CHOC Heart Patients Among First to Experience Clinic of the Future

A pilot program at CHOC Children’s is giving cardiac patients and their families more peace of mind. Launched by pediatric cardiologist and CHOC’s chief intelligence and innovation officer Dr. Anthony Chang, the CHiP (Cardiopulmonary Health intelligence Program) clinic provides home monitoring equipment to families for the purpose of tracking patients’ vitals, such as blood pressure and oxygen saturation. Through telepresence, families can also connect with their physicians without leaving their homes.

Dr. Anthony Chang
Dr. Anthony Chang, pediatric cardiologist and chief intelligence and innovation officer at CHOC Children’s

“Patients and families feel more comfortable outside the clinical setting. But when away from the hospital, parents can feel very anxious about their children’s health and well-being,” explains Dr. Chang. “Our CHiP clinic ensures continuity of care, while providing great comfort to parents who know they can connect with their physicians without visiting their offices.”

CHiP is based on another innovative idea from Dr. Chang: the iClinic. According to Dr. Chang, the iClinic is a philosophy of leveraging emerging technologies to help create efficiencies, improve workflow and the continuity of care for patients by bringing CHOC expertise to patients’ homes.  The ultimate goal is improving quality care and positive outcomes for patients.

CHOC Children's Heart Institute

There are five key components of the iClinic, all starting with the letter “I”:

  • Instantaneous – Instead of periodic measurements at home, monitoring devices can measure at any time.
  • Intermittent – Instead of being limited to scheduled visits, virtual visits can happen at any time. These virtual visits can include educational sessions, in addition to wellness checks.
  • Individual therapy – Precision medicine is built into the iClinic, including genomics and pharmacogenomics, to find the medicine or treatment best suited for the patient.
  • Intelligent data-driven medicine – All data is compiled and analyzed to make the best possible decisions, including personalized medicine and drug discovery.
  • Intuitive interactions – Through telepresence and the ability to provide instantaneous data with feedback, the iClinic contributes to an experience that feels authentic and intuitive.

Dr. Chang envisions rolling the “clinic of the future” to other specialties at CHOC, beyond CHiP.

“This is the clinic of the future. It is inclusive of wearable devices, avatars, artificial intelligence and genomic medicine. But it’s important to note we’re not using the technology for the sake of just using fancy gadgets.  We are leveraging emerging technologies to really change how we deliver care in the best possible way,” explains Dr. Chang.

Providers who are interested in piloting a similar program at their institutions are free to contact Dr. Chang at achang@choc.org.

CHOC-HOSTED INAUGURAL PACIFIC COAST FETAL CARDIOLOGY SYMPOSIUM PROVIDES VITAL EDUCATION

CHOC Children’s leads the way in fetal cardiology and fetal echocardiography, and recently shared its expertise at its first “Pacific Coast Fetal Cardiology 2017: An Interactive and Case-based Education Symposium.” Held at the Marriott Hotel, Newport Beach, the conference brought together nurses, sonographers, physicians, trainees and health care professionals from 50 different organizations across the country.

Led by Dr. Wyman Lai, medical director of echocardiography and co-medical director of the CHOC Children’s Heart Institute, and Anita Moon-Grady, from University of California, San Francisco, the event provided vital education on how to detect serious heart defects during pregnancy, and how to discern when to refer to a fetal cardiology specialist for further testing, counseling and intervention. Additionally, education was provided on  the current International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and American Society of Echocardiography (ASE) guidelines, including: how to improve screening efficacy; acquire the ability to rule out or assess for selected complex anomalies during fetal cardiology screening; diagnose obstructive left heart lesions and counsel families on treatment options and prognoses; use key features reviewed to diagnose heterotaxy syndrome; counsel patients on the benefits and limitations of early fetal echocardiography; and diagnose tetralogy of Fallot, its variants and when to refer to a pediatric cardiologist for treatment.

More than a dozen cases were presented by various speakers and featured obstructive left heart lesions, Heterotaxy syndromes, early fetal echocardiography and variants of tetralogy of Fallot. Keynote speakers included Dr. Wayne Tworetzky from Boston Children’s and Dr. Lynn Simpson from Columbia.

Dr. Neda Zadeh, CHOC geneticist, presented, “Understanding Fetal Screening for Chromosomal Abnormalities.” No screening test can detect all birth defects, she explained; however, diagnostic testing is the “gold standard”for prenatal diagnosis of a chromosomal abnormality. CHOC pediatric cardiologist, Dr. Pierangelo Renella, provided an in-depth clinical presentation, “Coarctation of the Aorta versus Interrupted Aortic Arch.”

A major highlight of the conference was a live demonstration of a fetal echocardiogram performed by Dr. Wyman Lai on a pregnant patient with a fetus who presented with tetralogy of Fallot. As he demonstrated the procedure on the large screen, attendees were enthralled with Dr. Lai’s presentation and diagnosis.

Learn more about CHOC’s Heart Institute and fetal echocardiography program

Find upcoming conferences and events: CHOC’s Continuing Medical Education

NeoHeart: Cardiovascular Management of the Neonate Conference, March 22-25

With the growing number of neonates with congenital heart disease, an upcoming CHOC Children’s conference will provide critical information for medical providers who are diagnosing and treating this complex patient population.

The NeoHeart: Cardiovascular Management of the Neonate conference, held on March 22-25, 2017 at the Manchester Grand Hyatt in San Diego, will cover pre- and post-operative management of complex heart disease, latest in the management of pulmonary hypertension, neonatal myocardium and hemodynamics, among others topics.

“The intent of the conference is to advocate for a team approach between the NICU, cardiac ICU, cardiology, and cardiac surgery for state-of-the-art cardiovascular management of the neonate, with the focus entirely on the patient,” says Dr. Amir Ashrafi, cardiac neonatologist at CHOC, and conference co-chair.

The anticipated event is expected to draw over 500 attendees from more than 11 countries. This includes top experts in the field, such as keynote speaker, Dr. William I. Norwood, Jr., founder of the Norwood procedure – a three-stage heart surgery that creates a new functional systemic circuit in patients with hypoplastic left heart syndrome. A special dinner with Dr. Norwood on his legendary career is slated for March 22.

The dynamic, TED-style talk conference will emphasize group discussion, says Dr. Ashrafi. He invites physicians, physician’s assistants, nurses, nurse practitioners, fellows, residents, and other allied health professionals who specialize in neonatology, pediatric cardiology, pediatric intensive care, and cardiothoracic surgery to attend.

After the conference participants will be able to:

  • Follow suggested pre and post-operative management guidelines for the neonate with complex heart disease.
  • Determine treatment options in the premature in the premature neonate with congenital heart disease.
  • Use suggested state-of-the-art management of pulmonary hypertension.
  • Consider neonatal mycocardium and hemodynamics of shock.
  • Follow updated protocols for feeding the neonate with CHD.
  • Review current controversies of the ductus arteriosus.
  • Employ suggested strategies for optimizing long-term neurodevelopmental outcomes.

Given the outcomes and interest surrounding the conference in the last few years, Dr. Ashrafi and his colleagues launched the first international neonatal heart society. The group plans to work closely with other professional organizations such as The Pediatric Cardiac Intensive Care Society.

To register for NeoHeart: Cardiovascular Management of the Neonate, visit CHOC’s website.  

CME credit is available.

 

Inaugural CHOC Conference on Fetal Heart Disease Detection and Management, April 28-29

Early fetal detection, obstructive left heart lesions, variants of Tetralogy of Fallot, and Heterotaxy syndrome are just some of the topics featured at the upcoming CHOC Children’s conference, Pacific Coast Fetal Cardiology 2017: An Interactive and Case-Based Educational Symposium, held on April 28-29, 2017 at the Newport Beach Marriott Hotel and Spa.

“Our conference will focus on the use of cases to convey important points on fetal heart disease detection and management,” says conference co-chair Dr. Wyman Lai, medical director, echochardiography, and co-medical director, CHOC Heart Institute.

Open to obstetricians, radiologists, maternal fetal medicine specialists, pediatric cardiologists and sonographers, the anticipated event will cover how to detect serious heart defects during pregnancy, and how to discern when to refer to a fetal cardiology specialist. Keynote speakers, Dr. Wayne Tworetzky from Boston Children’s and Dr. Lynn Simpson from Columbia University Medical Center, will be among the nationally recognized experts attending.

The conference is sponsored in part by the UCSF Benioff Children’s Hospitals and several ultrasound companies. Additionally, two parent support groups will be present as exhibitors. The groups have a mission to improve early fetal cardiac detection, which allows for 1) time for appropriate family counseling, 2) better planning of care for delivery location and method, and 3) better coordination of care between the multiple subspecialties involved.

“Studies have shown improved outcomes for cardiac patients who are diagnosed before birth compared to those diagnosed after birth. This highlights the importance of improving the fetal detection rate for congenital heart disease in our communities,” Dr. Lai adds.

After the conference participants will be able to:

  • Use suggested best practices for fetal cardiology screening
  • Apply the current International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and American Society of Echocardiography (ASE) guidelines to improve screening efficacy.
  • Rule out or assess for selected complex anomalies during fetal cardiology screening.
  • Diagnose obstructive left heart lesions and counsel families on treatment options and prognoses.
  • Use key featured reviewed to diagnose Heterotaxy syndrome.
  • Counsel patients on the benefits and limitations of early fetal echocardiography.
  • Diagnose Tetralogy of Fallot, its variants and refer for treatment.

Participants are invited to submit an interesting case, by March 14 at https://fetalcardiology.eventgrid.com/, in one or more of the following clinical areas:

  • Obstructive left heart lesions
  • Heterotaxy syndrome
  • Early fetal echochardiography
  • Variants of Tetralogy of Fallot

To register for Pacific Coast Fetal Cardiology 2017: An Interactive and Case-Based Educational Symposium, visit CHOC’s website.

Electrophysiology Advances Restore Patient’s Quality of Life

A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist.

Lauren Flotman, 15, had experienced irregular heartbeats for years before Dr. Francesca Byrne, a pediatric cardiology specialist, diagnosed her with supraventricular tachycardia, or SVT, and Dr. Tony McCanta, a pediatric heart rhythm specialist, repaired the condition through radiofrequency ablation.

Lauren Flotman

The episodes first surfaced when Lauren was about 8 years old and they began increasing in frequency as she aged. They’d occur without warning or pattern.

For Lauren and her family, the sudden attacks caused great concern. Not only was she drained and tired after an episode, but Lauren dreaded them happening, especially during a pep squad routine when her teammates were depending on her.

Lauren was elated to finally have a name for her condition.

“It was a huge relief for sure to have a diagnosis,” she says. “I always had to just describe the feeling because I didn’t have a name. Now I can say I have SVT.”

Lauren’s diagnosis was reached after a Holter monitor captured her heart racing at 220 beats per minute. Dr. Byrne referred Lauren to Dr. McCanta to discuss treatment options, which included anti-arrhythmic medications or an ablation procedure.  After reviewing their options carefully, the Flotmans decided to pursue ablation.

For Lauren’s ablation, Dr. McCanta used a new technology called an intracardiac echocardiogram, or ICE, to create a three-dimensional map of the inside of her heart without using fluoroscopy (X-Ray radiation), enabling a catheter to apply radiofrequency energy to the precise location in her heart causing her SVT.

ICE technology involves a tiny ultrasound probe imbedded into a catheter that is advanced through the vein directly into the heart, allowing for very clear, accurate image quality. These ultrasound images then integrate with a three-dimensional electroanatomical mapping system, which acts like a GPS (global positioning system) for the catheters within patients’ hearts, to provide an accurate real-time shell of the inside of the patient’s heart. This allows the doctor to safely move catheters inside the beating heart without using radiation.

While radiofrequency ablation has become a safe and common treatment for SVT in children and adolescents since the mid-2000s, intracardiac echocardiography (ICE) has not traditionally been used in pediatrics due to the large-sized catheters. But when a smaller catheter was created, which was more suitable for the size of young patients, Dr. McCanta and the electrophysiology team from the CHOC Children’s Heart Institute were among the first in the world to routinely utilize the new technology in pediatric and adolescent patients.

“For a young, healthy patient like Lauren, increasing safety and minimizing the use of radiation are extremely important, while still being able to provide a cure for her arrhythmia with ablation” says Dr. McCanta.

After a few days of taking it easy following the procedure, Lauren felt back to her usual self – only without the constant fear her heart would suddenly begin racing.

“Our team loves utilizing advanced technologies like ICE and three-dimensional mapping to help children, adolescents, and young adults with heart rhythm problems,” says Dr. McCanta, “Seeing patients like Lauren get back to all of the things they love doing is why we do this!”

Since the procedure, Lauren has been vocal at church to educate her peers about being conscious and vocal about their health.

Learn more about CHOC’s electrophysiology program.