Ryan Hansen Named Director, CHOC Children’s Heart Institute

Following a nationwide search, Ryan Hansen has been named director of the CHOC Children’s Heart Institute. In his new role, Ryan will work closely with hospital and physician leaders to advance strategies designed to make the Heart Institute a leading destination for pediatric and adolescent cardiovascular care.

“CHOC is clearly an organization on the rise with a talented medical staff, engaged employees and a very supportive executive leadership team dedicated to the hospital’s mission and vision. I look forward to bolstering CHOC’s excellent cardiovascular services, including embracing innovation and new technologies to better serve the children and families in our community and beyond,” said Ryan.

Ryan joins CHOC from Texas-based Memorial Hermann Health System, where he served as director, hospital operations, Heart & Vascular Institute.  During his six-year tenure there, he launched the Advanced Heart Failure, Heart Transplant and Lung Transplant Program, which has become the second largest transplant program in Texas and 13th largest in the nation.  Under Ryan’s leadership, the program developed into the top implanting center in Texas for transcatheter aortic valve replacements (TAVR) and total artificial hearts (TAH), while maintaining quality with clinical outcomes superior to national averages.  Additionally, Ryan was instrumental with the construction of the flagship, multidisciplinary advanced heart failure clinic and network of five cardiology clinics.

Prior to Memorial Hermann Health System, Ryan was the administrative director for the division of cardiology and heart failure at Baylor College of Medicine in the Texas Medical Center with responsibilities for the academic, research and clinical missions.  Ryan also served as a project manager in the institution with a focus on physician revenue cycle optimization and new EMR implementation.  He bridged the practice of medicine and the business of medicine to increase practice profitability and efficiency for the college.

After earning his bachelor’s degree in biology from The University of Texas at Austin, Ryan completed the dual master’s degree program (MBA/MHA) at University of Houston Clear Lake.  He currently resides in south Orange County with his wife and three young children.

“I am very excited to be in Southern California and to have the opportunity to partner with CHOC’s talented and highly-skilled medical staff to advance education, research and evidence-based medicine practices for the Heart Institute.  In addition to playing a vital role in preventive cardiology and improving the cardiovascular health of Orange County children, CHOC will be the healthcare provider of choice for advanced cardiac therapies,” stated Ryan.

Ryan can be reached at rhansen@choc.org.

CHOC Children’s Expands Fetal Cardiology Program

Approximately 1 percent, or 40,000, babies in the United States are born with a congenital heart disease each year. That’s almost 5,000 babies in California alone. In order to catch problems as early as possible, fetal cardiology specialists at the CHOC Children’s Heart Institute work with pregnant women to evaluate, diagnose and manage babies in utero who may be at risk for congenital heart defects, heart failure or rhythm disturbances.

CHOC offers the only comprehensive fetal cardiology services in Orange County, and our team has advanced training in fetal echocardiography, fetal magnetic resonance imaging, electrophysiology and genetics.

“Fetal echocardiography is a powerful tool that helps identify significant abnormalities and allows for family, delivery and interventional planning as necessary,” says Wyman Lai, MD, who recently joined CHOC from Columbia University in New York to lead CHOC’s non-invasive cardiac imaging program.

Fetal cardiac imaging is performed using ultrasound machines with the highest resolution imaging available, including 2D and Doppler analysis, as well as 3D technology. This allows us to perform first trimester screening so that patients can be referred at the earliest stages of pregnancy.

CHOC board-certified cardiologists perform fetal echocardiograms in their offices to help detect heart abnormalities before birth. At the time of appointment, patients receive a comprehensive diagnosis and care plan. Depending on the child’s condition, referrals to other experts, such as cardiac interventionalistscardiac electrophysiologistscardiac surgeons and heart failure specialists will be provided as needed. Early intervention improves the chance of survival after delivery for babies with severe defects.

Who Should Have a Fetal Echocardiogram

Pregnancies may be at risk for congenital heart disease for a variety of reasons.

Fetal risk factors include:

  • An abnormal appearing heart
  • Abnormal heart rate or arrhythmia on routine screening ultrasound
  • Aneuploidy (chromosomal abnormality)
  • Increased nuchal translucency thickness at first trimester evaluation
  • Noncardiac fetal structural abnormalities
  • A two-vessel umbilical cord
  • Identical twins
  • Fluid accumulation in the fetus.

Maternal risk factors include:

  • Maternal diabetes, lupus or other systemic disease that involves the heart
  • First-trimester use of known teratogens
  • Assisted reproduction technology
  • Maternal congenital heart disease.

Familial risk factors include:

  • A history of a previous child being born with a heart defect
  • The father being born with a heart defect
  • Other close relatives being born with heart defects or syndromes known to involve the heart.

Fetal Cardiology Referrals

If a pregnant woman is at high risk for delivering a child with congenital heart disease, our fetal cardiology specialists are available for consultation and referral. They can be reached at 714-509-3939, or you can find a fetal cardiologist here in our directory.

Know the Risks of Sunken Chest

Pectus excavatum, or sunken chest, is the most common congenital chest wall abnormality in children. Although some medical providers may think that the abnormality is purely a cosmetic problem, the limited chest cavity space can displace the heart as well as limit lung capacity, says Dr. Mustafa Kabeer, a pediatric surgeon at CHOC Children’s. Fifteen percent of patients can experience arrhythmia or mitral valve regurgitation, wherein the heart valves allow blood to leak back into the heart, as a result of the inward compression from the sternum.

Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s
Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s

Although the cause is unknown, 40 percent of patients report a family history of pectus excavatum, and 40 percent of cases occur in tandem with scoliosis, says Dr. Kabeer.

Parents may notice an indentation in their child’s chest wall either when they are first born, or closer to puberty, when changes in the chest wall can become more pronounced.

Dr. Kabeer urges medical providers to carefully evaluate symptoms, as they can be subtle and often go unnoticed. If a patient is older than 10 years with pectus deformities, he asks medical providers to look for signs of shortness of breath, difficulty breathing during exercise, unexplained dizziness, occasional chest pain or progressing changes in chest wall appearance.  Some patients notice they are not able to keep up with their peers. If they show even mild symptoms that were not previously recognized, they should be referred to the pectus excavatum team at CHOC, he explains.

The multidisciplinary team is comprised of experts in pediatric pulmonology, cardiology and surgery. The team performs various testing to examine heart and lung function, before and after surgery that expands the chest wall. By using the latest techniques in minimally invasive surgery that dramatically reduces the appearance of incisions, along with recent improvements in pain management, patients are able to return home and get back to their daily activities sooner than ever before.

“We have a comprehensive team ready to evaluate these patients because chances are high that they have some compromise on the cardiopulmonary system given the compression of the sternum. This is not generally noticeable until they are in some kind of increased activity at which point the increased demand from the body has difficulty being met by the heart and lungs,” Dr. Kabeer says.

“These patients should be referred to pediatric surgeons because we are trained in the minimally invasive procedure and should be the first line approach to this problem; there is no need to put a child through a more invasive operation that is not needed,” he adds.

Dr. Kabeer recommends the following referral guidelines:

  • Age < 10 years can be monitored and symptoms and severity of deformity based only on exam should be logged. No studies are necessary at this time unless symptoms are severe at which point, they should be referred to the pectus excavatum team at CHOC, but workup is not necessary prior to referral.
  • Age >10 years with very mild pectus deformities and with no symptoms can be referred or observed.
  • Age >10 years with pectus deformities that are moderate or severe with or without symptoms and mild deformity with symptoms should be referred to the pectus excavatum team at CHOC. No imaging or workup is necessary until seen by the pediatric surgeon.

To contact Dr. Kabeer, or to refer a patient, please call 714-364-4050.

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Meet Dr. Laura Totaro

CHOC Children’s wants its referring physicians to get to know its specialists. Today, meet Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s at Mission Hospital.

Dr. Laura Totaro

Q: What is your education and training?

A: I attended Loma Linda University Medical School and graduated in 2011. I then became part of the first UC Irvine/CHOC Children’s pediatric residency class and graduated from the program in 2014. I was board-certified in Pediatrics in 2014.

Q: What are your administrative appointments?

A: I am the hospitalist representative for both the CHOC Children’s at Mission Hospital Intensive Care Committee and the CHOC Children’s Infection Prevention Committee.

Q: What are your special clinical interests?

A: I am most interested in infectious disease and autoimmune disorders.

Q: How long have you been on staff at CHOC?

A: Two years.

Q: What are your most common diagnoses?

A: Seizures, asthma, bronchiolitis, pneumonia, and gastroenteritis/dehydration.

Q: What would you most like community/referring providers to know about you or your division at CHOC?

A: In an effort to better facilitate transfer of care, we now offer 24/7 hospitalist coverage at both CHOC campuses.

Q:  What inspires you most about the care being delivered here at CHOC?

A: The CHOC community provides a unique focus on healthcare for kids that goes beyond just the basics. The entire care team including the doctors, nurses and additional staff who strive to provide personalized care that not only treats a physical illness but also addresses the needs of the entire family. I am inspired by the culture of physicians and nurses that are constantly learning and trying to provide the best care they possibly can. It is such a pleasure to work in a place where everyone seems to truly enjoy their job and are trying to find ways to be even better at them.

Q: Why did you decide to become a doctor?

A: I grew up in a healthcare-focused community where I was exposed to medicine from a young age. I was inspired by the doctors around me and was fascinated by the human body. I also wanted a career that would allow me to help others here in my immediate community and abroad.

Q: If you weren’t a physician, what would you be and why?

A: I would run a travel blog and be a food critic.

Q: What are your hobbies/interests outside of work?

A: Travel, exploring new restaurants, art, and music.

Q: What’s the funniest thing a patient has ever told you?

A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

CHOC Children’s Health Center, Mission Viejo Moves to New Location

CHOC Children's Health Center, Mission ViejoBeginning Jan. 18, 2016, CHOC Children’s Health Center, Mission Viejo will be located at: Los Altos Medical Plaza, 26691 Plaza, Suite 130, Mission Viejo, CA 92691.

Our spacious new location features 10 exam rooms and a procedure room. The following outpatient specialty care services will continue to be offered: cardiology, endocrinology, gastroenterology, nephrology, neurology, pulmonology, rheumatology and surgery (pre- and post-op).

Hours are Monday-Friday, 8 a.m. – 5 p.m. For questions, please contact Dini Baker, manager specialty clinics at CHOC, at dbaker@choc.org.