Many people are surprised to hear that congenital heart disease is the most common birth defect in the United States and the leading cause of death in the first year of life. Even fewer realize that congenital heart disease is more common than cystic fibrosis, muscular dystrophy and all childhood cancers combined.
As I helped my children cut out their “heart-shaped” Valentine’s Day cards last month, I couldn’t help thinking about the difference between our romantic image of the heart and its actual shape.
Those of us who have the privilege of taking care of children with heart defects have come to rely on the extraordinary technological advances in medical imaging over the past century that have brought us increasingly clear, strikingly accurate, and truly beautiful images of the human heart.
Up until the 1950s, the images available to help us diagnose heart defects were limited to chest X-rays, which were woefully inadequate because they only provide information about the size and outline of the heart. Physical examination and the child’s symptoms were much more useful in guesstimating the most likely diagnosis.
A major breakthrough occurred in the 1950s with the development of angiography. For the first time, we were able to see the outlines of structures within the heart. These images allowed us to accurately identify holes within the heart, narrowed or leaky valves, and many other categories of heart defects.
While this was a huge advance, there were downsides – the imaging required sedating the child and placing catheters into her veins and arteries, and used radiation to take moving pictures of the heart. Still, cardiologists and surgeons finally had accurate information to help create recommendations and plan treatments.
The next major advance came almost 30 years later with the development of echocardiography. This type of imaging uses sound waves to visualize the heart and surrounding vascular structures. Although the first pictures were blurred, the technology improved rapidly, ultimately producing stunning images and allowing precise diagnosis of many forms of heart defects.
Currently two- and three-dimensional echocardiography produce beautiful images of the moving structures of the heart. In addition, tiny transducers are now placed in the esophagus, or even within the heart, to make these images even more accurate.
But even this modality has its limitations. Measurements of chambers and vessels are imprecise, and air within the lungs inhibits the transmission of sound waves necessary to create the images. Thus, echocardiography is less reliable for examinations of structures which lie near or beneath the lungs.
In the past decade, cardiac MRI and cardiac CT have become increasingly sophisticated, and are now integral to the process of making diagnoses and treatment plans for children with a number of very complex heart defects.
OHSU Doernbecher has one of the most advanced MRI systems in the world (click on this link to watch an MRI clip of a narrowed right ventricle pulmonary valve that has caused the pulmonary artery to enlarge).
Dianna Bardo, M.D., one of Doernbecher’s experts in pediatric cardiac imaging, creates exquisite moving images of the heart, lungs and vascular structures throughout the chest. The detail she is able to provide, in structures that can be as small as a millimeter in diameter, are truly breathtaking and are changing the field.
Many experts within pediatric cardiology predict that technological advances on the horizon will result in even more precise images of the heart. It stands to reason that the more precisely we visualize the intricate details of the heart, the better our results.
Those of us who base our decisions, plan and even guide our procedures with these images eagerly welcome each new advance. Dr. Bardo, and her colleagues are an essential part of the Doernbecher pediatric cardiology team.
Although we use the word ‘defect,’ there is beauty in every child’s heart, whether three or four chambers, holes, fused leaflets or narrowed vessels.
Whatever its shape, the heart captivates, fascinates and enchants us all.
Laurie Armsby, M.D.
Associate Professor of Pediatrics, Division of Pediatric Cardiovascular Medicine
OHSU Doernbecher Children’s Hospital
Dianna M. E. Bardo, M.D.
Associate Professor of Pediatrics, Divisions of Diagnostic Radiology and Cardiovascular Medicine
OHSU Doernbecher Children’s Hospital