Heart patients: first understand, then treat

Feeling after receiving a beautiful Christmas gift. The sensation after buying a new car, complete with all the innovative applications associated with it. This is how Gregor Krings and Merella Mullenchot, respectively, described their first days after installing the latest 3D equipment in the heart catheterization room at Wilhelmina Children’s Hospital (WKZ), which reopened this week. “Now we can make clearer images and treat patients more accurately and safely,” says pediatric cardiologists.

For more than ten years, WKZ has been the only medical center in our country where 3D images of children with a congenital heart defect are made before and during cardiac catheterization. By producing a “3D map” of their heart and the immediate environment in this way, doctors know exactly what treatment is possible and what isn’t. In fact, the patient’s parents are also aware of this – as well as the child himself if he is old enough to understand – because they are given a digital video of the indoor situation to take home.

Talking at school

“Some kids give a speech at school about a heart defect and then show the video to their classmates,” says Gregor Krings, chief of pediatric cardiology. “The image is very clear: it’s not black and white and two-dimensional, but realistic, so it’s color and three-dimensional.”

exploration tour

But with medical equipment, it’s just like a smartphone or an Ipad: after a while the device starts to malfunction and it’s time for a more modern device. Mirella Molenschot: “We have been very happy with our 3D equipment for many years. Thanks to the old device, we have come this far with 3D imaging, and we can now also share the many experiences with heart patients with doctors who treat children with other diseases. Consider surgical treatment For kidney and liver tumors at the Princess Maxima Center. Or surgery for children with an incorrectly formed esophagus or trachea. Then we sit in front of the computer with other doctors, create 3D files from a CT scan and look at the problem from all sides – as if we were holding it in our hands But the new 3D equipment offers many possibilities.. Gregor and the third pediatric cardiologist who performed cardiac catheterization in children, Anna, Gregor, embarked on a journey of discovery to explore these possibilities. fine tune and get to know her.”

Better and faster

Better image quality, less pressure on the patient and faster access to desired images. These are the biggest benefits of innovation brought by Siemens. Mirella: “For a good 3D image, fewer shots are needed and the shot scanning time is shorter: 3.8 seconds instead of 5 seconds. This means that the patient is less burdened with x-rays and needs less contrast medium. Moreover, after recordings , the current image appears on our screen earlier than before. In addition, the image is clearer and more details can be seen, so that the 3D character is improved. ” Gregor: “We have already shared the patient’s body, but now Are we in the middle. “

Highly complex care

Each year, WKZ pediatric cardiologists use cardiac catheterization on an average of 150 to 200 children with a congenital heart defect. “We’re using 3D technology for two-thirds of these boys and girls,” Gregor says. “This is very complex care by definition. The patient lies down with an X-ray tube spinning around him or her: within 3.8 seconds, the tube rotates 180 degrees. Within ten seconds, the system automatically creates the first 3D image. We edit that, think ahead. and background, until we get the desired image in one to ten minutes.”

Don’t hurt the neighbors

The pediatric cardiologist talks about “careful planning.” He gives an example: “In Utrecht, we developed the technique of an oval stent, which is a metal tube that can be placed in a narrowed pulmonary artery, for example, to widen it. The stent is in a catheter that is inserted through the groin and then moved toward the heart. But you can’t just put a stent.” You will first have to check in and about the heart whether you are Neighbour narrowing of the artery; Think of the airways, the body artery, and the coronary artery. For example, if a stent flattens a coronary artery, the patient is at risk of death. So it is necessary First to understand, then act. This is exactly where 3D technology helps. We can also 3D print the heart before any cardiac catheterization to get an accurate image. Then you have an individual model of the patient’s heart in your hands.”

mimic blood flow

Careful planning and research go hand in hand at WKZ, so that innovations in the 3D field are developed and patient care continually improved. Gregor: “Suppose we are discussing the best possible treatment for a child with a congenital heart defect. Nowadays we can also simulate blood flow by applying ingenious technology such as computational fluid dynamics. We not only visualize the heart in 3D, but also see the consequences of a particular procedure On the flow of blood on the screen. How will the blood flow if we do this? And how can we ensure better blood flow?

horse kick

More than ten years of 3D experience with children with congenital heart defects has also expanded treatment options for boys and girls with other heart problems. Gregor: “A five-year-old girl who loves horses. Once she got behind a horse and got kicked in the chest. She was in pain and was taken to WKZ. In the 3D images, we saw a huge tear on the outside of her large artery. The vein hadn’t ruptured yet. Then we studied the rupture. In 3D resolution, we looked at the options, and we finally closed the large artery with a stent inside. The girl is healthy again.”

No open heart surgery

The fact that WKZ can perform cardiac catheterization at an increasingly higher level has the added advantage that open-heart surgery can be avoided for a larger number of children. There is no need to open their chests and connect them to a heart-lung machine. In addition, the patient recovers faster after cardiac catheterization than after open-heart surgery. Sometimes open heart surgery is the best case scenario, but it cannot be followed, for example because the patient is too weak. Then cardiac catheterization may be the only way to give the child a chance of survival.

An interview with Gregor Krings about cardiac catheterization in children

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