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. 

In the Spotlight: Wyman Lai, M.D.

A nationally-recognized pediatric cardiologist with expertise in fetal cardiology and non-invasive imaging for heart disease in fetuses and children has joined CHOC Children’s. Dr. Wyman Lai is the new medical director of echocardiography at CHOC; co-medical director of the CHOC Heart Institute, and assistant division chief of cardiology with CHOC Children’s Specialists.

“CHOC has a fabulous mix of state-of-the-art care, community presence, and academic achievement. I thoroughly enjoy working with my colleagues, who strive to provide the very best care available. The administrative staff at CHOC has also been extremely supportive. Together we are building a pediatric service that rivals any in the region, and we have our sights on even higher goals,” Dr. Lai says.

Dr. Lai’s passion for helping others inspired him to become a doctor. His original plan was to go into academic primary care pediatrics, and he majored in maternal and child health for his Master of Public Health degree. Early in his training, he switched to pediatric cardiology after becoming fascinated with what the pediatric cardiologists were doing.

“In pediatric cardiology, we are able to make a profound difference in the lives of our patients. With our surgical colleagues, we have made incredible advances in life-saving therapies over the past five decades,” Dr. Lai says. “The heart is an amazingly complex organ; it starts off as a simple tube, and it’s a wonder that it ever develops normally into a four-chambered pumping organ that delivers oxygen efficiently throughout our body.”

Dr. Lai attended medical school at the Alpert Medical School of Brown University. He completed his residency at UCLA Ronald Reagan Medical Center, followed by a pediatric cardiology fellowship at UCLA Medical Center, and later, a pediatric cardiology MRI fellowship at Boston Children’s Hospital.

Since joining CHOC, Dr. Lai has been treating patients with complex congenital heart disease. He is also treating patients with the full spectrum of heart conditions, from heart murmurs to chest pain and syncope.

Dr. Lai’s approach towards his patients and their families is to treat them like family members.

“As with all families, however, not everyone is the same,” he explains. “Some patients and parents want more medical information and some less. Some want to be very involved in the decision-making process and some not so much. My practice is to provide them with enough information and support, so they feel comfortable with the decisions they are making.”

Along with Drs. Nita Doshi and Pierangelo Renella, Dr. Lai is helping to build a great program in fetal cardiology at CHOC. He is also working with Dr. Renella to grow the congenital cardiac MRI program, including the use in non-invasive imaging for creating 3D heart models.

“We recently used a 3D cardiac MRI dataset to print several heart models that were used to assist in the planning of care for a child with complex congenital heart disease. Another area of innovation is our purchase of new patient monitoring software in the cardiovascular ICU that will help us to identify patients at risk for acute deterioration before it happens,” Dr. Lai says.

In April, Dr. Lai will serve as co-program director for an inaugural conference hosted by CHOC, Pacific Coast Fetal Cardiology 2017: An Interactive and Case-Based Educational Symposium, in Newport Beach. The conference supports CHOC’s efforts to improve the success of fetal cardiac screening in the region, he says.

Dr. Lai is a prolific author who has published numerous journal articles and chapters, and has contributed to several high-level textbooks utilized throughout the country. He has lectured extensively in the United States and internationally. Dr. Lai is a member of the American College of Cardiology, American Society of Echocardiography, and American Academy of Pediatrics, among other professional organizations. In addition, he sits on the National Board of Echocardiography Board of Directors.

His ongoing academic interests include creating a reliable set of normal values for cardiovascular structures in newborns and children, developing pediatric cardiac MRI guidelines, and testing new cardiac MRI sequences.

In his spare time, Dr. Lai loves spending time with his family. He also enjoys swimming, biking and running. He hopes to run in this year’s Boston and New York marathons, which he has participated in the past. He is also attending classes for a health care executive MBA at UC Irvine.

For cardiology referral guidelines, click here. To refer a patient, call 888-770-2462. 

To contact Dr. Lai, please call 714-509-3939.