Advanced Cardiac Imaging Techniques for Clinical Challenges

Non-invasive MRI for Neonates

Precise cardiovascular anatomy is required for neonatal surgical planning. CT angiogram is commonly used to complement echocardiography. However, in small neonates, CT angiogram can be challenging due to a lack of power-injectable vascular access and rapid contrast transit, secondary to higher heart rates.

At the Ward Family Heart Center at Children’s Mercy Kansas City, Non-Invasive Advanced Cardiac Imaging and Echocardiography are utilizing MRI techniques that make it possible to obtain high-resolution images in small neonates, yet limit their exposure to ionizing radiation.

In these cases, a swaddling technique is used to calm the infant for the MRI exam, eliminating the need for sedating anesthesia. Utilizing a blood pool contrast agent for MR angiography that can be infused in a small peripheral intravenous line enables the acquisition of these images necessary for surgical planning. These techniques are used in neonates weighing down to 2 kilograms.

MR angiograms and additional functional imaging also have been used in clarifying critical details in lesions, like vascular rings, Tetralogy of Fallot with pulmonary atresia and atrioventricular septal defect in neonates. This demonstrates that these MRI techniques are diagnostic in neonates, thus reducing the risks of CT and anesthesia while complementing echocardiography.

Utilizing Point-of-Care Ultrasound for Cardiac Evaluation During COVID-19

The novel coronavirus SARS-CoV-2 is known to cause significant cardiac dysfunction, effusion, thromboembolism and coronary dilation. As the COVID-19 pandemic spread across the nation and these cardiac complications began to surface in the pediatric population, Non-Invasive Advanced Cardiac Imaging and Echocardiography at Children’s Mercy began searching for ways to safely and effectively detect these issues.

In addition to traditional ultrasound equipment, the team quickly pivoted to adopt a hand-held ultrasound probe that can be connected to an iPad. Because the unit is significantly smaller and more compact, cleaning and sanitizing it after each patient exam is much simpler. Plus, the technology can be readily utilized at the bedside with diagnostic image quality.

The team’s workflow was to perform the point-of-care exam, and if the scan revealed findings requiring more comprehensive evaluation, a follow-up detailed echocardiography exam was planned. For those patients with normal exams, the detailed echo was deferred.

Overall, point-of-care ultrasound has helped improve workflow and expedite care for pediatric patients admitted for COVID-19, while ensuring safety of patients and health care workers. Thanks to its portability and ease of use, the heart center imaging team is now training critical care specialists and neonatologists at Children’s Mercy in how to perform these ultrasound examinations at the bedside, putting access to this lifesaving testing at their fingertips.

Serving as the Echocardiography Core Lab for FDA Investigation of New Transcatheter Pulmonary Valves

Since 2012, the Non-Invasive Advanced Cardiac Imaging and Echocardiography Lab at Children’s Mercy has served as the Echocardiography Core Lab for FDA investigation of the safety and effectiveness of transcatheter pulmonary valves.

These valves are being developed by Edwards Lifesciences and include the SAPIEN 3 and Alterra transcatheter heart valves. The lab continues surveillance of patients who received the SAPIEN valve, which has been recently approved by FDA for clinical use.

In order to monitor valve safety and effectiveness over a five-year time frame, patients receive from five to nine different echo studies pre- and post-implant for each device under investigation.

The lab has performed more than 1,500 echo studies related to these valves since 2012, validating the team’s expertise in pediatric echocardiography while providing access to longitudinal follow-up data on hundreds of patients.

Developing New Apps for Advanced Imaging

Like many non-invasive pediatric cardiology programs, Children’s Mercy utilizes Lean methodology and meets all guidelines from the American College of Cardiology and the American Heart Association for advanced cardiac imaging. The program utilizes 3D printing capabilities for surgical planning; has a robust telemedicine platform that offers image transfer, archiving and expert interpretation of cardiac imaging studies; and provides 3D echocardiography and myocardial strain imaging surveillance for oncology patients post-treatment through the hospital’s Cardio-Oncology Clinic.

A program under development places the program on the leading edge of pediatric cardiology by using a novel online module-based curriculum to enhance pediatric cardiology fellowsʼ echo education. Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. All fellows completed pre- and post-tests, validated by independent expert imagers and surveys. All of the fellows participated in the pilot study. Test scores improved after completing the modules, and most fellows maintained a higher score at four weeks, suggesting good knowledge retention.

Learn More About Advanced Imaging at Children’s Mercy

Sanket Shah, MD, MHS; Co-Director of Advanced Cardiac Imaging and Director of Echocardiography

ssshah@cmh.edu

Erin Opfer, DO; Co-Director of Advanced Cardiac Imaging

ekopfer@cmh.edu

For consults, admissions or transport call: 1 (800) GO MERCY / 1 (800) 466-3729.