Mending a baby's defective heart requires the cool of a bomb squad commander and the precision of a Swiss watchmaker. If a doctor misses the target by just half a millimeter when suturing an artery, it can nick the artery and jeopardize a child's life.
"It can be catastrophic; their delicate cardiovascular systems simply cant tolerate blood loss well," says Anastasios Polimenakos, MD, a pediatric heart surgeon at the Rush Center for Congenital and Structural Heart Disease.
Thankfully, pediatric heart surgeons and pediatric interventional cardiologists at Rush have the technology and tools as well as the nerves of steel to meet the challenges of treating babies with hearts as small as strawberries and blood vessels as thin as a single hair.
Early Detection, New Approaches
Recent advances in diagnostics (see sidebar) have allowed doctors to prepare and develop treatment plans to be put into action immediately after birth for conditions such as heart valve abnormalities, holes in the heart, transposed arteries and malfunctioning heart chambers.
And today, many heart defects can be treated without surgery. By using a catheter and an image-guidance system to thread tiny instruments through blood vessels to reach the heart, interventional cardiologists can patch holes in the heart, implant artificial heart valves and use stents to widen blood vessels. Facilities like Rush's hybrid catheterization suite allow surgeons and interventional cardiologists to perform procedures separately or simultaneously, as well as switch midprocedure, if necessary from catheterization to open surgery without moving the patient from room to room, giving babies the best of both worlds.
For some congenital heart conditions, open heart surgery is still the best option because of the defects complexities. Transposition of the great arteries, for example, is a life-threatening condition in which the two major arteries leaving the heart are reversed. In newborns, surgeons must switch and reattach these major arteries as well as reconnect the coronary arteries. Using special magnifying glasses, surgeons work with microvascular tools to sever the straw-sized major arteries and suture them in the correct positions. "We then reconnect the hair-thin coronary arteries," says Polimenakos. "Precise movements are necessary to keep the vessels from kinking or twisting, which can cause the heart rate to drop and blood pressure to crash."
Fortunately, a baby's chances of surviving such a procedure are extremely high. In fact, there has been a dramatic increase in survival for children born with serious heart defects thanks to advances in diagnostics and treatment not to mention steady hands and cool heads.
Learn about Matthew, who was born with a congenital heart defect, and watch other patient stories at www.rushstories.org.
Options for prenatal testing
The following prenatal tests offered by the Rush Fetal and Neonatal Medicine Program can help identify heart defects:
- First and second trimester 3-D/4-D ultrasonography
- Fetal echocardiography
- Maternal serum screening, also known as serum quadruple screen
- Percutaneous umbilical blood sampling