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We are in a stadium style classroom here at Duke Medical – attendance is projected to be about 100. The first speaker will be Dr. Angelo Milazzo, speaking on Prenatal Consultation and Fetal Echo Cardiography.
I may be able to get an MP3 of the event later today!
Karin Coltier just started. We’re under way!
25-30% of Dr. Milazzo’s consults involve Prenatal Echo – since he started, many improvements. At it’s simplist, it is a highly sophisticated system of taking piuctures. Prenatal imaging gives access to certain views of the heart that you can’t see after birth. Image on screen looks like a candy cane, it is the Aortic arch!
But you can’t see everything – there are still technical problems. It is not perfect.
You need the right conditions, patience, time, and a good relationship with the mother.
Prenatal Echo gives you the chance to plan the next step if there appears to be a problem. Treatment can be planned well in advance to be effective and reduce complications.
Majority of new CHD patients were diagnosed before birth.
Who needs fetal echo? Moms with heath issues (CHD, Diabetes) mom has or has had a serious infection, in vitro fertilization can cause an increased chance of all birth defects, certain medications.
Baby diagnosed with other birth defcts – fetal echo done because risk of a 2nd defect is increased. Baby with normal heart structure but abnormal beats (arrhythmia).
Most women referred for echo between 22 and 26 weeks of pregnancy – that is the best window. The echo is read by a Pediatric Cardiologist. scan can take 20 minutes to 2 hours, depending on variables and what is being looked for.
Images used to be stored on VHS, now stored digitally. The echo probles can cost $10,000+!
End Presentation – 15 minute break!
Next Speaker: Dr. William Darden. Subject: History and future of Cardiac Catherizations
What is Caridac Catherization? A medical procedure to diagnose/treat cardiac problems.
1929: Dr. Werner Forssman did a catherization on himself, walked to Radiology lad, and x-rayed himself!
1958: Dr. Mason Sones did first coronary angiography.
1964: Dr. Charles Dotter did first ballon of a vessel.
1974: first ASD closure done by cath. Patient still spent days in the hospital!
VSD closure by cath is becoming more popular, but surgery is still the standard of care. Hearts electrical system runs through the Ventricular septum, so need to be very careful and usually better done by surgery.
3D mapping is about 15 years old, becoming more popular. Draws a “map” of the heart from inside! Reduces amount of X-rays needed.
Electrophysiology: The future is now. Stereotaxis moves probles and catheters by magnet, no direct handling needed.
The future? Electrophysiology is limited by adult procedures since Coranary Heart Disease outnumbers Congenital Heart Defects by a great number. The adult tools are being adapted for children. Heart valves inserted by catheter are in trials. VERY new: stents made of absorbable metal.
Aortic and Pulmonary valves can be balloned while in the womb. Very new, less than 10 years old. New things are coming all the time.
End of Presentation!
My presentation went well. I’ll post the text a little later.
Next speaker: Dr. Jay Campbell. Subject: Cardiac MRI: Past Present and Future.
Pediatric Cardiology started backwards – autopy to explain why/how deformed hearts worked. Helen Taussig learned through study of regular X-rays.
Xrays don’t take very long, non invasive, portable. Disadvantages of x-rays can give limited information, cant measure function of the heart, child gets dose of radiation.
Next step: Angiography. Advanages: good view of anatomy of heart. Disadvanages: more radiation, it is an invasive procedure.
Echocardiography came next. First images very primative. Non invasive, no radiation, good details about heart anatomy. Disadvantages: As patient ages, you can’t see details as well. Can’t see arteries/veins outside of the heart.
Cardiac MRI: How it works Hydrogen atoms in body are all affected by magnets. MRI using magnetism makes Hydrogen atoms alighn, computer reads differences. MRI first became available in early 1980’s.
MRI a heart is hard because MRI works best with stable structure – heart is constatly moving. Heart rates are not constant, so can’t set MRI standards.
MRI Advantages: good image resolution, no need to be put to sleep. Disadvantages – not good on smaller organs (children)
MRI can read ToF very well. Also good for Transposition of the Great Arteries. MRI can also see HLHS quite well. Echo is good for younger patients, but in older patients with HLHS, MRI will become more useful.
What might be coming next? Working on tests for Coronary Arteries. Also working on Fetal MRI. Working on MRI use in Cath Lab. Major hurdles – most Cath lab materials are metal.
End of Presentation!
Dr. James Jaggers – Neurodevelopmental outcomes in children with CHD
CHD costs exceed 2 billion dollars for inpatient care alone! Until recently, the concentration was on helping CHDers LIVE… now looking more at quality of life. Most CHD survival rates ate 95% and up.
Parents want to know how quality life is going to be affected. Early surgeries put patients in ice to cool body and slow heart. This can result in brain damage.
How and when does nurological damage occur? Brain is made up of white matter and grey matter. White matter injury occurs with decreased oxygen to the brain. Cell death, swelling closes off important sections of the brain. Cells can undergo genetic changes, causing them to die later- known as “programmed death.”
Heart Defect survivors can also have problems with grey matter, which is important for phycomotor development.
Risk of imparement increases with complexity of the heart defect. 2 different MRI studies show that 2/3 of single ventricle defects have some form of neurological damage. (sometimes so slight as to be undetectable.)
(This is pretty technical and i am having a hard time following it – Forgive me)
Don’t think the sky is falling – 75% or more of CHD survivors fall in normal ranges. But there is an increased risk.
End of Presentation!