A two-year-old girl died as a result of an undiagnosed hole in her heart, an inquest has found.
Aimee Keogh, of Glenbrook, Old Singland Road, Limerick, went into cardiac arrest in an ambulance on the grounds of University Hospital Limerick on July 10th, 2014, as she was being prepared for urgent transfer to Crumlin Children's Hospital.
The girl suffered 17 seizures before her admission to hospital the previous day and was being transferred to Dublin for a paediatric cardio echo.
Following a previous admission to University Hospital Limerick in March 2014 with febrile convulsions caused by tonsillitis, 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 Annemarie Murphy said she found the X-ray to be normal.
She said a multidisciplinary team who 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 for the review.
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.
She said children can wait up to two years to see a paediatric cardiologist.
However, she explained, Aimee Keogh became an urgent case when she presented on July 9th and her condition had deteriorated. Seizures had become more frequent and were not related to any underlying illness.
The inquest also heard from consultant paediatric neurologist Elizabeth O’Mahoney, who saw the girl privately in June.
Examination ‘normal’
She concluded that her neurological examination was normal and the source of the seizures was not the brain. Other possible causes had to 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.
The Coroner’s Court heard Aimee was referred as an urgent case to Crumlin Children’s Hospital on July 9th, but she went into cardiac arrest as her ambulance was preparing to leave the following day 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 said this type of disease could 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.