CARDIAC
IMAGING
Sometimes, defining a heart problem
requires being able to see the heart’s spatial relationship
to neighboring structures in the body. Three-dimensional
echocardiography (3DE) represents the logical step from
the traditional echocardiographic techniques. It provides
a greater number of cross-sectional images, which gives
the impression of depth.
When performed almost instantaneously,
it is called “real-time 3-D” (RT3D) recording
an entire cardiac cycle (contraction and relaxation of
the heart) in a short time. Texas Children’s is one
of the first pediatric hospitals in the United States
to offer RT3D.
The technique gives accurate ventricular volumes and better
anatomical definition of heart lesions, which allows more
pre-surgical planning by the healthcare team. Also, quicker
acquisition of the image requires less sedation, or sometimes,
no sedation at all.
Doctors use magnetic resonance imaging
(MRI) of the heart in conjunction with echocardiograms
and catheterization to diagnose and check heart problems.
“This procedure replaces neither echocardiography
nor cardiac catheterization, but gives the doctor an alternative
non-invasive technique for cardiac diagnosis,” noted
Dr. G. Wesley Vick, a pediatric cardiologist at Texas
Children’s Heart Center.
MRI particularly is effective at evaluating cardiovascular
disorders that involve the aorta, pulmonary arteries,
pulmonary veins and systemic veins.
Magnetic resonance imaging uses a large
magnet, radio waves and a computer to produce clear pictures
of the heart. This painless test has no known side effects.
Because any movement during the MRI will blur the picture,
young patients usually are sedated.
In addition to on-site testing, Texas
Children’s echocardiography laboratory is connected
with fiberoptics to other Houston hospitals. Real-time
images of a newborn’s heart are transmitted to the
Heart Center's echocardiography laboratory
for diagnosis and treatment recommendations.
Texas Children’s also performs echocardiograms at
outlying cities, such as College Station, Texas, and plans
to expand these services.
Once a fetus with
a heart defect has been diagnosed at Texas Children’s
Heart Center,
a team of highly trained cardiologists prepares for the
baby’s arrival. In a word, that’s what perinatal
cardiology is — preparation.
Most mothers come to Texas Children’s
echocardiography lab after an obstetrician’s routine
ultrasound indicates a heart defect in the unborn child.
In the echo lab, the baby’s heart is evaluated in
detail: the anatomy, its function and the flow of blood
to the heart. Evaluating the baby’s heart before
it is born allows specialists to prepare for the baby’s
best possible outcome.
If the fetus has problems in utero (in the womb), like
cardiac dysfunction, cardiologists can treat the baby
by medicating the mother.
“It’s a matter of making the diagnosis and interpreting
it for the family, so they understand the implications
for the pregnancy,” said
Dr. Nancy Ayres, medical
director of Texas Children’s echocardiography lab.
Perinatal cardiology care is a constellation of the diagnosis,
intervention and preparation. It impacts decisions like
where a mother delivers her baby. For example, if the
echo shows that the baby’s heartbeat is slow, the
baby may need a pacemaker very soon after birth. The mother
may be advised to deliver in the Texas Medical Center
so her baby may be transported immediately to Texas Children’s
neonatal intensive care unit.
Perinatal cardiology care prepares
the parent for the news of a baby’s heart defect.
It is devastating when a family is expecting a healthy
baby and then learns there is a problem.
“We
can give them information, and they prepare themselves
and maybe other family members or brothers and sisters
who need to know,” Dr. Ayres said.
The future of perinatal cardiology
is moving beyond diagnosis toward the realm of intervention.
Successful intervention requires a multidisciplinary complement
of a talented, high-risk obstetrical service, neonatology
support and skilled thoracic surgeons who can operate
on very immature structures. These talents exist at Texas
Children’s Heart Center.
“I am the baby’s fetal cardiologist and advocate,
and I use my expertise in pediatric cardiology to help
the team devise a game plan for the best way to care for
that mother, baby and family,” Dr. Ayres said.
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