Browsing Tag

pediatric congenital heart disease

Cardiology

Taking a Multidisciplinary Approach to Congenital Heart Defects Months Before Birth

Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1% (about 40,000) births per year. Most are diagnosed early in pregnancy, leaving parents months to obsessively worry over their baby’s fate. But at the UAB Fetal Cardiac Diagnosis and Care Clinic, a collaboration between the University of Alabama at Birmingham and Children’s of Alabama, families can learn early on in their pregnancy what to expect prenatally, during delivery and in the postnatal period from a team of specialized physicians focused on their baby’s specific needs.

“Families get hit with the news that their baby has heart disease and it’s like a body blow,” said Children’s cardiologist Robb Romp, M.D. “We can demystify some of the scariness,” he said.

Clinic participants include pediatric cardiologists, cardiothoracic surgeons, maternal-fetal medicine specialists and a geneticist. “It is one of the quintessential multidisciplinary programs we run,” Romp said. “The goal is to recognize what the problems are prenatally and then ensure all the necessary resources are in place to care for the baby after birth.”

The half-day clinic meets monthly with between three to five families, about 50 a year, whose babies are known to have complex congenital heart disease. Patients come from throughout Alabama and surrounding states.

The clinic “helps families understand how many different providers are assisting in the care of their baby and that we are all working collaboratively,” Romp said. It also provides a very real perspective on how the team makes decisions, because the clinicians talk through the case with the family, he said. For instance, the issues the obstetrician focuses on may be different from those of the cardiologist. “The needs of both patients, mother and baby, need to be balanced to ensure both do well during and after the pregnancy,” he said.

The team’s nurse practitioner, Laura Brasseale, coordinates all follow-up meetings and ensures the family tours areas of the hospital where their baby may require care.

Brian Casey, M.D., who directs the Division of Maternal-Fetal Medicine at UAB,spent 23 years at the University of Texas Southwestern in Dallas before moving to UAB in 2018. “After my arrival here, I was immediately impressed with this scheduled monthly meeting between the pediatric cardiologists and the Maternal-Fetal Medicine group at UAB,” he said. “This extraordinary collaboration allows for early discussions of prenatal treatment and delivery planning in order to optimize the baby’s outcome and  provides state-of-the-art care at a very high level for our patients.”

Fetal Diagnosis and Care

Learn more about the UAB Fetal Diagnosis and Care Clinic, a collaboration between the University of Alabama at Birmingham and Children’s of Alabama.

Cardiology

‘Not-So-Stressful’ Stress Testing Evaluates Pediatric Congenital Heart Disease and Exercise-related Complaints

exercise_labPut a seemingly timid child with congenital heart disease (CHD) on a treadmill, attach electrodes to their chest and place a mask over their mouth and nose to measure gas exchange, and it’s amazing what you can learn about their cardiovascular and pulmonary health.  That’s the premise behind Children’s of Alabama’s new Cardiometabolic Exercise Testing Lab, which opened this summer. The lab was made possible through the generosity of Gene and Leslie Cash in loving memory of their daughter Kelly Cash.

“Exercise capacity can be highly predictive of the risk of complications related to CHD, including developing heart failure,” said pediatric cardiologist Camden Hebson, M.D., who runs the lab. “Given that the heart and lungs are usually the limiting factors on the extent of exercise capacity, stress testing is a wonderful way to evaluate how well patients are supported.”

In contrast, evaluating a child at rest, as with an EKG and echocardiogram, “is like evaluating the quality of a car when it’s in the shop versus taking it out on the road and seeing how well it drives,” he said.

While the test mimics the traditional stress test, the use of the mask to measure oxygen consumption (VO2) and CO2 elimination is particularly important, Hebson said.

“These become the key variables to say from a quantitative standpoint how well the heart and lungs support you as you exercise,” he said.

Children who have been living with a heart condition for years may underappreciate the severity of their symptoms, he said. The exercise test, however, provides objective data that can demonstrate problems and allow intervention.

“Many patients become accustomed to how they feel with exercise, yet with stress testing we can identify limitations early on and thus intervene in a timelier manner,” he said.

The test also enables serial assessments to assess function over time.

In some instances, he said, a patient’s symptoms are attributed to cardiovascular function, but the stress test can show it was related to pulmonary function instead.

“Sometimes that’s hard to tease out because we’re always focused on the heart,” he said. “Exercise testing offers a way to make that connection.”

Children as young as 7 years old can complete the test, he said, and those that can’t walk or run on the treadmill can use a bike. The key point is that “they need to be comfortable enough to come in and wear a mask, EKG leads, etc., while exercising,” he said.

To take some of the fear and anxiety out of the experience, the team has decorated the room to look more inviting with posters of sports figures and decals. They even added a scoreboard where kids can write their “code name” and see how they compare to others taking the test. The goal,  Hebson said, is to make the lab look less like a clinic or hospital setting and more like a place to have fun.

The test itself takes about 15 minutes, with another 30 minutes for the setup and explanations. It is typically covered by insurance.

Hebson, nursing staff, and parents are always in the room. As he noted, “We try to make it the least stressful as possible, even though it’s a stress test.”

Interested in a Pediatric Cardiology Fellowship at Children’s of Alabama?
Learn more at childrensal.org/pediatric-cardiology-fellowship.