A TWO-YEAR-OLD Limerick girl died as a result of an undiagnosed hole in her heart, an inquest has found.
Tragic Aimee Keogh, of Glenbrook, Old Singland Road, went into cardiac arrest in an ambulance on the grounds of University Hospital Limerick on July 10, 2014 as she was being prepared for urgent transfer to Crumlin Children’s Hospital. The inquest heard the heart condition was extremely rare in a child that age.
The infant had suffered 17 seizures in the period leading up to her admission to hospital on July 9 and was being transferred to Dublin for a paediatric cardiac echo.
Following a previous admission to UHL with febrile convulsions brought about by tonsillitis in March 2014, Aimee had a chest X-ray.
On examination of this X-ray, consultant radiologist Padraig O’Brien said he was suspicious of a septal defect, more commonly known as a hole between the chambers of the heart.
However, in her evidence paediatric consultant Anne Marie Murphy said she found the x-ray to be normal.
She said a multidisciplinary team, including consultants and radiologists, who subsequently reviewed the same x-ray over three weeks later also found it to be normal.
She admitted under cross-examination by the family’s solicitor Jerry Twomey that there was no cardiologist present at the review.
And while there was a consultant radiologist present Dr O’Brien was not present or consulted afterwards about his suspicions, the inquest heard.
Dr Murphy told the inquest there are no paediatric cardiologists working in hospitals outside of Crumlin and that adult cardiologists would not see a patient under 14 years of age.
She said that children can wait up to two years to see a paediatric cardiologist. However she explained that Aimee Keogh became an urgent case when she presented on July 9 after her condition had deteriorated, and seizures had become more frequent and not related to any underlying illness.
Dr Murphy also told Mr Twomey that a heart murmur observed in Aimee Keogh during her admission in March was “not unusual in children with intercurrent illness” and the murmur had resolved itself by the time of discharge.
The inquest also heard from consultant paediatric neurologist Elizabeth O’Mahoney, who saw Aimee privately in June.
She concluded that her neurological examination was normal; that the source of the seizures were not coming from the brain and that other possible causes must be considered, including cardiac and ear, nose and throat.
Dr O’Mahoney said she outlined her concerns to Dr Murphy who said she would be seeing Aimee at her review clinic the following month.
Limerick Coroner’s Court heard that Aimee was referred as an urgent case to Crumlin on July 9.
Evidence was heard that she was initially happy and smiling with a teddy bear when placed in the transfer ambulance the following day but had then started to cry, said “no nee-naw” and had one of her twitching spells. Aimee went into cardiac arrest as her ambulance was still preparing to leave for Crumlin and efforts to resuscitate her failed.
Retired paediatric pathologist Peter Kelehan said an autopsy found a large cardiac defect which amounted to a large hole between all four chambers of Aimee’s heart.
Dr Kelehan said he had never seen a child of this age with this type of abnormality and described how he had to refer to old text books.
He also said this type of disease was often associate can often persist for up to two to three years without the presence of any symptoms.
He concluded that death was caused by an undiagnosed major congenital cardiac disease.
Coroner Dr Tony Casey returned a verdict in accordance with the medical evidence.