questions for dr daniel mclennan
Q. In what way has medical technology progressed in the last decade in Australia for the treatment of Congenital Heart Defects & Diseases?
A. In the last decade medical technology has advanced the field of paediatric cardiology significantly. Due to the introduction of Cardiac MRI we are now able to image the heart in real time. Allowing us to see the function of the heart, as well as being able to see the effect that a patient's cardiac lesion has on the flow of blood into and out of the heart. It allows us to better clarify the anatomy of the heart. It also allows us to 3 and 4D image the flow into vessels, helping us better direct the surgeons on the surgical approach.
Using CT scanners and MRI we can, using 4D Printers, print out real life sized models of the heart. This allows us to vidualise the heart as it would look and allows the surgeons to better prepare for surgery.
The advancement in the echocardiography machines allow us to better image the heart and even allow 3D echo. It helps to better visualise the heart and prepare for surgery.
In terms of the cardiac surgery, we have much better techniques and technology. The cardiac bypass machines are much better at keeping the patient's blood at near normal during the surgery. We have better pre-operation and pos-toperation knowledge and the patient's outcomes are much better.
Q. What are some of the most significant breakthroughs in Cardiology that have greatly aided in the treatment of Congenital Heart Defects & Diseases in children?
A. MRI as mentioned above is a very significant breakthrough and still a very young area of Cardiology. It's potential has still not been fully met.
Intervention Radiology has also had significant breakthroughs. We are now able to perform many procedures through the vessels in the groin. This means that patients that use to have 4-7 days in hospital with pain post-surgery are now able to come in and have the hole in the heart (ASD, VSD or PDA) blocked by a devices and able to go home the next morning. It has reduced hospital admission length and cost dramatically.
Q. What medical technologies currently exist for the treatment of Hypoplastic Left Heart Syndrome?
A. This is an interesting question. HLHS is a very complex disease. It is diagnosed when the mother is pregnant most of the time, sometimes once the baby is born. The antenatal echo allows us to prepare the family for the birth of the baby. These children require several operations over the first 4 years of their life, to convert the right side of the heart into the ventricle that pumps blood around the body and the blood that would normally go to th right heart, to be bypassed straight to the lungs. This is called the Norwood Procedure, which consists of three steps.
First, the DKS (Damos-Konno-Stamsel) with Sano shunt (from RV to PA). Then the bi-directional Glenn shunt (Implant SVC into the pulmonary artery). Then lastly the Fontan (baffle blood from the IVC straight into the PA's via a conduit). This is the technology that exists in the treatment. Then, using Echo and MRI we are able to further evaluate and manage the long term risks of this disease and prepare for the future. Lots of these patients when they are young adults will have failing Fontans and either die or need a heart transplant.
Q. Can you give me an insight into the research which is currently being undertaken at Westmead Children's Hospital and how will it benefit children with Congenital Heart Defects & Diseases?
A. We are a small unit comparatively to other big centres around the world. We have one study looking at patients with Long QT Syndrome. We are preparing another study looking at Aortic roots in patients having Echo. We are looking at exercise tolerance and MRI changes in patients with Transposition of the great arteries (TGA) post arterial switch operation. These studies will help to better evaluate the long term side effect on patients post-operation and how we can improve surgical techniques for more optimal outcomes.
Q. In the past 12 months, what has been the most common type of Heart Condition diagnosed at the hospital. Based on research, is there a reason for this?
A. Ventricular Septal Defects are the most commonly diagnosed heart condition. I'm not sure there is much research explaining why this is. It has to do with embryology and the way the heart is made. It is just more likely like any other defect.
Q. What medical outcomes and/or advancements does Westmead Children's Hospital project to see in the near future that could aid in the treatment of Congenital Heart Defects & Diseases in children?
A. With more work and research with MRI and Exercise testing we predict to see better long-term outcomes from cardiac operations. With the use of 3D imaging it will help us to better prepare for surgery. With more procedures in the cath lab we predict to see less reliance on surgery and shorter waiting times for patients having interventional procedure.
A. In the last decade medical technology has advanced the field of paediatric cardiology significantly. Due to the introduction of Cardiac MRI we are now able to image the heart in real time. Allowing us to see the function of the heart, as well as being able to see the effect that a patient's cardiac lesion has on the flow of blood into and out of the heart. It allows us to better clarify the anatomy of the heart. It also allows us to 3 and 4D image the flow into vessels, helping us better direct the surgeons on the surgical approach.
Using CT scanners and MRI we can, using 4D Printers, print out real life sized models of the heart. This allows us to vidualise the heart as it would look and allows the surgeons to better prepare for surgery.
The advancement in the echocardiography machines allow us to better image the heart and even allow 3D echo. It helps to better visualise the heart and prepare for surgery.
In terms of the cardiac surgery, we have much better techniques and technology. The cardiac bypass machines are much better at keeping the patient's blood at near normal during the surgery. We have better pre-operation and pos-toperation knowledge and the patient's outcomes are much better.
Q. What are some of the most significant breakthroughs in Cardiology that have greatly aided in the treatment of Congenital Heart Defects & Diseases in children?
A. MRI as mentioned above is a very significant breakthrough and still a very young area of Cardiology. It's potential has still not been fully met.
Intervention Radiology has also had significant breakthroughs. We are now able to perform many procedures through the vessels in the groin. This means that patients that use to have 4-7 days in hospital with pain post-surgery are now able to come in and have the hole in the heart (ASD, VSD or PDA) blocked by a devices and able to go home the next morning. It has reduced hospital admission length and cost dramatically.
Q. What medical technologies currently exist for the treatment of Hypoplastic Left Heart Syndrome?
A. This is an interesting question. HLHS is a very complex disease. It is diagnosed when the mother is pregnant most of the time, sometimes once the baby is born. The antenatal echo allows us to prepare the family for the birth of the baby. These children require several operations over the first 4 years of their life, to convert the right side of the heart into the ventricle that pumps blood around the body and the blood that would normally go to th right heart, to be bypassed straight to the lungs. This is called the Norwood Procedure, which consists of three steps.
First, the DKS (Damos-Konno-Stamsel) with Sano shunt (from RV to PA). Then the bi-directional Glenn shunt (Implant SVC into the pulmonary artery). Then lastly the Fontan (baffle blood from the IVC straight into the PA's via a conduit). This is the technology that exists in the treatment. Then, using Echo and MRI we are able to further evaluate and manage the long term risks of this disease and prepare for the future. Lots of these patients when they are young adults will have failing Fontans and either die or need a heart transplant.
Q. Can you give me an insight into the research which is currently being undertaken at Westmead Children's Hospital and how will it benefit children with Congenital Heart Defects & Diseases?
A. We are a small unit comparatively to other big centres around the world. We have one study looking at patients with Long QT Syndrome. We are preparing another study looking at Aortic roots in patients having Echo. We are looking at exercise tolerance and MRI changes in patients with Transposition of the great arteries (TGA) post arterial switch operation. These studies will help to better evaluate the long term side effect on patients post-operation and how we can improve surgical techniques for more optimal outcomes.
Q. In the past 12 months, what has been the most common type of Heart Condition diagnosed at the hospital. Based on research, is there a reason for this?
A. Ventricular Septal Defects are the most commonly diagnosed heart condition. I'm not sure there is much research explaining why this is. It has to do with embryology and the way the heart is made. It is just more likely like any other defect.
Q. What medical outcomes and/or advancements does Westmead Children's Hospital project to see in the near future that could aid in the treatment of Congenital Heart Defects & Diseases in children?
A. With more work and research with MRI and Exercise testing we predict to see better long-term outcomes from cardiac operations. With the use of 3D imaging it will help us to better prepare for surgery. With more procedures in the cath lab we predict to see less reliance on surgery and shorter waiting times for patients having interventional procedure.