This article originally appeared in Pathways, a magazine
published for physicians and the community by UMass Memorial Medical
"When I was growing up in the 1970s, there was no echocardiography available
to detect congenital heart disease," said Darshak Sanghavi, MD, a pediatric
cardiologist at UMass Memorial Children's Medical Center. "The doctor used a
stethoscope and, perhaps, could detect a leaking valve by listening to the
heart. And he usually only found that if a child presented with breathing
"But with today's diagnostic imaging technology, we can know if there are
congenital heart defects before there are symptoms," he continued. "With fetal
echocardiography, we can even know about problems before a child is born."
The technological advances in cardiac imaging for pediatric patients are helping
to address a significant health problem. According to the American Heart
Association, an estimated 35,000 babies in the United States - eight out of
every 1,000 - are born with a heart defect each year. This makes congenital
heart defects the most common birth defect and the number-one cause of death
from birth defects during the first year of life. Sadly, many newborns with
major congenital heart defects are diagnosed at autopsy, Dr. Sanghavi noted.
"But it is our hope that these imaging advances can help save these children,"
To that end, the UMass Memorial Children's Medical Center Division of
Pediatric Cardiology has made a significant investment in cardiac imaging
technology - including fetal echocardiography, transthoracic echocardiography
and cardiac MRI -as well as talent.
The Children's Medical Center is committed to providing the highest-quality
diagnostic imaging available today. As proof of this commitment, the division
recently transferred its imaging systems to a fully digital platform, an upgrade
that translates into improved data flow and efficiency - which also yields
benefits for referring physicians.
"By digitizing the entire medical
record, we can send information to a referring physician with a single click,"
said Dr. Sanghavi. "Plus, our notes are electronically dictated and transcribed,
so we can fax reports to referring physicians quickly and easily. It definitely
helps to improve communication."
The data and image management capabilities of the digital system also enhance
clinical care. "In imaging a child's heart with echo, we look at 50 to 60
different structures," explained Dr. Sanghavi. "This is a huge amount of data
compared to imaging an adult heart. In the past, these studies were stored on
VHS videotape and, once completed, had to be stored off-site since they required
so much space. When you needed to view a previous study, retrieving it consumed
"Now, the digital studies are stored on a server and instantly available," he
continued. "I can call up previous studies and reports from my office, the NICU,
at home - anywhere a high-speed Internet connection is available. This kind of
access to information is invaluable for timely clinical decision-making."
Similarly, digital images can be transferred quickly between specialists at
the UMass Memorial Children's Medical Center in Worcester and Children's
Hospital in Boston, where pediatric patients who require cardiac catheterization
or surgery are transferred for this segment of their treatment. The team works
closely with surgical and interventional cardiologists at Children's, and the
digital capabilities the two to share information seamlessly.
It is in the area of image quality, however, that the new digital technology
arguably confers the greatest benefits.
"Most congenital heart disease treatment depends on accurate images of what's
going on, and seeing it clearly at various points in time," Dr. Sanghavi stated.
"But children are not just little adults; imaging their hearts requires special
equipment and higher-frequency ultrasound probes. A 400-gram infant in the NICU
has a heart the size of a cherry tomato that cannot be visualized with an adult
probe. Fortunately, companies today have developed diagnostic equipment
specifically for these smaller bodies. And they deliver crystal-clear pictures,
enhanced even further by digital technology.
"Fetal echo gives us complete pictures of the heart and the ability to define
blood flow patterns at 19 to 22 weeks," he continued. "This enables parents and
their doctors to plan deliveries better and, in the case of some rhythm
disturbances, to medically intervene while the fetus is in utero and cure the
child without surgery."
As children grow, it becomes increasingly difficult to visualize their hearts
using echocardiography. Cardiac MRI has become an essential imaging modality to
assess cardiac function and vascular anatomy. It enables the team to easily
visualize the intracardiac anatomy and thoracic vessels in older children and
young adults with a clarity that surpasses that of echocardiography."
"It's hard to overstate just how much the diagnosis and treatment of
congenital heart disease have improved in the last 20 to 30 years as a result of
these advances," Dr. Sanghavi added.
Having advanced pediatric imaging capabilities available in this region is a
big plus for community pediatricians as well. "To have these imaging
capabilities available right here in the local community is wonderful," said
Lynda Young, MD, a pediatrician in private practice in Worcester for more than
30 years. "It speeds diagnosis and our ability to make decisions about what we
can do for the patient.
"And to have the personal contact with these specialists means a great deal,"
she continued, referring to the cardiology team. "They're excellent about
keeping me informed when they see one of my patients. I always get a call at the
time the patient is seen and receive a timely follow-up referral letter, so I
know their thoughts and what to tell my patient's parents.
"And they're easy to access," Dr. Young added. "You don't have to wait six
months for an appointment. They're available on an emergency basis, too."
"We're here in the clinic four days a week for both pediatric outpatients and
fetal consultations," Dr. Sanghavi noted. "We welcome the opportunity to see
patients for an evaluation so that we can help referring physicians determine
the most appropriate tests and imaging parameters to address a specific
From fetal echo to assessment at birth, in the NICU, and through childhood
and adolescence, the team is fully outfitted to care for pediatric patients with
congenital heart disease