>> WHEN YOU HAVE A CHILD WITH ANY TYPE OF PROBLEM,
PARTICULARLY CONGENITAL HEART DISEASE,
YOU WANT TO BE AT A PLACE THAT HAS EXPERTISE IN ALL
ASPECTS OF THEIR CARE.
>> THE NUMBER OF BABIES THAT, OR CHILDREN OR ADULTS,
EVEN, THAT COME THROUGH OUR HEART PROGRAM WITH
CONGENITAL HEART DISEASE IS HUGE.
>> WE HAVE A BREADTH OF EXPERIENCE HERE AT THE
FETAL HEART PROGRAM THAT REALLY IS SECOND TO NONE SIMPLY
BECAUSE OF THE VOLUME.
>> TO BE GOOD AT WHAT WE DO, YOU HAVE TO HAVE EXPOSURE TO
THIS GROUP OF PATIENTS ON A ROUTINE AND CUSTOMARY BASIS.
>> BECAUSE SO MANY PATIENTS COME THROUGH,
WE HAVE THE LUXURY OF BEING ABLE TO PROVIDE
CARDIAC-SPECIFIC SUPPORT SYSTEMS.
>> WE HAVE A PROGRAM HERE CALLED THE IMPACT PROGRAM.
THIS STANDS FOR IMMEDIATE POSTPARTUM ACCESS
TO CARDIAC THERAPY.
THIS PROGRAM WAS DEVELOPED TO DEAL WITH THAT SMALL
SUBSET OF FETUSES WHO NEED IMMEDIATE CARE AFTER BIRTH.
WE ARE ABLE TO MARTIAL THE ENTIRE FORCES OF THE CARDIAC
CENTER--INTERVENTIONALISTS, ANESTHESIA, NURSING, SURGERY,
WHATEVER IS NECESSARY-- IN THESE INFANTS
WHO IMMEDIATELY NEED ACCESS TO CARE.
>> OUR CARDIAC INTENSIVE CARE UNIT,
CARDIAC STEP-DOWN UNIT, CARDIAC ORS,
THEY'RE ONLY TAKING CARE OF CHILDREN,
INFANTS AND CHILDREN WITH HEART DISEASE.
>> YOU HAVE TO HAVE EXPERTISE TO KNOW WHEN TO
VARY THE MANAGEMENT FOR A PARTICULAR CHILD.
>> SO THERE'S THE USUAL STUFF YOU'D READ ABOUT IN
A TEXTBOOK OR THAT YOU WOULD LEARN IN YOUR TRAINING,
BUT EVERY CHILD IS AT RISK FOR SOMETHING HAPPENING
THAT'S NOT QUITE USUAL.
EVERY CHILD IS AT RISK FOR HAVING SOMETHING ON THEIR
ECHO, SOME PART OF THEIR HEART THAT ISN'T EXACTLY
WHAT YOU WOULD HAVE EXPECTED.
AND THOSE UNUSUAL THINGS, IF THEY'RE MISSED,
CAN BE A BIG PROBLEM FOR THE BABY AND,
IF THEY'RE IDENTIFIED, CAN MAKE THE HOSPITAL COURSE
FOR THE BABY MUCH BETTER.
>> AS MUCH AS WE WOULD LIKE TO THINK THAT MEDICINE IS
A TRUE SCIENCE, EXPERIENCE AND LEARNING IS VERY IMPORTANT
IN HOW YOU TAKE CARE OF THESE KIDS.
>> IN THE TRADITIONAL HOSPITAL STRUCTURE,
ALL OF THESE DIFFERENT PEOPLE WORK IN DIFFERENT
DEPARTMENTS OR SILOS.
BUT WHAT WE RECOGNIZED IS WE REALLY ALL HAVE TO COME
TOGETHER AS ONE GROUP TO GIVE THE KIDS AND THEIR
FAMILIES THE BEST CARE WE CAN.
>> HAVING A TEAM THAT WORKS TOGETHER TO DEAL
WITH CHILDREN WITH CONGENITAL HEART PROBLEMS
IS A HUGE ADVANTAGE.
>> IT'S A GROUP THE SPECIALISTS IN ALL THE AREAS
THAT ARE NEEDED TO TAKE CARE OF THESE PATIENTS.
>> AND THAT IS NOT JUST SURGERY.
THAT IS CARDIOLOGY.
THAT IS RESPIRATORY THERAPY.
THAT IS GENETICS.
>> CARDIAC ANESTHESIOLOGISTS,
DEDICATED TEAM OF CARDIAC NURSES--
>> SOCIAL WORKER, LACTATION SPECIALISTS,
CHILD LIFE SPECIALISTS--
>> AND THE ENTIRE SUPPORT SYSTEM THAT'S NECESSARY
TO PROVIDE ANYTHING THAT IS MEDICALLY OR SURGICALLY
NEEDED TO TAKE CARE OF A CHILD WITH CONGENITAL
HEART DISEASE.
>> SOMETIMES, FORTUNATELY, I THINK,
THE ONLY TREATMENT A CHILD WITH A VERY SERIOUS HEART
DISEASE NEEDS IS CATHETER THERAPY.
>> THE CHILDREN'S HOSPITAL OF PHILADELPHIA HAS A VERY
LONG LEGACY OF INNOVATION AND NEW STRATEGIES
FOR DEALING WITH ALL KINDS OF DISEASES IN CHILDREN.
>> CARDIAC CATHETERIZATION STARTED VERY MUCH AS REALLY
THE FIRST WAY YOU COULD LOOK AT PICTURES OF THE HEART
AND DIAGNOSE HEART PROBLEMS.
BUT THE REAL BREAKTHROUGH ACTUALLY OCCURRED HERE
IN CHILDREN'S HOSPITAL.
DOCTOR WILLIAM RASHKIND, WHO WAS OFTEN CONSIDERED
THE FATHER OF INTERVENTIONAL CATHETERIZATION,
DEVELOPED A TECHNIQUE THAT COULD SAVE BLUE BABIES WITH
TRANSPOSITION WHO OFTEN DIED BECAUSE THEY JUST DIDN'T
HAVE ENOUGH OXYGEN IN THEIR BLOODSTREAM.
AND HE WAS THE FIRST ONE TO USE A CATHETER TO TREAT
A HEART PROBLEM IN CHILDREN.
>> THIS PROCEDURE NOW ALLOWS US TO OPEN UP THE HOLE
BETWEEN THE UPPER CHAMBERS, ALLOW MIXING OF RED AND BLUE
BLOOD, AND ALLOW STABILIZATION OF THE INFANT
UNTIL WE CAN MOVE TOWARDS SURGERY.
>> FROM THAT, THE FIELD HAS REALLY BLOSSOMED
OVER THE YEARS.
>> AND THIS IS THE HISTORY THAT CHOP HAS IN SO MANY
DIFFERENT AREAS WHERE THERE HAVE BEEN PIONEERS IN NOT
ONLY HEART DISEASE, BUT IN ALL AREAS OF CHILDREN'S HEALTH.
>> WE'RE ALMOST UNIQUE IN THE WORLD IN HAVING
A CARDIAC ANESTHESIA TEAM.
>> PATIENTS WITH CONGENITAL HEART DISEASE HAVE UNIQUE
AND DIFFERENT PHYSIOLOGIES THAN CHILDREN WHO DO NOT
HAVE STRUCTURAL HEART DISEASE.
>> WE COULDN'T DO WHAT WE DO WITHOUT CARDIAC ANESTHESIA.
>> THE ANESTHESIOLOGISTS ARE RESPONSIBLE FOR ALL
THE PERI-OPERATIVE CARE OF THE CHILD,
THAT IS, GETTING THE CHILD TO THE OPERATING ROOM,
MAKING SURE THE CHILD IS STABLE WITHIN THE OPERATING
ROOM, AND THEN IMMEDIATELY AFTER THE OPERATION,
WORKING WITH THE INTENSIVE CARE UNIT TEAM TO MAKE SURE
THE CHILD IS STABLE.
>> WE'RE ABLE TO SAFELY TAKE CARE OF THEM FOR BOTH THEIR
CARDIAC PROCEDURES AS WELL AS ANY OTHER SURGICAL
OR DIAGNOSTIC PROCEDURES WHERE PATIENTS NEED SEDATION
OR ANESTHESIA.
>> BASICALLY, OVER 500 PEOPLE ARE INVOLVED
IN THE CARDIAC CENTER.
>> THE ABILITY TO BRING ALL OF THESE SERVICES TOGETHER
WITH THE FOCUS ON THE FETUS AS A PATIENT IS WHAT'S
UNIQUE ABOUT THE FETAL HEART PROGRAM.
>> IT'S THE WAY THE CARE IS DELIVERED IN THE CARDIAC
CENTER, AS WELL.
>> TAKING CARE OF THE WHOLE FAMILY AND THE WHOLE INFANT,
NOT JUST, YOU KNOW, THE SPECIFIC HEART MALFORMATION.
>> IT'S INCREDIBLY COMPASSIONATE.
IT'S INCREDIBLY PATIENT-FOCUSED.
SO THESE JUST AREN'T REALLY SMART PEOPLE;
THEY'RE REALLY SMART PEOPLE WHO ARE WORKING TOGETHER
WITH THE PATIENTS IN THE MIDDLE OF ALL THE DECISIONS
THAT WE'RE MAKING.
>> ALL OF THIS IN ORDER TO CREATE THIS SMOOTH CONTINUUM
OF CARE FROM FETAL LIFE, FROM LIFE IN THE WOMB,
TO LIFE AFTER BIRTH.