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Physicians Update

 
Spring 2009

Prenatal Diagnosis Key to Successful Treatment of Congenital Heart Disease

03/01/2009

Prenatal DiagnosisThanks to progress in surgical technique and postoperative care, up to 90 percent of babies born today with congenital heart disease will live to adulthood. And given these advances, diagnosing children with congenital heart disease in utero is more important than ever before, says Brian Reemtsen, M.D., cardiothoracic surgeon and director of the Congenital Heart Surgery Program at Mattel Children’s Hospital UCLA.

“For these very sick patients, optimal care is provided when we know what to expect from the patient before birth,” Dr. Reemtsen explains.

Unfortunately, he notes, many patients do not receive adequate prenatal care, and even for patients who do receive routine prenatal ultrasound in the community, a significant number of congenital defects go unrecognized. For those babies with congenital heart defects, identifying them in utero can be lifesaving, says Thomas Klitzner, M.D., Ph.D., chief of pediatric cardiology at UCLA.

In addition to facilitating timely diagnosis, advanced imaging modalities offer a better view of the fetal and infant heart, which is roughly the size of a walnut. Of particular value, Dr. Klitzner notes, are fetal echocardiography, three-dimensional echocardiography, and the ability to see increasingly smaller structures on CT scans and cardiac MRIs.

“This eliminates the need for surgeons to explore, because they know exactly what they’re going to see before they operate,” Dr. Reemtsen says.

The ability to perform successful infant surgery for virtually all forms of congenital heart disease represents a major advance, attributable to better visualization, instrumentation and surgical techniques. Hypoplastic-left-heart syndrome, among the most-common congenital defects, was considered a fatal disease two decades ago; today, though it takes multiple surgeries, the vast majority of these children survive into adulthood.

Prenatal Heart Disease“The key is not only good surgery, but also excellent pre- and postoperative care,” Dr. Reemtsen says. “That is where the multidisciplinary approach makes all the difference for these extremely sick patients.” At Mattel Children’s Hospital UCLA, for example, the Congenital Heart Surgery Program benefits from partnerships with the Interventional Cardiology Program, where advances in the use of balloons and catheters have improved postsurgical care, and the Pediatric Electrophysiology Program, where experts are available to treat pediatric arrhythmias.

In addition, labor and delivery at UCLA is on the same floor as the Pediatric Heart Center so that any procedure needed for the infant can be done without delay or the need to transfer from one facility to another. This is particularly advantageous for high-risk deliveries, such as those involving patients with hypoplastic-left-heart syndrome.

Patients who require it also benefit from advances in heart trasplantation. Recent developments include the advent of a pediatric ventricular-assist device. The Berlin Heart is the first such device made specifically for pediatric patients. It is helping to serve as a bridge for patients with failing hearts who might otherwise die waiting for a transplant.

 





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