>> 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.