>> THE WHOLE POINT OF THIS
PROGRAM WAS TO MAKE THIS
EASILY ACCESSIBLE, TO MAKE
THE RESOURCES OF THE CARDIAC
CENTER EASILY ACCESSIBLE
TO FAMILIES AND PATIENTS
AND TO REFERRING PHYSICIANS.
>> MOST OF THE KIDS THAT
COME THROUGH AN OUTSIDE
PHYSICIAN'S OFFICE DO NOT
HAVE THESE COMPLEX DISEASES,
SO THEY REALLY PROVIDE
THE FIRST LINE AND ONE OF
THE MOST DIFFICULT THINGS,
AND THAT IS TO IDENTIFY THESE
KIDS, TO BEGIN WITH, AND
GET THEM INTO THE PROGRAM.
>> MOST OF OUR FAMILIES ARE
COMING FROM THEIR HIGH-RISK
OBSTETRICIANS OR EVEN BEING
REFERRED FROM PEDIATRIC
CARDIOLOGISTS, LOCALLY
OR ACROSS THE COUNTRY.
>> WHEN PATIENTS ARE
REFERRED HERE FOR AN
EVALUATION PRENATALLY, THEY
UNDERGO A FAIRLY INTENSIVE,
USUALLY ONE-DAY EVALUATION.
>> TYPICALLY THAT'S DONE
THROUGH A LEVEL II TYPE
ULTRASOUND, AN
OBSTETRICAL ULTRASOUND,
WHERE THE FETUS IS
SCANNED FROM TOP TO BOTTOM,
LOOKING AT OTHER ORGAN
SYSTEMS BESIDES JUST
THE HEART ITSELF.
>> THAT'S TO MAKE SURE
THAT THERE AREN'T OTHER
ABNORMALITIES THAT CO-EXIST
WITH A PRIMARY CARDIAC
ABNORMALITY.
>> IN MANY, MANY CASES,
CONGENITAL HEART DISEASE
IS ISOLATED;
IT OCCURS ON ITS OWN.
BUT OFTENTIMES IT CAN OCCUR
WITHIN A CONTEXT OF SOME
OTHER TYPE OF PROBLEM.
THERE ARE A NUMBER OF
CHROMOSOMAL ANOMALIES
THAT CAN BE ASSOCIATED
WITH DIFFERENT FORMS
OF CONGENITAL HEART DISEASE,
COMMON THINGS BEING TRISOMY 21,
OR DOWN SYNDROME.
THERE CAN BE OTHER FORMS
OF TRISOMY DISEASES WHICH,
UNFORTUNATELY, HAVE A
MUCH POORER OUTCOME.
>> THEY MAY OR MAY NOT THEN
ALSO HAVE A FETAL MRI ADDED
TO THE EVALUATION, AND
THEN THEY HAVE THE EXTENSIVE
FETAL ECHOCARDIOGRAPHY.
THE KEY TO THE FETAL
PROGRAM IS IMAGING,
TO BE ABLE TO DO ULTRASOUNDS
AND MAKE THE DIAGNOSIS
OF CONGENITAL HEART DEFECTS
VERY EARLY IN FETAL LIFE.
>> WE NOW HAVE TECHNOLOGIES
THAT CAN ALLOW US TO LOOK
AT THE FETUS AS EARLY AS
10 TO 12 WEEKS' GESTATION.
>> WE ACTUALLY HAVE TWO
DEDICATED FETAL SONOGRAPHERS
THAT THIS IS ALL
THEY'RE DOING.
>> WE ARE VERY CONFIDENT
WHEN WE DO THE SCAN,
SO WE MAKE THE PATIENT
ALSO FEEL MORE COMFORTABLE.
>> MY JOB IS TO REALLY
GET A FULL UNDERSTANDING,
OR AS BEST OF AN
UNDERSTANDING AS WE CAN
HAVE, FOR HOW THESE BABIES
ARE GOING TO BEHAVE AFTER
THEY'RE BORN.
>> TO ANALYZE THE
STRUCTURE OF THE HEART,
BOTH FROM AN ANATOMICAL
AND A STRUCTURAL STANDPOINT
AND A FUNCTIONAL STANDPOINT,
AND TO LOOK AT BLOOD FLOW
PATTERNS.
>> IT'S INCREDIBLE, THE THINGS
THAT WE CAN SEE TODAY.
WE CAN SEE
ALMOST EVERYTHING.
BY THE END OF THE PREGNANCY,
WE CAN REALLY GET A GOOD
UNDERSTANDING WITH WHAT
THE BABY'S PHYSIOLOGY
IS GOING TO BE.
>> EVERY BABY LOOKS LIKE A
REAL BABY TO ME BECAUSE
I CAN SEE BABY'S MOVEMENT.
I CAN SEE BABY'S
HANDS; I CAN SEE BABY'S,
YOU KNOW, HEART AND
THE ENTIRE CIRCULATION.
>> IF WE DIDN'T HAVE THE
DIAGNOSTIC IMAGES TO TRACK
AND TREND, THERE'S A LOT
THAT WE WOULD NOT BE ABLE
TO HELP ANTICIPATE WITH
AND FOR FAMILIES.
>> IT'S HARD TO HEAR IT,
BUT IT WAS, FOR US,
EASIER TO ACCEPT
AND UNDERSTAND.
>> BECAUSE THEN YOU CAN
PREPARE YOURSELF FOR WHEN
THE BABY IS BORN AND
WHAT NEEDS TO BE DONE.
>> I'M VERY PLEASED TO BE
ABLE TO GIVE YOU SOME GOOD
NEWS TODAY.
>> AFTER THEY HAVE
THEIR FIRST SCANNING,
THEY SIT DOWN WITH ONE OF
THE PHYSICIANS AND THE NURSE
COORDINATOR, AND THEY'RE
TOLD IN EXTENSIVE DETAIL
WHAT THE DIAGNOSIS IS.
>> THEY EXPLAINED
WHAT, YOU KNOW,
COULD HAPPEN, YOU
KNOW, HOW THE HEART,
THE MAKE-UP OF THE HEART WAS
A LITTLE BIT DIFFERENT THAN
OTHER BABIES,
JUST TALK ABOUT,
LIKE, THE WAY THE BLOOD
FLOW IS GOING TO HAPPEN,
TALK ABOUT THE DIFFERENT
STAGES OF THE OPERATION.
>> HAVING THIS
INFORMATION UPFRONT,
KNOWING ABOUT THESE--THE
SPECTRUM OF THESE ANOMALIES
UPFRONT, CAN CERTAINLY
HELP FAMILIES IN TERMS
OF DECISION MAKING AND CAN
ALSO BE HELPFUL IN TERMS
OF PREPARATION AND KNOWLEDGE
ABOUT WHAT NEEDS TO BE DONE
WHEN THESE BABIES ARE BORN.
>> OUR OUTCOMES
ARE MUCH BETTER,
WE FEEL, BECAUSE WE KNEW
AND HAD TIME TO PLAN
AND UNDERSTAND THE
CONCEPT OF EVERYTHING.
