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System links PCICU to Children's Hospital by Mary Helen Yarborough Public Relations Surgeons are operating on an infant's heart to mend a congenital birth defect. While the procedure on the heart defect is not brand new, MUSC Children's Hospital's electronic monitoring system—involving a live video feed from the operating room and constant display of the baby's vital signs—is new and is the only one like it in the state.   In fact, there aren't many like it in the country. The electronic system, nestled on the fourth floor of the main hospital, links the Pediatric Cardiology Intensive Care Unit (PCICU) with the rest of Children's Hospital.   Andy Atz, M.D., a pediatric cardiologist and medical director of PCICU, oversees this new digital system that allows virtual and instantaneous reviews of images once delayed by standard X-ray systems and ground transportation.   Members of the PCICU team observe an open-heart procedure on an infant while keeping a watch on vital signs. The monitors provide details of the child's condition. “This is telemedicine, the new wave in digital medical technology. We can even e-mail digital images of ultrasound pictures of the heart to our colleagues in Greenville or Columbia,” said Atz.   He said images can be transmitted to cardiologists and surgeons via Internet as a way for physicians and nurses to share and review procedures for best practices and immediate feedback on management decisions and outcomes. But the system is still growing. “We actually have more technology than we are using,” Atz said. “Right now, we're focusing on specialized care.”   Dr. Andy Atz Such specialized care includes therapies for congenital heart defects in children. “Most children who are critically ill with congenital heart conditions in South Carolina come here (to MUSC), and are admitted directly to the PCICU,” Atz said. He said that some children are followed from fetus until after 18 years of age. “Patient care for these children may start in utero. We look at the fetuses that might have heart disease and we monitor the mothers carrying the child, so we are prepared to treat the child within the first few minutes of life.” A national model MUSC's Division of Pediatric Cardiology, of which the PCICU comprises an important part, has performed so successfully that the National Institutes of Health recently renewed it as a member of an elite network of hospitals administering clinical trials involving congenital heart disease. Now one of eight clinical centers in the nation, MUSC has five ongoing clinical trials and expects to launch more this year, Atz said. One of the studies in this Pediatric Heart Network in which MUSC is involved is the largest randomized clinical trial in pediatric heart surgery in the world, which will include 460 patients at 14 centers, he said.   “We are dealing with complicated heart lesion (hypoplastic left heart syndrome), in which only one ventricle is a functional pumping chamber,” Atz said. “We are testing two different types of surgeries to see if one has superior outcomes.” A beacon for heart care Children come from throughout the state for the specialized care delivered in this dedicated PCICU. Only about 20 to 25 dedicated PCICUs exist in the nation, Atz said, and none in nearby states of North Carolina, Virginia or Maryland.   Meanwhile, MUSC's PCICU is an important link for pediatric cardiology across the state, Atz said. For the state's pediatric cardiologists—four in Columbia, five in Greenville and one in Florence—“We're the hub of a spoke-and- wheel phenomenon,” he said. “All of the cardiologists know one another, and we are in constant contact with each other.” A great ending When Craig Dearnaley was 9 years old, he started getting extremely nauseated and weak.   “He was sicker than snot,” Atz said. “He had been healthy, then rapidly got extremely ill. He was throwing up, so we were looking at intestinal problems. Then we found that his heart was so big that it was seen down into his abdomen.”   Dearnaley had myocarditis, which is an inflammation, probably from infection, of the heart muscle. Atz said that with some people, these conditions heal themselves, but for little Dearnaley, it kept getting worse and worse.   “Hour by hour, we were getting close to putting him on true life support—a life-saving lung-and-heart machine called ECMO,” Atz recalled. “Then, we got a heart transplant donor. The call came in at just the right time.”   Dearnaley now is 11 years old and is about to earn his black belt in karate. To look at him, one would never assume that he had ever been that sick, or become a heart transplant recipient. The heart transplant and MUSC's successfully tested anti-rejection drug therapy has eliminated many complications traditionally experienced by patients, Atz said.   “The way we're doing immunosuppressive therapy now, these kids look normal,” Atz said. “We're on a level of world class heart institutions.” Many system benefits The benefit of MUSC's PCICU system over most others in the country is that the Children's Hospital is not a freestanding hospital. That enables the child to benefit from the graduated care within the entire MUSC system.   A key component to the success of MUSC's PCICU is the transportation system.   “Meducare has made all of this possible,” Atz said. “We can fetch a kid in a few hours and bring him in,” said Atz, adding that in other large metropolitan areas, such as Atlanta, transportation is complicated and lagging. “The transportation system is much better here.”   The PCICU has evolved from a cramped eight-bed unit first designed in 1984 to a new, modern and spacious 12-bed unit that opened last year.   The primary focus for the entire staff is the heart: three surgeons, 10 cardiologists (of which three are intensive care trained), nine pediatric cardiologists in training, 35 RNs and five clinical assistants, all dedicated to the PCICU.   When the new hospital is completed, the adult cardiology will move from the main hospital, while the pediatric cardiology will remain at Children's Hospital, Atz said.     Friday, Oct. 20, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.