Advancing Cardiac Imaging Through Collaboration
|Girish S. Shirali, MBBS,
Synergistic collaboration between Children’s Mercy cardiologists, cardiac surgeons and radiologists has resulted in the use of MR and CT to arm surgeons with enough information so when they enter the heart, they can do the operation in the most accurate way. This can potentially reduce the amount of time the patient is on cardiopulmonary bypass, which can affect many systems, not just the heart and lungs.
Innovations in imaging the developing heart
"The standard way the heart has been imaged historically has been constrained by technology. The world around us is three-dimensional; and yet the way that we have looked at the heart through imaging, through an echocardiogram, is a twodimensional view of a very, very complex structure," says Girish S. Shirali, MBBS, FASE, FACC, Melva and Randall L. O’Donnell, PhD, Chair in Pediatric Cardiology; Division Director of Cardiology; and Co-Director of The Ward Family Heart Center at Children’s Mercy. "So we are working on making the adoption of three-dimensional imaging into a more mainstream modality."
Three-dimensional views and reconstructions, using echocardiography, MRI and CT angiography, are used for unprecedented, clear images of tiny cardiac, pulmonary and vascular structures in neonates, infants and children.
Diagnosing complex cardiac lesions prenatally
The advanced cardiac imaging available at The Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy enables early diagnosis of complex cardiac lesions. This allows cardiologists and surgeons to plan early intervention before the child is delivered.
Pregnant mothers whose fetuses have serious cardiac diagnoses can deliver at Children’s Mercy, knowing the finest in cardiovascular management, including imaging, intervention and surgery are immediately available. A clear advantage to having both mother and neonate at Children’s Mercy is the safety of avoiding transport of fragile newborns with complex heart disease.
Improving outcomes through clinical and translational research partnerships
As the only free-standing children’s hospital between St. Louis and Denver, Children’s Mercy Kansas City has more than 14,000 hospital admissions and more than 370,000 outpatient visits per year. The Kansas City Metro area has a population of nearly 520,000 children under age 18.
The Ward Family Heart Center at Children’s Mercy offers the most advanced cardiovascular diagnostic and treatment options in the nation to approximately 5,000 Kansas City Metro area children with congenital heart disease. The Center also serves children with heart disease from western Missouri, Kansas, Oklahoma, Arkansas, Nebraska, Iowa and several foreign countries.
"We are blessed with an enormously busy clinical program and robust research infrastructure,” notes Dr. Shirali. “With our high patient volumes, we are ideally situated to generate a body of evidence on identifying predictors of heart disease and the impact of imaging on outcomes. "Additionally, our joint effort as pediatric cardiologists and cardiovascular surgeons with our translational research unit is enlightening us as clinicians about advanced mechanics of cardiac function and dysfunction through our scientists’ work in animal models."
Leading the way in training and implementation of advanced cardiac imaging
Dr. Shirali has spent the past decade training adult and pediatric cardiologists and sonographers, nationally and internationally, in 3D echocardiography and other forms of advanced cardiac imaging. As a contributor to the advanced cardiac imaging consensus documents of the American Association of Echocardiography and the European Association of Echocardiography, Dr. Shirali is planning a series of national conferences and workshops in Kansas City for hands-on training in 3D and other advanced cardiac imaging. These conferences also will provide hands-on sessions in mining and manipulating large imaging data sets around the most complex congenital cardiac diagnoses.
"The goal for me has always been to get the most realistic representation of the inside of the heart so that we can communicate with our surgeons and colleagues and there are no surprises when they go to the operating room," says Dr. Shirali. "I’m passionate about training people in this field because I feel that it really makes a difference to outcomes."