:pray:will be thinking of you over the next two weeks.... So sorry there is no one to tell you what to do either. Hope your other two kids can give you some extra strength in the coming days.......

Thank you everyone for your good wishes and explanations on how things work on the site.

It will be a long week, but until we know what are particular "issues" are there is little that we can do.



Rachel, the sharing of your experience is truly appreciated - and thank you for being so open and honest, we do need to know the good the bad and the ugly, so that we go into this with our eyes open. (Not that I expect you could ever be prepared)

I had no idea the scan would take 3 hours! I think I will phone the social worker you referred to and see what information they can offer us prior to our appointment.

MistyFying, you give me a glimmer of hope that perhaps we may walk away on Friday with a different result to our original scan? (However small) Do you have the all clear following your initial operations or do you face further down the track?

We do so treasure our two beautiful children, and count our blessings that they are happy and healthy.

I thought I would return and update, given our appointment with the cardiologist yesterday - while we do not have HPLHS or DORV the prognosis is apparently much the same - it is either double inlet left ventricle or Hypolplastic tricuspoid valve and Hypoplastic right ventricle.

In all - this is a 1 in 20,000 event, while HPLHS is 1 in 5000. We initially thought that perhaps this is a better result - but the cardiologist tells us that this is not the case there is no differentiation between the two (HPLHS and this). Thought the risks with the first operation seem significantly reduced.

We spent a pretty solid day yesterday with Dr's obstetricians, Social Workers and the like finding out about our options in a fair bit of detail.

Basically we have 4 weeks maximum to decide if we are to proceed with the pregnancy or terminate. There is no easy answer.

My mind is going around in circles - next step is a Psycologist (I think that is it) on Tuesday who will help us work through the pros and cons of each option.

Nicole

Hi Nicole,

I am so terribly sorry that you have found yourself in this situation, I sympathise with you. It sounds like you are taking all of the right steps to get as much information as possible. I have been in a very similar position.

At my 12-wk scan there was a very high nuchal fold, after doing a CVS we found out that there was a chromosome problem called mosacism. Instead of there being a 'trisomy' so a whole extra chromosome, there were extra 'fragments' of DNA in 70% of the cells, which geneticist's have told me is extremely rare (I also had an amnio to confirm this). Anyway, all of this resulted in a serious heart condition very similar to what your bub has. There were some other markers that were starting to appear like fluid around the brain and and obstructed bowel. She was also behind in development. No one could tell us if other problems would arise, as they couldn't tell what chromosome the fragments belonged to, but it wasn't looking good.

We decided to terminate at 19-wks based on the seriousness of the heart condition, the chromosome abnormality & the other problems, like the fluid on the brain.

There were times where I really lost it thinking I had done the wrong thing and what if the doctors got it wrong etc. The prelimanary results showed that the heart condition was what they expected, but worse. This gave me a little peace. It has been 7-mths since I lost her and it still really hurts but I feel my DH & I made the best decision for her and us, as hard as that is to say.

I don't wish to upset you as I know how distraught you would already be. I just wanted to be honest about my experience. It's encouraging to read some of the other ladies stories, and that there bubs are pulling through. Also, It doesn't sound like your bubs has a chromosome problem, so there is a big difference there. Big hugs to you as you and your DH make this difficult decision :hug:. If you have any questions at all please don't hesitate. All the best to you.

Nicole, I was wondering where you were up to with getting the next scan plus all the consults.

Good idea to see the Physc - my DH and I saw one together when we needed to make a decision around palliative or repair surgical options for our DS. We really benefited from someone helping us to get clear on the options and how we would come to a decision. My DH and I process info and decisions so differently that it was really helpful to talk about HOW the decision was to be made and not just WHAT decision was to be made.

If there is ANYTHING you need from me, more info, more quest, just anything; please let me know.

Its such a hard and confusing and conflicting time - I am thinking of you.

Rachel

Thank you for letting us know how you are doing. Such a pity that the results couldnt have been better on friday.

Just keep in mind that we are all here for you! Whatever you need! :hug:

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There were times where I really lost it thinking I had done the wrong thing and what if the doctors got it wrong etc.

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:hug: for you too hun, so sorry you have had to live through the last few months!

Thank you Berry1 - I totally understand your comment "what if they got it wrong" - that is extremely frightening to me also (they assure me in our case this is not the case) - however I have read how things have been different at birth to that diagnosed during the early ultrasounds. Take comfort from the results, it sounds like they reaffirmed your decision.

I am totally torn at the moment - we have a tentative booking for a termination commencing Friday (the tablets) and induce labour on the Monday - we are under to obligation to proceed, but risk having to wait a week to 10 days after making a decision otherwise. (When I make up my mind, I need to do it "now")

We have gone through all the reasons why a termination makes sense for us - our two children at home while away with operations; what they would miss out on while caring for a child with additional needs (possibly special needs), our distance from Melbourne and specialty services (4 hours), our age, the risk to our unborn child at every turn - complications, infections - from the time it takes its first breath and that this is a palliative option - they will never be "fixed". I question whether I have the strength to watch my child go through so much - I look at my 6 year old and 3 year old and know how I would feel if something was to happen to them or if I were to lose them now.

BUT, then I look at our preliminary diagnosis - because the issue is now with the right ventricle, the risks associated with the first operation are 5% versus 25% with the left ventricle (installation of a stint - no heart bypass or reconstruction of aorta) - and that is if the operation is required. We then join HLHS babies with all the same risks and same operations and probable need for heart transplant. We have been told that there are usually no other associated problems with this abnormality, and have been cleared for genetic issues. Our baby is growing at the normal rate for 19 weeks gestation. Am I being selfish not giving our child a chance at life? Is it my right to take that away?

Had we gone into Friday, determined that we would do anything for this child, we would have been excited with the revised diagnosis.

I think I have a conflict of head and heart - but I can't yet make a decision with any real confidence (it changes daily).

DH is very rational and works through things logically - he is struggling with the choice, but sees termination as our best long term option - while I say that, dealing with a termination is another thing all together.

I am starting to question whether or not I will ever reach a point where I am at peace with my decision.

Thank you Rachel - I am hoping that speaking with the Psch will help us reach some conclusion with confidence.

Thank you everyone for your support.

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I am starting to question whether or not I will ever reach a point where I am at peace with my decision.

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you are probably right.... to have a child with special needs (huge),to see what your other children have to miss out on because of this (huge), to add that extra stress to your marriage (huge), to have to live through an induction and a birth of a child that will 'look' perfect but know you made the decision to end the pregnancy (huge)...

All i know is either option will be hard on you and your family. There will be people that will not understand your decision no matter what you choose....

I know that there will be bad days, but i also know that you DO have the strength to get through this.... However much support you need, we are here for you!

Tegam, thank you for your kind words.

Nicole, I have been really feeling for you and hope you are holding up ok. In terms of 'questioning whether you will come to a place of peace with your decision' I understand what you mean. In my situation, I wasn't so much 'at peace' because making that decision as a women who desperately wants that baby goes against your natural instincts, but I did come to a place where I knew it was the best thing to do for her. What really helped me cope afterwards was knowing that before we made the decision, we saw every specialist we could, did all the tests we could and explored every option and took into account the 'solid facts'. Also, getting support & understanding of my decision from those closest to me was really important, as I needed them to reassure me after the event. My husband was very rationale about the decision as well, it took me longer to get there, but we did it together, which is vitally important.

It's good that you are taking this week to think & talk about it and to see a psch, all really good steps. If you have any questions at all, please do ask. Obviously I can only offer advise from one perspective, but there are some great ladies here who can certainly give advise from the other, which is important. Hugs to you this week :hug:

Nicolabee I'm sorry you're in the midst of this right now :hug:

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(installation of a stint - no heart bypass or reconstruction of aorta)

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this is what my son had done when he was born. He had the stint at 3 days, and then underwent bypass surgery at 3 months to close some major holes in his heart. He recovered very quickly from the open heart surgery and was home in 10 days.

You asked what his prognosis is - I go back to his cardiologist once a year to check the repairs are growing with his body (the stint is synthetic). The cardiologist does an echo, takes blood pressure, checks circulation, height, weight etc to ensure everything is ok. He will only have to have more surgery if one of the repairs fails (they think this is very unlikely). He was in hospital for 3 months when he was born. We lived approx 70 mins from the hospital and I travelled up and back each day and my husband went in every night after work for a visit, and we had an 18 month old at home to look after. The 18 month old hasn't shown any real after-effects of the turmoil during that period of her life (just to reassure you that your other kids will be fine - don't let that weigh too heavily on your mind when making your decision).

I know just how awful it is to know there may be something wrong with your baby :hug:

Berry1, you certainly sound as if you exhausted all possibilities before making your heartbreaking decision. That is what I wish to achieve, but still feel like I have a long way to go.

MistyFying, by what they have told us, it sounds as if your son's situation is different to ours - they are talking the stint, then the same 2 operations as for HLHS finishing with the Fontan, and all the long term issues of it being palliative and not a "fix". Is this the same path that you are on, or is it different? (as this sounds a lot more positive than that put forward to us)

I do wonder if what they see now in their ultrasounds is what they would see in another 4 weeks, let alone at birth? When we asked this they were quite adamant that it wont change.

DH and I have major issues at the moment with the thought of termination and burying a child whose life we will have brought to an end. Can we live with ourselves, and is that our right if there is a viable option for a somewhat healthy life, even if it does come with risks?

We still need to explore these options further. I am going to try and make contact with the cardiologist again at the RCH to answer our questions.

Thankyou everyone for your support and the sharing of your experiences, we really appreciate it.

Nicole

Nicole, have you been told that it is a palliative and not repair pathway? I would hate to think you had this thought from me and not your cardiologist. There is such a great difference in the outcome and quality of life; as you can see Mistyfying's son and mine have quite different stories.

If you have been told of the longer term needs/issues that can make a significant difference to your decision. Also, the best information they can give you is based on todays technology. So my sons life expectancy is too short (for me to be comfortable with) but is based on todays ability not on what medical sicience will be able to offer us in the next decade or two. We have stored our sons stem cells from birth to be used for him when the science has the abilty to grow another heart for him.

I am not pro-life and would not dream of trying to sway you either way. I just am trying to offer you a longer term view - such a hard thing to get a hold of when you are confronted with the imediacy of your babies need for surgery soon after birth and time in hospt etc.

The last few years have been incredibly hard for us and at the same time as we have experienced great and terrible sorrow and despair we have also experience overwhelming joy and thankfulness for things that may appear trivial to others.

Rachel

DOH! Posted at the same time as you Nicole.

Our DS has a Fontan!

Nicole, I hope you are doing ok hun. Thinking of you :hug:

Laura Grace was born at 2.14 on Monday 25th May 2009 - to early for this world.

She was perfect, tiny but perfect - but with a heart that could not sustain her life.

Thank you everyone for your support and the sharing of your stories. You are all very brave - much braver than I could ever be.

Nicole, I am so sorry for you loss. My heart goes out to you and your family. You are brave. Just know that I am thinking of you and sending you love.

Laura Grace is a beautiful name.

Rachel

Nicole, I am sorry for your loss hun :hug:, such a difficult thing for a mum to go through. Your beautiful girl is in peace and pain free. Be kind to yourself during this difficult time. Thinking of you.

I am so sorry to hear of your loss. :hug:

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Laura Grace was born at 2.14 on Monday 25th May 2009 - to early for this world.

She was perfect, tiny but perfect - but with a heart that could not sustain her life.

Thank you everyone for your support and the sharing of your stories. You are all very brave - much braver than I could ever be.

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Beautiful name for im sure a beautiful Girl! So sorry her little heart was not for this world...

YOU ARE BRAVE! I can not comprehend how you are feeling and what you have been through. I hope your DH and extended family are ok and that your other children give you strength at this time.

Wishing i could give you a real life hug or at least cook you dinner......

i;m so sorry to hear about your little girl

Yesterday was Laura's due date. It's surprising sometimes, how you do find the strength to soldier on.

I would like to share the next part of our story, for those who may be searching for information as I was; as to possible outcomes.

We consented to Laura having an autopsy to confirm the diagnosis, this was quite scary, as I was petrified they would come back and say, "sorry, we got that a bit wrong, not quite as a bad as we thought". But that was not the case.

Firstly I would like to say, we had the support of the Fetal Management Unit at the Royal Womens Hospital in Melbourne. They were fantastic and couldn't do enough for us, in providing information to assist us in making decisions (would never once tell us what we should do - and we asked!), to helping explain results, and sometimes answer the same questions. They have all the specialists down one corridor. We spoke to Neonatologists, cardiologists, geneticists, psychologists, social workers, obstetricians and their fantastic coordinator a midwife (and Mum) during our many visits.

We now know that (as a result of a new DNA array test) that Laura was missing some DNA, not chromosomes, but small peaces of DNA. These particular DNA are linked in with the heart. Laura's case so far is unique, however some similar cases (missing less DNA than Laura) show children with significant brain damage; delayed speech, lack of muscle control to name a few. She was also extremely small - less than the 5th percentile for her gestation.

In summary Laura had three major issues - severe growth restriction; the DNA deletion; and the Hypolplastic Right Heart. The geneticist explained to us that each one these issues was potentially fatal on its own, let alone stacked upon each other. It appears that each of these issues were interdependent, not isolated occurrences.

Had we not made the choice we did - when we did; we were probably going to be faced with a similar dilemma in another couple of weeks due to her restricted growth, to deliver early (c section) or allow her to die in utero (due to the placenta not feeding her - it was equivalent to that of a 14 week at 20 weeks).

At the same time; for heart surgery to be successful, we were constantly told, she would need to be full term and a good weight. On top of this, apparently, given the genetic condition, cardiologists often refuse to operate due to the poor chance of recovery.

We received many answers from the geneticist, from this new test (and testing my DH and I) they could tell us that Laura's condition was not inherited (which also means our son and daughter will not be impacted by this) and if we decide to try again, we are back in with everyone else at our age when it comes to risk. One other answer was that this occurred at conception - so there is nothing I could have done to have caused this.

While yesterday I mourned the loss of my daughter, and the dreams that we had for extending our family; some of the guilt has been lifted, as realistically I know that had we elected to proceed; Laura would never have made it to term; not even close.

I hope my story is not over; we have decided to try again. We will still go through extensive testing (more for peace of mind; and my age than for medical reasons alone); but again with the support of the Fetal Management Unit (FMU) we have our plan mapped out.

I need to smile again and look forward with a positive focus. For me this is what I need to do, for Laura and our family.

Take care
Nicole
xoxo

Dear Nicole, thinking of you on the due date of your beautiful daughter Laura Grace. What a lovely name for an angel.

I am so glad that you have some answers about Laura's issues and it's great news that her birth and death have provided you with hope for the future.

Wishing you all the best.

Nicole :hug: thinking of you and remembering your precious daughter Laura Grace.

Hi Nicole,

It is difficult getting through those important dates, little Laura will always be in your heart :hug:

I am glad that the test results confirmed that you & your DH definitely made the right decision, it is such an incredibly hard one to make. Your story is so similar to mine, my daughter had a fatal heart condition (left side) amongst other major issues and would not have survived. In our case there was additional DNA rather than DNA missing.

All the best with TTC again, to give you some hope I can say I am now 21-wks pg and little one has is doing fantastic, a Prof of fetal medicine did all of our scans and has given us the all clear - the biggest relief of my life! We were like you it was a 'random event' and our risk this time was the same as any other women my age. I wish you & your DH all the very best for a BFP soon and a beautiful healthy bub. Just so you know there is a thread 'TTC after late loss or stillbirth' in the 'Loss / Miscarriage' section. The ladies in there are so incredibly supportive. Take care.