Now 2 years old, Lilly has successfully undergone the first two stages of surgical palliation for HLHS and continues to receive ongoing care through a close partnership between Children’s Mercy Kansas City and Children’s Mercy Wichita. Her care team includes pediatric cardiologist Rabah Daoud, MD, who provides longitudinal cardiology follow-up in Wichita, allowing much of her routine cardiac monitoring and advanced imaging to occur closer to home. 

The expansion of Children’s Mercy Wichita is helping improve access for regional families managing complex pediatric conditions. With enhanced specialty services, advanced cardiac imaging capabilities and coordinated care pathways, patients like Lilly can receive comprehensive follow-up care locally while still benefiting from the expertise and resources of the Ward Family Heart Center in Kansas City. 

“Lilly has successfully completed the first two stages of her surgical repair and is now awaiting her third,” Dr. Daoud said. “Thanks to the comprehensive cardiac imaging and specialized care now available here in Wichita, she has been able to receive the advanced testing and close follow-up she needs much closer to home.” The ability to identify concerns early, provide timely intervention and reduce the burden of travel has helped support Lilly’s progress and quality of life. 

Lilly’s journey highlights the value of integrated pediatric specialty care, demonstrating how collaboration between regional and tertiary care teams can improve access, continuity and outcomes for children with congenital heart disease throughout the region.

• Rita France presented and Dan Forsha chaired and presented the hands-on Pediatric Strain Learning Lab.
• Rita France organized the Society of Pediatric Echo [SOPE] networking event.
• Dan Forsha was a panelist interviewer of Meryl Cohen during the Pediatric Echo Trailblazers session
• Dan Forsha judged the Brian Haluska Sonographer Research Award competition.
• Melanie Kathol received FASE recognition and managed the CMKC Heart Center Cardiac Imaging Core Lab Booth throughout the conference.

  Abstracts:  

• Diagnosis Associated Defects and Management of 10-year Follow-Up of Anomalous Left Circumflex Coronary Artery from the Right Pulmonary Artery
  • Authors – Abhijikumar Jayasckat, Chris Mathis, William Gibson, Lauren Littell, Jenna Schermerhorn, Kayla Sayre, Sanket Shah
• A case series of prenatal diagnosis of right aortic arch, right ductus arteriosus and significant congenital heart disease
  • Authors – Jenna Schermerhorn, Hayley Hancock, Nitin Madan, Anmol Goyal, Kelsey Brattrud, Sanket Shah, Maria Kiaffas
• Expect the Unexpected: Three-Dimensional Transesophageal Echocardiography Shows Double Orifice Left Atrioventricular Valve in Unbalanced Right Dominant Atrioventricular Septal Defect
  • Authors – Pezad Doctor, Mohamed Aasshiq Abdul Ghayum, Katie Moore, Tyler Johnson, Anmol Goyal, Sanket Shah
• Coronary Artery Fistula, Ventricular Septal Defect and Vascular Ring; Prenatal Diagnosis, Postnatal Course, and Percutaneous Fistula Closure
  • Authors – Lauren Littell, Toby Rockefeller, Maria Kiaffas, Nitin Madan, Doa Aly, Sanket Shah
• Triple orifice right and double orifice left atrioventricular valve in a patient with atypical atrioventricular septal defect variant.. Poster presented at: American Society of Echocardiography (ASE) Echo Expo; 2026.
  • Authors – Adenike Adenikinju, Mariano Gonzalez Coral, Lauren Littell, Sanket Shah, Edo Bedzra, Anmol Goyal
• Continuous Quality Improvement in Pediatric Echocardiography: A Multi-Year Journey of Measurable Impact”
  • Authors – Ashley Warta, Laura Kuzava and Rita France 

By presenting innovative research, leading educational sessions and sharing best practices, the Ward Family Heart Center team demonstrated the collaborative approach that drives excellence in patient care, education and discovery. Their contributions at ASE 2026 further reinforced Children’s Mercy’s reputation as a leader in pediatric cardiac imaging and congenital heart disease care.

The statement, “Update on Education for Families and Patients With Pediatric Heart Disease: A Focus on Technological Advancements, Procedures, and Transitions of Care,” was developed by nursing leaders and multidisciplinary complex care teams with extensive experience supporting children with congenital and acquired heart disease and their families. It synthesizes over a decade of emerging evidence on best practices for patient and family education across the care continuum, including procedural preparation, interstage monitoring, transitions of care, and the expanding role of digital health technologies.

The statement emphasizes a family-centered, trauma-informed approach to education and communication, underscoring the need to align clinical information with patient and caregiver understanding at each stage of care. It also highlights the critical role of interdisciplinary collaboration among cardiologists, nurses, psychologists, child life specialists, therapists, and social workers in supporting outcomes and long-term adjustment.

“Dr. Gross-Toalson and I have long shared a clinical focus on family-centered and trauma-informed care,” said Dr. Erickson, who chaired the writing group. “As we developed this updated statement, it was essential that these principles be explicitly incorporated into the evidence base.”

The original AHA statement on this topic was published in 2003. Work on the update began in early 2024. Following extensive peer review, the statement was approved through the AHA scientific review process in October 2025 and published online in March 2026.

Significance for Clinical Practice

AHA Scientific Statements are widely cited in peer-reviewed literature and are frequently used to inform clinical guidelines, grant applications, and health policy. They serve as expert consensus documents reflecting the current state of cardiovascular evidence.

“This paper provides a structured, evidence-based framework to guide cardiology providers in integrating education and well-being into clinical practice,” said Dr. Gross-Toalson. “Because cardiology appropriately emphasizes evidence-based care while tailoring decisions to individual patients, it was critical to apply that same rigor to education, communication, and family support.”

She added that families consistently identify communication with the care team as a key determinant of psychosocial adjustment. Standardizing and simplifying educational approaches—while remaining responsive to individual learning needs—may support improved long-term outcomes.

Notably, the authors extend beyond traditional educational recommendations, addressing how cognitive, emotional, developmental, and social factors influence how patients and families receive, process, and apply clinical information.

Additional perspective from Dr. Erickson is available in an accompanying AHA Science YouTube video.

Prenatal Diagnosis and Early Postnatal Intervention

Evelyn’s care journey began prenatally when a routine 20-week anatomy scan identified potential congenital heart disease. She was referred to the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy, where she was diagnosed with critical aortic stenosis. The diagnosis prompted close weekly fetal surveillance, as physiologic changes from fetal to postnatal circulation would ultimately determine postnatal management.

“Physiology changes so much from fetal to postnatal life that you really don’t know how things are going to look,” said Brian Birnbaum, MD, FACC, FAAP, Interim Division Chief of Cardiology.

Evelyn was delivered at 39 weeks via planned C-section at the Fetal Health Center in May 2023. Immediately after birth, she underwent an urgent atrial septostomy in the cardiac catheterization lab to improve cardiac output and systemic perfusion. Postnatal evaluation confirmed critical aortic stenosis with severe left ventricular dysfunction.

“Her aortic valve was extremely small, and the left ventricle had already sustained significant scarring from chronic pressure overload,” said William Gibson, DO, Cardiothoracic Surgeon, Ward Family Heart Center and Brendan Tripp Elam Transplant Center.

Given the severity of ventricular dysfunction and right ventricular involvement, the care team determined that traditional staged single-ventricle palliation would not provide adequate long-term support. A multidisciplinary discussion led to the decision to pursue a transplant pathway.

Bridging to Transplant

At five days of life, Evelyn underwent a hybrid palliation procedure, designed to stabilize her circulation and optimize her candidacy while awaiting transplant. The procedure involved pulmonary artery banding, atrial septal stenting and rerouting systemic circulation through the right ventricle.

The procedure was complicated by intraoperative instability requiring CPR, but she recovered and was subsequently listed for heart transplantation at 10 days old with 1A status, among the youngest transplant candidates evaluated at Children’s Mercy.

Evelyn remained in the Cardiac Intensive Care Unit (CICU) for the duration of her wait. While many infants with similar physiology require a ventricular assist device, Evelyn was successfully managed medically with intravenous support, allowing her to avoid VAD placement and maintain developmental progress.

“When infants are waiting for transplant in the ICU, our goal is to preserve development as much as possible,” said Jill Van Stright, CCLS, CTRS, Child Life Specialist II. “Because Evelyn could be medically managed, she was able to experience as close to six months of early childhood as possible within the ICU environment.”

Transplant and Recovery

After six months on the transplant waitlist, a suitable donor heart became available. Evelyn underwent heart transplantation without major intraoperative complications, though the procedure required additional donor aorta to reconstruct her hypoplastic aortic arch, adding surgical complexity.

“The transplant went as smoothly as we could hope,” said Dr. Gibson.

Postoperatively, Evelyn experienced several expected complications, including a respiratory viral infection, hepatic vein stenosis requiring stenting, transient vocal cord paralysis and arrhythmias. None resulted in long-term sequelae.

Gradually, she demonstrated improved perfusion, weight gain and energy. By the holiday season, she transitioned from intensive care to a medical-surgical unit and was later discharged to the Ronald McDonald House to facilitate close outpatient monitoring.

Life After Transplant

Evelyn returned home in early 2024 and continues to receive multidisciplinary follow-up through the Advanced Cardiac Therapies and Transplantation program. Her current regimen includes dual immunosuppression and arrhythmia management, along with scheduled labs, quarterly clinic visits and annual cardiac catheterizations.

“She’s doing extremely well clinically and developmentally,” said Kay-Leigh Lawrence, MSN, RN, CPN, CCTC, Nurse Coordinator. “Her progress has been excellent.”

Now nearly 3 years post-transplant, Evelyn is meeting milestones with the support of speech, physical and occupational therapy. She is preparing to start preschool and recently took on a new role as an older sibling.

For her family and care team, Evelyn’s case highlights the importance of prenatal diagnosis, early multidisciplinary collaboration and individualized decision-making in managing complex congenital heart disease—even in the youngest patients.

Children's Mercy presentations

James O’Brien, MD, FACS – “Topics in Surgical and Catheter-Based Therapeutic Interventions 2026” (Moderated); “Yes, I Am Going to Do That to the Heart: Creating Trust Between Patient and Surgeon”

Stacy Reynolds, CPNP-PC – “Tackling SSI’s: A Nurse-Led Solution,” “Managing Medications in Real Life,” “Beyond the Technology: When Worlds, Culture and Care Collide”

Bianca Cherestal, MD – “Group Discussion on Acute Care – Inpatient Cardiology Learning: Case Presentations and Scenarios”

Geetha Raghuveer, MD, MRCP, MPH, FAAP, FACC, FAHA – “How to Care for Your Coronaries Early in Life! Lifestyle and Prevention of Atherosclerotic Coronary Artery Disease”

Lisa Laddish, DNP, CPNP-AC, CPNP-PC - “Congenital Heart Disease and Post-Operative Management: A Master Class for Nurses, APPs, and Front-Line Clinicians,” “Managing Medications in Real Life," “Together in Innovation and Discovery: Showcasing Top Nursing Oral Abstracts” (Moderated), “Together at the Table: Breakfast With Cardiac Nursing Leaders”
 

Abstracts

• Daniel Forsha, MD, MHS, Physician, Heart Center
• Mahmoud Jaara, MD, Pediatric Fellow, GME Fellowship Education
• Ashley Valenza, Student Research Assistant, Clinical Pharmacology and Toxicology
• Tony Zunica, MD, Pediatric Fellow, GME Fellowship Education

Through learning, sharing and networking, the conference aims to equip the pediatric and congenital cardiovascular care community with tools to help patients achieve a normal quality and duration of life while supporting their families. 

Integrated emotional, cognitive and mental health support — alongside world‑class cardiac care

Children’s Mercy is proud to introduce the Heart Center Wellbeing Program, a comprehensive model of care that brings together specialized psychosocial support and neurodevelopmental services with traditional cardiac treatment — so families receive seamless, whole‑heart care from diagnosis through recovery.  

What’s new

The Heart Center Well-Being Program unites two established services — the Thrive Program and the Cardiac Neurodevelopmental (CND) Program — to strengthen provider collaboration and deliver cohesive, family‑centered support in both inpatient and outpatient settings.  

Why it matters

Children with heart conditions — and their families — benefit when emotional health, coping skills, learning and development are supported alongside medical care. By expanding access to these resources, the program helps families navigate treatment, build resilience and optimize developmental outcomes across the care journey.  

Who we serve

From prenatal diagnoses through transitions for adult congenital heart disease, the Heart Center Wellbeing Program connects patients and families to the right experts and resources at the right time, making it easier to get the help they need. 

Meet the team and explore services here. 

This clinic treats children with elevated pressure in the blood vessels connecting their heart and lungs. Families benefit from consulting both cardiology and pulmonology specialists simultaneously and are supported by a team of physicians, a nurse practitioner and a nurse coordinator who helps manage the child's complex needs, from medication pre-approvals to arranging in-home equipment.

“One of the greatest strengths of our program is the partnership between cardiology and pulmonology. Dr. Birnbaum from cardiology is our program director, and Dr. Singh from pulmonology is our co-director. This collaboration truly sets us apart as a PH program,” said Kate Carp, RN, PH nurse coordinator. “We conduct joint inpatient rounds and outpatient clinics, allowing both specialties to maintain ongoing communication and collaboration in providing quality, seamless care. Families appreciate the convenience of consulting with two specialties in one visit, ensuring everyone is aligned on the plan for their child.”

Brian Birnbaum, MD, PH program director, emphasized the importance of patient-centered care in seeking RCP accreditation, “Accreditation helps us provide the strongest clinical care to our patients and families. We aim to provide excellent PH care, and accreditation helps to exemplify that. It lets our patients see that we want to remain at the forefront of developments in the pediatric PH world.” Kate Carp, RN, added, “On a practical level, seeking accreditation has motivated us to improve PH-related education for staff and establish written guidelines and protocols reflecting the specialized care we provide.”

The accreditation was awarded based on a variety of factors, including the quality and depth of resources available for expert care of PH patients and the array of therapies offered by the center.

In this new role, Dr. Wagner will lead the development of a world-class translational cardiovascular research program, building on the strengths of the Children’s Mercy Research Institute (CMRI) while exploring new opportunities for innovation and collaboration. His responsibilities include:

• Oversight and execution of all Heart Center research operations
• Mentorship and training of research staff and future cardiovascular scientists
• Building strategic partnerships with regional institutions (e.g., KUMC, Stowers Institute)
• Securing funding to ensure long-term program sustainability

 “I first came to Children’s Mercy as a third-year medical student rotating on the cardiology ‘Blue Team’ service. From that day forward, I was hooked and knew I wanted to become a Pediatric Cardiologist,” says Dr. Wagner, “Almost 20 years later, I am honored and humbled to cultivate another great program in the Heart Center that will improve the lives of our cardiac patients.”

Dr. Wagner’s vision includes establishing three distinct research tracks:

1. Exploratory and Pre-Clinical Research
2. Clinical and Diagnostic Trials
3. Cardiovascular Outcomes Research

About Dr. Wagner

Dr. Wagner is the Matson Family Endowed Professor in Cardiac Research and Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. He joined Children’s Mercy in 2013 and has served as Division Director of Clinical Pharmacology and Toxicology for more than five years. His research has significantly advanced the understanding of pharmacogenomics and precision medicine in pediatric cardiology.

He has led and contributed to numerous NIH-funded studies and national trials, including FUEL and FALD, and has received over $4.5 million in external funding. Dr. Wagner is also the principal investigator of the IMPROVE-FALD program and director of the Cardiology Pharmacogenomics Repository (CPR).

• 100% 1-year patient survival post heart transplant
• Third best overall survival rate in the country from listing
• Regional leader in ventricular assist device (VAD) patient volume
• Successful transplantation of single-ventricle patients at all three stages of repair: Norwood, Glenn, Fontan
• Shorter average length of stay for patients: 12 days (National average: 21 days)

Heart transplant volumes

The number and types of pediatric heart transplants performed at Children’s Mercy between 2019 and 2024 (fiscal year).

Heart transplant survival rates

Patient Survival
1/1/2021 – 6/30/2023 for 90-day and 1 year
7/1/2018 – 3/12/2020 and 6/13/2020 – 12/31/2020 for 3 year

Children’s Mercy Kansas City has outstanding pediatric heart transplant patient and graft survival while caring for complex patients at all ages. The Scientific Registry of Transplant Recipient (SRTR) tracks outcome metrics including graft and patient survival. Access the SRTR outcomes. 

Heart recipient age

Scientific Registry of Transplant Recipients

The age of patients who received pediatric heart transplants at  Children’s Mercy between 2018 and 2022.

Heart transplant by diagnosis

Scientific Registry of Transplant Recipients

The diagnoses of patients who received pediatric heart transplants at Children’s Mercy between 2019 and 2024 (fiscal year).

We shared more than 15 presentations and abstracts:

Presentations:

Aliessa Barnes, MD - "Pediatric and Congenital Cardiovascular Healthcare Administration II: Sharing and Learning From Each Other-A Conversation Amongst Leaders," "Hey What Do You Think: Topic 9: Time for VAD or Intensive Medical Therapy"

Allie EuDaly, RN, BSN, CCRN - "Challenging Cases: Stories of Hope and Healing"

Lisa Laddish, DNP, RN, CPNP-AC, PC - "Complete Common Atrioventricular Canal Defect: Postoperative Care and Outcomes," "Tetralogy of Fallot: Postoperative Care and Outcomes," "Coarctation of the Aorta: Postoperative Care and Outcomes," "From the Bedside to Boardroom to Academia: Hope, Heal and Learn - How Can the Nursing Profession Continue to Move these Concepts Forward?" "Stuck in the Middle: How should Nursing Manage Ethically Challenging Situations?"

Sarah Lagergren, DNP, APRN, ACCNS-P, CPN - "Evidence-based Practice: Challenges and Successes: Provider Use of Patient Portal to Partner with Parents of Pediatric Acute Care Cardiology Patients," "Use of Colchicine in the Treatment of Pediatric Pericarditis"
 

Geetha Raghuveer, MD, MRCP, MPH, FAAP, FACC, FAHA - "Nuts and Bolts of Cardiometabolic Health Clinic: What a Cardiometabolic Clinic and National Preventive Pediatric Cardiology Program"

Sanket Shah, MD, MHS, FAAP - "Hey, This Does Not Belong Here: Imagine Evaluation of a Prosthetic Mitral Valve: This is How I Do It"

Douglas Zavadil, MPS, CCP, FPP - "Challenges of a Transport ECMO/VAD Program"

Abstracts:

• Mohamed Abdul-Ghayum, MBBS
• Adenike Adenikinju, MD 
• Lavina Desai, MD
• Nitin Madan, MD
• Laura Martis, MSN, RN, CPNP-AC
• Amanda McIntosh, MD
• Jenna L Schermerhorn, DO
• Tara Shores, BSN, RN, CBC
• Tony Zunica, MD

Kudos to our team for sharing their expertise in a variety of topics such as fetal tachycardia, prosthetic mitral valve and postoperative care and outcomes. Their commitment to staying up-to-date in the latest in cardiology is why our heart center is Built From The Heart.

Three Children’s Mercy Kansas City disciplines — neonatology, fetal cardiology and maternal fetal medicine — are collaborating with hospitals across North America to answer an important question: How does delayed umbilical cord clamping impact the neurodevelopment of babies with congenital heart disease (CHD)? 

Research has established that delaying cord clamping for 30 to 45 seconds or longer benefits both preterm and full-term newborns. Delayed cord clamping can: 

• Preserve the baby’s red blood cells. 
• Reduce the need for transfusions. 
• Improve iron levels, which reduces the risk of anemia and boosts brain development. 
• Decrease the risk of necrotizing enterocolitis. 
• Decrease the risk of brain bleeds. 
• Improve neurological and developmental outcomes. 

Newborns with CHD have been excluded from previous cord-clamping studies because of their complex health variables, including how blood volume affects newborns with cardiac issues.  “The reason they were excluded before is the reason we need the study now,” explained Laura Vricella, MD, FACOG, Medical Director of the Elizabeth J. Ferrell Fetal Health Center. 

“The already established benefits of delayed cord clamping may certainly be favorable to newborns with CHD,” said Maria Kiaffas, MD, PhD, Director of Fetal Cardiology, who outlined some of the hypotheses the study will be able to test.

 “Newborns with certain types of CHD (i.e. cyanotic) do benefit from a robust amount of red blood cells, and the ones that will need surgery may need less transfusions when they start with a good hematocrit. In addition, the decreased risk of necrotizing enterocolitis, a common complication in newborns with CHD, can favorably affect their morbidity and length of hospitalization.” 

“These kids are known to be at higher risk for neurological developmental issues,” said John Daniel, MD, MS, Neonatal ECMO Director. “The brain may receive less oxygen as a fetus in certain CHD types, and then newborns live in a persistently hypoxic state. They often go on cardiopulmonary bypass to have their operations. There are a lot of risk factors.” 

The new multi-site study, “CORD-CHD: Cord clamping among neonates with Congenital Heart Disease,” is led by Carl H. Backes, Jr., MD, from Nationwide Children’s, with Dr. Kiaffas and Dr. Daniel serving as site Principal Investigators at Children’s Mercy. The study is funded through the National Institutes of Health’s National Heart, Lung and Blood Institute. 

The study randomizes participating families into two groups: One where cords are cut after a delay of 30 to 60 seconds and one where cords are cut between 60 and 180 seconds following delivery. Patients will have neurodevelopmental follow-ups at 3-4 months, 9-12 months, and 22 to 26 months of age. The study will recruit participants for five years and run until 2030. With a total sample-size goal of 600, Children’s Mercy is tasked with enrolling 5 to 10 families per year. 

“We’ve sailed past our recruitment goals,” said Cheri Gauldin, BSN, CCRC, Senior Research Nurse Coordinator, Children's Mercy Research Institute. The team started recruiting participants in February and has already enrolled 11 families and completed 10 deliveries — the most of any participating site so far. 

When the team identifies a potential candidate (around 40% of the center’s deliveries have some form of CHD), they explain the study to the family at an interdisciplinary care meeting. Most families have been familiar with delayed cord clamping, either from previous births or by talking to their obstetricians, and have been eager to participate. 

“The Fetal Health Center has done an amazing job,” said Cheri. “They are being very proactive with helping us make sure everybody knows who’s enrolled.”  With the cooperation of today’s Fetal Health Center families, the innovative study will ensure future patients get the best evidence-based care possible. 

“This study wouldn’t be possible without the center,” agreed Dr. Daniel. “As our center continues to grow, we wanted to introduce research that bridges the gap between neonatology and maternal fetal medicine. This is a truly multidisciplinary study, and our Fetal Health Center is uniquely positioned to offer it to families.” 

Learn more about our Heart Center, Neonatology and Fetal Health Center at childrensmercy.org.

 

What are Leadless Pacemakers?

Leadless pacemakers are small (some up to 93% smaller) pacemakers implanted through a puncture site in a vein in the leg instead of the veins in the chest or through an open chest surgical operation. These procedures are performed by the Electrophysiology Service, led by the Director of Electrophysiology, Dr. Philip Chang. Following implantation, leadless pacemakers are self-contained inside the heart without any extension to a device pocket under the skin surface where we traditionally place pacemaker devices.

Why Leadless Pacemakers?

Leadless pacemakers are less invasive to implant and are self-contained within the heart, thereby minimizing risks of infection and activity restrictions. For example, one of our patients developed an infection with a traditional pacemaker, and we had to remove it altogether. We then replaced it with a leadless pacemaker, which provided the same pacemaker functions and support while eliminating some of the factors that led to the patient's previous pacemaker infection. Another patient had a leadless pacemaker implanted as a first choice over a traditional pacemaker based on the patient's specific pacing needs and to minimize long-term infection risks. If you have questions about leadless pacemakers or would like more details, please email Dr. Chang at pmchang@cmh.edu.

About Dr. Philip Chang

For those who may not know, Dr. Philip Chang, MD, FACC, FHRS, is the primary operator at Children’s Mercy who implants leadless pacemakers. More about him is below:

Dr. Philip Chang, MD, FACC, FHRS, joined the Ward Family Heart Center at Children’s Mercy Kansas City in March 2022 as the Director of Electrophysiology. Before his appointment at Children’s Mercy, he was the Director of Pediatric and Congenital Heart Electrophysiology at UF Health Shands Children’s Hospital. Additionally, he has previously served as the Director of the Adult Congenital Heart Disease Care Program at Keck Medical Center of USC (Los Angeles, CA) and Director of Electrophysiology at the Los Angeles County + USC Medical Center.

Dr. Chang has experience and expertise in all facets of pediatric and congenital heart electrophysiology. His clinical and research interests include complex arrhythmia ablation procedures; zero- or low-fluoroscopy EP/ablation procedures; cardiac implantable electronic devices, including pacemakers, defibrillators, and resynchronization devices; transvenous lead extraction; and arrhythmia management in adults with congenital heart disease. He has extensive and ongoing experience in implantable device therapies, including leadless pacing, direct conduction system pacing, transvenous cardiac resynchronization device implantation in pediatric and ACHD patients, and subcutaneous defibrillator implantation. He is also actively involved in original and multi-center/collaborative research projects.

Dr. Chang is board certified in Pediatric Cardiology and Adult Congenital Heart Disease. He is a fellow in both the American College of Cardiology and the Heart Rhythm Society.

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.