The field of pediatric cardiology and cardiac surgery is advancing rapidly, as is the program at Kentucky Children’s Hospital.
“It is exciting that the fetal ultrasound has become extremely good at diagnosing heart defects well before babies are born,” said Dr. Mark Plunkett. Pregnant women and their spouses can now talk with the doctor about the surgery that will be required to fix the heart defect after the baby is born.
“The benefit is twofold because the parents know there is a problem, and we can talk about the plan for heart surgery or intervention once the child is delivered and discuss the possible outcomes, which may put their mind at rest to some degree,” Plunkett said.
Ten to 20 years ago, these babies would be born cyanotic and have breathing problems, and there would be a rush to figure out what was wrong. Some of these children may not have survived. Today open-heart surgery can be done as soon as the baby is born. Usually the operation is performed in the first one to two weeks of life, once the baby is stabilized.
The spectrum of defects varies, and so does the spectrum of diagnosis and treatment. Echocardiography is the best screening tool. “Chest x-rays are good at giving a big picture of the chest and the structures, but echocardiography is the mainstay of diagnosing heart problems and defects in children,” Plunkett said. Though echocardiography has been around a long time, it has become more refined and sensitive.
If something is wrong, it is usually repaired as early as possible with a high success rate. “Procedures have become more refined over time, and with that, the outcomes and prognosis of children have improved dramatically,” said Plunkett.
The hybrid technique is new. In this procedure, the pediatric cardiologist and surgeon work together, the pediatric cardiologist with a catheter and the surgeon with open heart surgery.
Some conditions such as holes in the heart are repaired surgically. “We go in and put a patch over the hole and close it so the heart can grow and function normally,” Plunkett said.
The cause of heart defects in children is still not widely understood. The formation of the heart is a complex process. During a baby’s development in utero, if one important step does not happen perfectly, a heart defect occurs. Heart defects are not usually caused by anything that happened to the mother during the pregnancy, Plunkett said. “Some [defects] seem to be related to chromosomal problems or genetic problems, but that is not the majority,” he said.
Doctors should encourage pregnant women to have a prenatal screening with an ultrasound. If a heart defect is identified early, steps can be taken to prepare the baby and manage the condition.
“There are a limited number of procedures that can be done with catheters on the fetuses before they are born,” Plunkett said. He said it will be interesting to see what can be done through this type of fetal intervention in the future. Cardiologists are optimistic.
“When we consider that 50 years ago almost all of these children died and now 85 percent to 90 percent of them can look forward to a long healthy life, it is amazing what has happened in such a short time,” said Plunkett. “The future looks very bright, promising and exciting.”
By Jamie Lober, Staff Writer