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Doctors and nurses talk about the Fetal Heart Program at The Children's Hospital of Philadelphia. From referral and diagnosis, planning and delivery to treatment and the future, doctors and nurses are making great strides in the diagnosis and treatment of congenital heart defects. Use the links below to navigate through the series.
J. William Gaynor, MD: When you have a child with any type of problem, particularly congenital heart disease, you want to be at a place that has expertise in all aspects of their care.
Sarah Tabbut, MD: The number of babies that, or children or adults even, that come through our program with congenital heart disease is huge.
Unknown Speaker: We have a breadth of experience here at the Fetal Heart Program that really is second to none simply because of the volume.
Susan C. Nicolson, MD: To be good at what we do, you have to have exposure to this group of patients on a routine and customary basis.
Sarah Tabbut, MD: Because so many patients come thorough, we have the luxury of being able to provide cardiac-specific support systems.
Robert E. Shaddy, MD: We have a program here called the "Impact Program." this stands for, Immediate Postpartum Access to Cardiac Therapy. This program was developed to deal with that small subset of fetuses who need immediate care after birth. We are able to marshal the entire forces of the Cardiac Center — interventionalists, anesthesia, nursing, surgery, whatever is necessary in these infants who immediately need access to care.
Denise D. Donaghue, RN: Our cardiac intensive care unit, cardiac step down unit, cardiac OR’s, they're only taking care of children, infants and children with heart disease.
J. William Gaynor, MD: You have to have expertise to know when to vary the management for a particular child.
Sarah Tabbut, MD: So there's the usual stuff you'd read about in a textbook or that you would learn in your training, but every child's at risk for something happening that's not quite usual. Every child's at risk for having something on their echo, some part of their heart that isn't exactly what you would have expected. And those unusual things, if they're missed, can be a big problem for the baby. And if they're identified, can make the hospital course for the baby much better.
J. William Gaynor, MD: As much as we would like to think that medicine is a true science, experience and learning is very important in how you take care of these kids.
Jonathan J. Rome, MD: In the traditional hospital structure, all of these different people work in different departments or silos. But what we recognized is we really all have to come together as one group to give the kids and their families the best care we can.
Thomas L Spray, MD: Having a team that works together to deal with children with congenital heart problems is a huge advantage.
Susan C. Nicolson, MD: It's a group of specialists in all the areas that are needed to take care of these patients.
Thomas L Spray, MD: And that is not just surgery, that is cardiology, that is respiratory therapy, that is genetics,
Thomas L Spray, MD: -- cardiac anesthesiologists, dedicated team of cardiac nurses,
Unknown Speaker: -- social worker, lactation specialists, child life specialists,
Unknown Speaker: -- and the entire support system that's necessary to provide anything that is medically or surgically needed to take care of a child with congenital heart disease.
Jonathan J. Rome, MD: Sometimes, fortunately, I think, the only treatment a child with very serious heart disease needs is catheter therapy.
Robert E. Shaddy, MD: The Children's Hospital of Philadelphia has a very long legacy of innovation and new strategies for dealing with all kinds of diseases in children.
Jonathan J. Rome, MD: The cardiac catheterization started very much as the first way you could look at pictures of the heart and diagnose heart problems. But the real breakthrough actually occurred here in Children's Hospital. Dr. William Rashkind, who was often considered the father of interventional catheterization, developed a technique that could save blue babies with transposition, who often died because they just didn't have enough oxygen in their bloodstream. And he was the first one to use a catheter to treat a heart problem in children.
Robert E. Shaddy, MD: This procedure now allows us to open up the hole between the upper chambers, allow mixing of red and blue blood, and allow stabilization of the infant until we can move toward surgery.
Jonathan J. Rome, MD: From that, the field has really blossomed over the years.
Robert E. Shaddy, MD: And this is the history that CHOP has in so many different areas, where they have been pioneers in not only heart disease, but in all areas of children's health.
J. William Gaynor, MD: We're almost unique in the world in having a cardiac anesthesia team.
Susan C. Nicolson, MD: Patients with congenital heart disease have unique and different physiologies than children who do not have structural heart disease.
J. William Gaynor, MD: We couldn't do what we do without cardiac anesthesia.
Unknown Speaker: The anesthesiologists are responsible for all the perioperative care of the child, that is, getting the child to the operating room, making sure the child is stable within the operating room, and then immediately after the operation working with the intensive care unit team to make sure the child is stable.
Susan C. Nicolson, MD: We're able to safely take care of them for both their cardiac procedures, as well as any other surgical or diagnostic procedures, where patients need sedation or anesthesia.
Thomas L Spray, MD: Basically, over 500 people are involved in the Cardiac Center.
Jack Rychik, MD: The ability to bring all of these services together, with the focus on the fetus as a patient is what's unique about the Fetal Heart Program.
Denise D. Donaghue, RN: It's the way the care is delivered in the Cardiac Center as well.
Unknown Speaker: Taking care of the whole family and the whole infant, not just, you know, the specific heart malformation.
Denise D. Donaghue, RN: It's incredibly compassionate. It's incredibly patient focused. So these just aren't really smart people. They're really smart people who are working together with the patients in the middle of all the decisions that we're making.
Jack Rychik, MD: All of this in order to create this smooth continuum of care from fetal life and life in the womb to life after birth.
Contact the Fetal Heart Program for more information