Heart healthy: Advances in technology give cardiac patients better outcomes.

AuthorBlake, Kathy
PositionCARDIAC CARE

The tiniest heart-surgery patient weighed 2 pounds.

At Levine Children's Hospital in Charlotte, little ones with congenital defects--conditions their hearts were born with--are cared for by a team of nurses, child-life specialists, surgeons, anesthesiologists and intensivists who handle about 480 heart catheterizations and 300 open-heart surgeries a year.

Part of that team is Joseph Paolillo, who serves as Levine's director of pediatric cardiac catheterization, and Paul Kirshbom, chief for the division of pediatric and congenital heart surgery for Levine Children's and Sanger Heart & Vascular Institute. Both Levine and Sanger are affiliated with Atrium Health.

"That was the smallest baby we've done a procedure on here. It's not easy. It's a taxing thing for us, because it's hard to distance yourself from the families. In pediatric cardiology, you don't just have the one patient--you have the families," Paolillo says. "The majority of heart defects are diagnosed before children are born, so that gives a fair amount of time to meet with the families and let them prepare, tour the facility, meet the people. That kind of approach helps them cope."

"With kids," Kirshbom says, "each one is a custom job. Congenital heart disease has 1,000 different flavors --each a little bit different. It's a huge, emotional thing. Every family comes in with different expectations. There are folks from big families, rural areas, other countries. It's dramatically varied. You're providing hope for their child, a hope they didn't think existed. But most of the children grow up, go to school, get jobs. It's not a death sentence anymore."

The toolbox for petite hearts is different than that for adults. Most equipment is designed for big people. "It's a lot more art than science sometimes," Kirshbom says.

Levine Children's, like other North Carolina hospitals, is acquiring new devices, new technologies for cardiologists and surgeons to intricately navigate fragile arteries, veins, vessels and muscle tissue. It is a continuously evolving profession, in the care of tiny babies as well as older children and adults.

"In general, the procedures we do on babies are usually to open valves or close blood vessels that should have been closed before birth," Paolillo says. "With older children, there are certain holes in the heart--atrial septal defects, which is a hole between the upper chambers. And we're very involved here in a new device that has come out."

Levine Children's is one of 20 centers testing the W.L. Gore & Associates Inc.'s GORE CARDIOFORM Septal Occluder, for closure of small to medium-size holes. The hospital is now in the second phase of a trial.

Congenital heart defects affect about 1% of the population. Some holes in the heart will fix themselves, Kirshbom says, while some children will have three to five operations early in life. Technology has advanced dramatically, he says. However, Levine Children's performs about a dozen pediatric heart transplants annually. "Organ donation needs to be stressed in our country," he says.

Paolillo works mostly in the catheterization laboratory. "Cardiac catheterization is done for a number of reasons. Sometimes it's to gather information; sometimes it's to take care of patients between different surgical stages to see how the last operation worked out and what needs to be done," he says. "A lot of children who come to the lab are pretty sick, and they're just struggling without an interventional procedure."

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