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Superior Pre-and Postnatal Care to Treat Congenital Heart Defects Leads to Rapid Growth

Dentkas_GardinerIn April 2014, after a review of relevant literature, the American Heart Association (AHA) released a scientific statement on the diagnosis and treatment of fetal cardiac disease. The AHA writing group, comprised of 18 physicians and one nurse, provided recommendations related to the specifics of fetal diagnosis and described the components of fetal echocardiography in detail.

“This is the first comprehensive statement on fetal heart disease made by the American Heart Association,” says Gurur Biliciler-Denktas M.D., co-director of the Fetal Cardiology Program at The Fetal Center at Children’s Memorial Hermann Hospital and an associate professor of pediatric cardiology at UTHealth Medical School. “It provides detailed information about modalities for fetal cardiac assessment, protocols for screening and referral, experience required for performing and interpreting studies and available fetal therapies.”

The AHA statement’s release coincides with a period of rapid growth for The Fetal Center, as well as the divisions of Pediatric Cardiology and Pediatric Cardiovascular Surgery at UTHealth Medical School. “Our volumes at The Fetal Center have increased and will continue to grow as more physicians develop an understanding of the importance of fetal cardiac screening, and because they have confidence in our diagnostic and surgical outcomes,” Dr. Denktas says.

Once an expectant mother is referred to The Fetal Center to confirm the diagnosis of a congenital heart defect, she has access to a fetal cardiology team that consists of three affiliated physicians. Two of them – Dr. Denktas and Monesha Gupta, M.D. – also see patients after birth, ensuring continuity of care. Since 2008, Dr. Denktas has extended that continuity into adulthood through an adult congenital heart disease clinic for patients age 16 and older.

“Screening for congenital heart disease has generated a lot of interest in the last few years because of poor detection rate, with only one in four babies with major congenital defects discovered in ultrasound scans,” says Helena Gardiner, M.D., Ph.D., who specializes in fetal echocardiography and is co-director of the Fetal Cardiology Program at The Fetal Center. “The diagnosis of cardiac disease in the fetus is generally made with ultrasound, but obstetricians were not ordering enough views of the heart. The International Society of Ultrasound in Obstetrics and Gynecology revised their guidelines a couple of years ago to include five transverse views of the heart, a proven and practical protocol. These guidelines were created to raise the bar and push providers around the world to the next level.”

Since her arrival at The Fetal Center in July 2013, Dr. Gardiner has established the Congenital Heart Defect Screening Program, which works to improve early detection and care by educating and training health professionals, campaigning for improvement and raising awareness of the signs of undetected heart defects in the community. Through the program Dr. Gardiner trains sonographers to perform the five transverse views to improve their skill, confidence and their success in the detection of heart defects before birth.

“We’ve taken our skilled technicians to referring maternal-fetal medicine specialists and obstetricians and trained their staff onsite in fetal heart screening,” says Dr. Gardiner, a professor at UTHealth Medical School with dual appointments in the department of Obstetrics, Gynecology and Reproductive Sciences and the department of Pediatric Cardiology. “We give them practical hands-on training and show examples of heart defects to encourage them to use the five transverse-view approach. As a result we’re seeing more referrals of major congenital heart defects early in gestation from these offices.

When babies with major heart conditions are diagnosed before birth, health professionals can plan for their care effectively, supporting and preparing parents through the pregnancy to ensure that the baby is born in a tertiary care facility with access to experts in fetal medicine and fetal cardiology, as well as multidisciplinary specialists. At The Fetal Center and Children’s Memorial Hermann Hospital, care of mother and baby is a team effort based on an integrated care pathway.

The expert multidisciplinary team at The Fetal Center has contributed to the growth of its referral network and an increase in patient volumes. Referrals to the fetal cardiology program for major heart defects have more than doubled in the last 12 months. “The overall increase in fetal cardiology volumes has led to an increase in the number of pediatric cardiovascular surgeries we perform,” says William Douglas, M.D., chief of pediatric cardiovascular surgery and director of the Children’s Heart Institute at Children’s Memorial Hermann Hospital. An associate professor and director of the division of Pediatric Cardiovascular Surgery at UTHealth Medical School, Dr. Douglas is actively recruiting a third pediatric cardiothoracic surgeon in response to the new demand.

“Our volumes are now growing at the rate of 10 percent annually,” he says. “We’re actively involved with The Fetal Center – I see one or two moms each week at the Center whose babies have been diagnosed with congenital heart disease. While most babies do not require emergent surgery, these mothers have the advantage of knowing in advance so they can prepare themselves mentally and emotionally. It’s very difficult on mothers who learn immediately after delivery that their baby has a heart defect and will face surgery in the next few days. Our operative team is prepared to do surgery on relatively short notice, but we’re grateful that more and more defects are diagnosed before birth.”

With a new director of the division of Pediatric Cardiology in place at UTHealth Medical School, the fetal and pediatric cardiology programs are poised for future growth. John P. Breinholt, M.D., was named director of the division and chief of pediatric cardiology at Children’s Memorial Hermann Hospital in June.

His collaboration with Dr. Douglas extends well beyond his short time at Children’s Memorial Hermann Hospital, having worked with Dr. Douglas for the last eight years during annual medical mission trips to Bolivia. “When the position became available, Dr. Douglas encouraged me to consider it, then introduced me to Eric Eichenwald, M.D., chair of the department of Pediatrics. I was impressed with his leadership and the leadership from the other associated divisions and departments. I was excited about the opportunity to contribute to the growth of this program,” said Dr. Brienholt.

An interventional cardiologist whose clinical interests include cardiac catheterization, implementing new devices in the nonsurgical treatment of heart defects and hybrid surgical/catheter procedures, Dr. Breinholt has a bold vision for Children’s Memorial Hermann Hospital and the division of Pediatric Cardiology. “Within the next year, I’d like to see us introduce pulmonary valve implants and expand the number of hybrid procedures cardiologists and cardiovascular surgeons perform together. We want to further integrate our services and develop practice plans to ensure that the care we provide is totally seamless. We meet weekly with The Fetal Center staff to discuss strategy and to ensure the family is taken care of from prenatal diagnosis through pregnancy and delivery and through adulthood.”

Learn More

To learn more about the fetal cardiology program, visit childrensmemorialhermann.org/fetalcardiology