Infographic: Amazing Heart Facts

What’s a better time than Valentine’s Day to learn more about the heart?

This infographic will help you expand your heart smarts.

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Electrophysiology Advances Restore Patient’s Quality of Life

A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist.

Lauren Flotman, 15, had experienced irregular heartbeats for years before Dr. Francesca Byrne, a pediatric cardiology specialist, diagnosed her with supraventricular tachycardia, or SVT, and Dr. Tony McCanta, a pediatric heart rhythm specialist, repaired the condition through radiofrequency ablation.

The episodes first surfaced when Lauren was about 8 years old and they began increasing in frequency as she aged. They’d occur without warning or pattern.

For Lauren and her family, the sudden attacks caused great concern. Not only was she drained and tired after an episode, but Lauren dreaded them happening, especially during a pep squad routine when her teammates were depending on her.

Lauren was elated to finally have a name for her condition.

“It was a huge relief for sure to have a diagnosis,” she says. “I always had to just describe the feeling because I didn’t have a name. Now I can say I have SVT.”

Lauren’s diagnosis was reached after a Holter monitor captured her heart racing at 220 beats per minute. Dr. Byrne referred Lauren to Dr. McCanta to discuss treatment options, which included anti-arrhythmic medications or an ablation procedure.  After reviewing their options carefully, the Flotmans decided to pursue ablation.

For Lauren’s ablation, Dr. McCanta used a new technology called an intracardiac echocardiogram, or ICE, to create a three-dimensional map of the inside of her heart without using fluoroscopy (X-Ray radiation), enabling a catheter to apply radiofrequency energy to the precise location in her heart causing her SVT.

ICE technology involves a tiny ultrasound probe imbedded into a catheter that is advanced through the vein directly into the heart, allowing for very clear, accurate image quality. These ultrasound images then integrate with a three-dimensional electroanatomical mapping system, which acts like a GPS (global positioning system) for the catheters within patients’ hearts, to provide an accurate real-time shell of the inside of the patient’s heart. This allows the doctor to safely move catheters inside the beating heart without using radiation.

electrophysiology
Dr. McCanta and the electrophysiology team at CHOC were among the first in the world to routinely utilize intracardiac echocardiography in pediatric and adolescent patients.

While radiofrequency ablation has become a safe and common treatment for SVT in children and adolescents since the mid-2000s, intracardiac echocardiography (ICE) has not traditionally been used in pediatrics due to the large-sized catheters. But when a smaller catheter was created, which was more suitable for the size of young patients, Dr. McCanta and the electrophysiology team from the CHOC Children’s Heart Institute were among the first in the world to routinely utilize the new technology in pediatric and adolescent patients.

“For a young, healthy patient like Lauren, increasing safety and minimizing the use of radiation are extremely important, while still being able to provide a cure for her arrhythmia with ablation” says Dr. McCanta.

After a few days of taking it easy following the procedure, Lauren felt back to her usual self – only without the constant fear her heart would suddenly begin racing.

electrophysiology
Lauren’s longtime arrhythmia has been repaired and her quality of life has dramatically improved, thanks to the electrophysiology team at CHOC.

“Our team loves utilizing advanced technologies like ICE and three-dimensional mapping to help children, adolescents, and young adults with heart rhythm problems,” says Dr. McCanta, “Seeing patients like Lauren get back to all of the things they love doing is why we do this!”

Since the procedure, Lauren has been vocal at church to educate her peers about being conscious and vocal about their health.


Get the facts about CHOC's advanced electrophysiology program



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Meet Dr. Wyman Lai

Just in time for American Heart Month, meet Dr. Wyman Lai, a nationally-recognized pediatric cardiologist with expertise in fetal cardiology and non-invasive imaging for heart disease in fetuses, and children at CHOC Children’s. Dr. Lai is the new medical director of echocardiography at CHOC and co-medical director of the CHOC Heart Institute.

Dr. Wyman Lai
Dr. Wyman Lai, medical director of echocardiography at CHOC and co-medical director of the CHOC Heart Institute.

“CHOC has a fabulous mix of state-of-the-art care, community presence, and academic achievement. I thoroughly enjoy working with my colleagues, who strive to provide the very best care available. The administrative staff at CHOC has also been extremely supportive. Together we are building a pediatric service that rivals any in the region, and we have our sights on even higher goals,” says Dr. Lai.

Dr. Lai’s passion for helping others inspired him to become a doctor. His original plan was to go into academic primary care pediatrics – a teaching and research position, and he majored in maternal and child health for his Master of Public Health degree. Early in his training, he became fascinated with what pediatric cardiologists were doing, and he switched to pediatric cardiology.

“The heart is an amazingly complex organ; it starts off as a simple tube, and it’s a wonder that it develops into a four-chambered pumping organ that delivers oxygen efficiently throughout our body,” says Dr. Lai. “In pediatric cardiology, we are able to make a profound difference in the lives of our patients. With our surgical colleagues, we have made incredible advances in life-saving therapies over the past five decades.”

Dr. Lai attended medical school at the Alpert Medical School of Brown University. He completed his residency at UCLA Ronald Reagan Medical Center, followed by a pediatric cardiology fellowship at UCLA Medical Center, and much later, a pediatric cardiology MRI fellowship at Boston Children’s Hospital.

Since joining CHOC, Dr. Lai has been treating patients with complex congenital heart disease. He is also treating patients with the full spectrum of heart conditions, from heart murmurs to chest pain and syncope.

Dr. Lai’s approach towards his patients and their families is to treat them like family members.

“As with all families, however, not everyone is the same,” he explains. “Some patients and parents want more medical information and some less. Some want to be very involved in the decision-making process and some not so much. My practice is to provide them with enough information and support, so they feel comfortable with the decisions they are making.”

Along with Drs. Nita Doshi and Pierangelo Renella, Dr. Lai is helping to build a great program in fetal cardiology at CHOC. He is also working with Dr. Renella to grow the congenital cardiac MRI program, including the use in non-invasive imaging for creating 3D heart models.

“We recently used a 3D cardiac MRI dataset to print several heart models that were used to assist in the planning of care for a child with complex congenital heart disease. Another area of innovation is our purchase of new patient monitoring software in the cardiovascular ICU that will help us to identify patients at risk for acute deterioration before it happens,” Dr. Lai says.

In his spare time, Dr. Lai loves spending time with his family. He also enjoys swimming, biking and running. He hopes to run in this year’s Boston and New York marathons, which he has participated in the past. He is also attending classes for a health care executive MBA at UC Irvine.





Learn more about CHOC fetal cardiology




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By the Numbers: CHOC Children’s Heart Institute

The CHOC Children’s Heart Institute offers state-of-the-art diagnosis and treatment for an entire spectrum of cardiac conditions, and we are the only Orange County facility to perform neonatal and pediatric open-heart surgery and cardiac catheterization.

In honor of American Heart Month, learn more about the institute.

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Why One Mom Is Thankful for CHOC This Year

By Karen Stapleton, CHOC parent and mom of Noah

Happy Thanksgiving! My name is Karen Stapleton, and my son Noah is a patient at CHOC Children’s. As I prepare to celebrate the holidays with my family, I’m grateful we can be together since we have so much to celebrate. I’m also grateful for Noah’s many doctors and nurses at CHOC because without them, my son wouldn’t be alive.

Noah’s birth story

When I was 29 weeks pregnant with Noah, we learned that he had Down syndrome. Another prenatal ultrasound showed an abnormality in his heart, and we were referred to Dr. Pierangelo Renella, a pediatric cardiologist at CHOC, who diagnosed Noah with tetralogy of fallot, a serious heart defect that causes poor oxygenated blood flow from the heart to the rest of the body. I was scared, but having been a CHOC patient myself as a child, I knew my son would be in good hands.

Karen and Noah in the NICU, shortly after Noah was born
Karen and Noah in the NICU, shortly after Noah was born

On July 27 of last year our lives changed forever— Noah was born! I chose to deliver at St. Joseph Hospital in Orange so that my son could be as close to CHOC as possible. When he was born, there were so many doctors and nurses around. I saw Noah quickly enough to give him a kiss before he was whisked away to the Neonatal Intensive Care Unit (NICU) at CHOC.

Shortly after birth, Noah’s care team also diagnosed him with Apert syndrome, a genetic disorder that causes certain bones to fuse early. For Noah, that was his skull, fingers and toes.

 

A series of surgeries begins at 3 days old

Noah’s first surgery happened just three days after he was born. Due to the complexity of Noah’s conditions, the surgery was a team effort from multiple CHOC specialties. Noah’s gastroenterologist Dr. Jeffrey Ho; his team of cardiologists Dr. Renella, Dr. Michael Recto, Dr. Anthony McCanta, and Dr. Gira Morchi; his pulmonologist Dr. Amy Harrison; his otolaryngologist Dr. Felizardo Camilon; and the entire NICU team came together to prepare him and get him through that surgery.

It was a success, and 31 days after he was born, Noah finally came home! Weekly trips back to CHOC’s clinics included visits to gastroenterology, pulmonary, cardiology and craniofacial specialists. It was another team effort to prepare Noah for a second open heart surgery that he would eventually need.

gates-and-noah
Noah and his cardiothoracic surgeon, Dr. Richard Gates

But a few weeks later, Noah had respiratory complications, which lead to an emergency open heart surgery at just 2 ½ months old. Thanks to Noah’s cardiothoracic surgeon, Dr. Richard Gates, and Noah’s fighting spirit, he was able to come home shortly after surgery.

Celebrating Christmas at CHOC

Just days before Christmas last year, Noah had to be admitted to CHOC for respiratory failure. It was scary to see my baby sedated for 19 days. Dr. Juliette Hunt, a critical care specialist, recommended that Noah undergo a tracheostomy, where a small opening is made in his windpipe and a tube is inserted to help him breathe. Making a decision like that is hard and scary for a mom, but I had complete trust in Noah’s team, and if they knew it would help Noah breathe easier, then I knew it was the right thing to do.

edited-christmas-stocking
Noah celebrated his first Christmas at CHOC

After that, Noah started to thrive. He gained weight and became strong enough for his next open heart surgery with Dr. Gates. After a mere six days in the Cardiovascular Intensive Care Unit following this surgery, Noah got to come home again!

Even when Noah is doing well, sometimes it can be scary to care for him when he’s at home. During one of our hospital stays, I confided this fear in one of Noah’s favorite nurses, Karissa. She gave me specific tips on what to do during his tummy time and baths, and gave me the courage to care for my son. She encouraged me, and reminded me that CHOC wouldn’t advise me to do anything that wasn’t safe.

Noah and Karissa, a registered nurse at CHOC

Noah’s first birthday

All of this is a lot for a little baby to go through before his first birthday, but Noah has always surprised us and pulled through. Celebrating his first birthday meant more than celebrating his first year of life; it meant celebrating every fight Noah had won over the last year, and it meant appreciating a milestone that at times we thought we might never reach. We decided a super hero theme was perfect for his party because we think of Noah as our little super hero.

Noah celebrating his first birthday

After his birthday, Noah continued to flourish and grow! He started rolling over and actively playing, and he has not stopped smiling.

This progress allowed us to prepare for his next major surgery, a frontal orbital advancement, to reshape his skull and forehead that has fused too early due to Apert syndrome.

Before surgery could begin, the doctors needed to cut Noah’s hair to make a safe incision in his skull. We marked another one of Noah’s milestones at CHOC— his first haircut!

Noah received his very first haircut at CHOC from his neurosurgeon Dr. Michael Muhonen, prior to a skull surgery.
Noah’s very first haircut happened at CHOC. He received it from his neurosurgeon Dr. Michael Muhonen, prior to skull surgery.

With the expertise of his neurosurgeon Dr. Michael Muhonen and his plastic surgeon Dr. Raj Vyas, and a very short stay in the Pediatric Intensive Care Unit, Noah came home again! After yet another successful surgery at CHOC, his brain can now continue to grow.

Noah has more hurdles and additional surgeries ahead of him, but even with how much he’s fought, he continues to smile. He’s not cranky and he doesn’t cry. He’s enjoying every single day he gets to be here – and that’s the life he has taught me to live too.

If Noah’s care team ever needs a reminder of why they do what you do, I tell them: My son would not be here today if it were not for each and every one of them here at CHOC. And for that, my family will be forever grateful.

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Choosing Your Child’s Heart Program

It can be frightening to hear that your newborn or child has a congenital heart defect and needs surgery. Congenital heart defects are relatively common, affecting about one in every 100 newborns in the United States. Your child’s doctor will often refer you to a heart surgeon if your child needs surgery. But, how do you know if the hospital where the surgery will be performed offers the best heart program for your child?

Not all hospitals that perform pediatric heart surgery are created equal. Infants and children who have heart defects or require heart surgery need to be cared for by a team of highly trained specialists in a facility that is designed to meet their needs. It’s best to do research on the hospital’s heart program, even if the surgeon or hospital has been referred by your child’s doctor.

One of the first things to look for in a pediatric heart program is to determine if the hospital has a specialized program and team of care providers who care exclusively to cardiac patients. Your child needs more than just a general pediatric surgeon and nurses, and adult heart surgeons typically don’t operate on children.

heart program

“Surgeons will be the first to tell you that pediatric heart surgery is a team effort,” said Dr. Richard Gates, surgeon-in-chief and medical director of the CHOC Children’s Heart Institute. “When looking for a heart program, look for an intensive care unit devoted entirely to pediatric heart patients, and if there are pediatric heart-focused nurses, anesthesiologists and perfusionists.”

A reputable, high-performing children’s heart program will use only specially trained and board-certified pediatric cardiologists, thoracic surgeons and anesthesiologists, as well as cardiac nurses and perfusionists (people who operate the heart-lung machine during surgery). The program should also have more than one heart surgeon in case an emergency arises and your child’s surgeon is not available.

Also, does your child’s heart program have a dedicated pediatric cardiovascular intensive care unit (CVICU) staffed with board-certified intensivists? A board-certified, pediatric cardiac intensivist has additional training in caring for critically ill children in the CVICU, and specialized CVICUs have been shown to improve patient outcomes and reduce complications.

When researching a heart program, be sure to also check if the hospital reports its heart surgical outcome rates. A reputable hospital will report their outcome rates to the Society of Thoracic Surgeons (STS) for the public to see. STS rates will often be displayed on the hospital’s website, but you can also access these numbers directly from the STS website. Remember, you want your program’s rates to be above the national survival rates.

Other designations to look for are hospital safety awards, such as Top Hospital designation by the Leapfrog Group. Leapfrog’s Top Hospital award is widely acknowledged as one of the most prestigious distinctions any hospital can achieve in the United States. Top Hospitals have lower infection rates, better outcomes, decreased length of stay and fewer readmissions. In 2015, only 12 children’s hospitals in the nation and only two in California earned the respected award.

CHOC Children’s has compiled a list of 10 questions to ask when choosing a heart program for your child. Use this checklist as a guide when talking to your medical provider before your child has heart surgery.

The CHOC Children’s Heart Institute offers state-of-the-art diagnosis and treatment for an entire spectrum of cardiac conditions. We have assembled an expert team of board-certified pediatric cardiologists, surgeons, intensivists, anesthesiologists, perfusionists, cardiovascular nurse practitioners, respiratory therapists, dietitians, social workers, child life specialists and case managers — all with specialized training and expertise. Learn more about heart surgery at CHOC.

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Twelve-year-old becomes first CHOC patient to receive life-saving device

Erin Greaves and her son, Sean.
Sean and his mom, Erin.

Erin Greaves woke to the sound of her son’s gasp and the dogs barking. The pediatric nurse raced to 12-year-old Sean’s room and immediately began performing CPR. When paramedics arrived, Sean was experiencing ventricular fibrillation, a serious heart rhythm problem that is the most common cause of sudden cardiac death. He was defibrillated twice before being taken to a nearby hospital, and subsequently transported to CHOC Children’s.

As a patient in CHOC’s pediatric intensive care unit, Sean underwent a series of tests, including a cardiac MRI, cardiac catheterization, exercise tests and genetic testing. Results revealed no structural damage to his heart and no underlying condition. Sean’s ventricular fibrillation was ruled idiopathic, which means no known cause.

Sean’s cardiologist, Dr. Anthony McCanta, has specialized expertise in the treatment of irregular heart rhythms and presented a unique option to Sean and Erin. Physicians primarily use implantable cardioverter defibrillators (ICDs) to treat the most serious heart rhythm problems. The device constantly tracks the patient’s heart rhythm and delivers an electric shock to the heart when it beats abnormally fast. Traditional defibrillators require electrical conductor wires, or leads, to be inserted into the heart through a vein in the upper chest.

Sean and his mom chose a newer treatment option called the Subcutaneous Implantable Cardioverter Defibrillator (S-ICD). The 12-year-old became the first CHOC patient to receive the device.

“The S-ICD is not as invasive as other ICDs since the sensing and defibrillating electrode is implanted directly under the skin of the chest wall and it is connected to a generator in the axilla, or lower armpit area. No component of the device is inside the veins, heart, or even the inner chest itself. Consequently, there are fewer future complications of leads in the vein and heart, and a much faster recovery time — tangible benefits for young active children,” explains Dr. McCanta.

Just one week after Sean’s frightening ordeal, he was back at home in excellent condition.

“Even though I am a pediatric nurse, I am a mom first. I have tremendous gratitude for Dr. McCanta and the CHOC team who took such excellent care of Sean. He is back at home, playing with the dogs and his friends, and looking forward to starting middle school in the fall,” says Erin.

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Dr. Anjan Batra Discusses Sudden Cardiac Arrest

Though rare, sudden cardiac arrest can be due to a range of underlying cardiac conditions, a CHOC Children’s cardiologist tells “American Health Journal.”

This can occur at anytime, but more often during sports activities, Dr. Anjan Batra says. Early indicators may be rapid heart rates, palpitations or chest pain during exercise. Dr. Batra recommends every child undergo a physical exam that includes cardiac screening.

Learn more about sudden cardiac arrest and its prevention in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 40 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

Anjan Batra, M.D., attended medical school at Ohio State University and completed his internship, residency and fellowship at the Children’s Hospital of Los Angeles.

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Identifying Sudden Cardiac Issues in Young Athletes

SUDDEN CARDIAC ARREST
“Sudden cardiac arrest is a condition in which the heart suddenly stops beating. If this happens, the blood pumped from the heart stops flowing to the brain and other vital organs. If it’s not treated in minutes, it leads to death,” says Dr. Batra, medical director of electrophysiology at CHOC Children’s and the division chief of pediatric cardiology at UC Irvine. Sudden cardiac arrest is usually caused by an irregular heartbeat, or a condition called arrhythmia. Depending on the type of arrhythmia, says Dr. Batra, it may or may not be life-threatening. Sudden cardiac arrest is not the same as a heart attack, in which blood flowing to a part of the heart muscle is blocked. In a heart attack, the heart usually doesn’t stop beating.

HEART RISK SYMPTOMS FOR YOUNG ATHLETES
“Young athletes that suffer sudden cardiac arrest usually have an inherited condition that tends to run in families. Often it is not previously diagnosed,” says Dr. Batra. A child’s family should seek medical help sooner rather than later if the child experiences a fast or irregular heartbeat, passes out or has chest pains, especially when active or exercising. Young athletes with a family history of cardiac problems also should be screened for possible heart problems, he says.

SURVIVING SUDDEN CARDIAC ARREST: WHAT TO DO
If someone you are with shows signs of a sudden cardiac arrest (chest pain; discomfort in one or both arms, the back, neck or jaw; or an unexplained shortness of breath), call 911 or ask someone else to call. Start CPR (cardiopulmonary resuscitation) immediately if the person is unconscious and not breathing. CPR will keep the blood circulating to the brain and other organs. Meanwhile, ask someone else to look for an automated external defibrillator (AED) and use it immediately. An AED is a portable device that sends an electric shock through the chest to the heart. The shock can restore a normal rhythm to the heart. AEDs are often kept in public places like schools and anyone can use one. “Every second matters. That’s the difference between life and death,” Dr. Batra says. In Orange County, about three-fourths of the public schools have an AED or are implementing an AED program, Dr. Batra says.

FAST FACTS

  • Number of sudden cardiac deaths in Orange County among young athletes, per year: About 5
  • Number of youths who experience sudden cardiac arrest annually (estimates vary widely): 1,000-9,500
  • Number of people of all ages in the U.S. who experience non-traumatic sudden cardiac arrest annually; 9 to 10 victims from this group die annually from this group die: 424,000

View the full feature on Kids and Cardiac Issues

Dr. Batra
Dr. Anjan S. Batra
CHOC Pediatric
Cardiologists

PHYSICIAN FOCUS: DR. ANJAN S. BATRA

Dr. Batra is the medical director of electrophysiology at CHOC Children’s and the chair of cardiology at UC Irvine. Dr. Batra is a respected leading researcher in pediatric cardiology, working on several ongoing research projects to help children with heart disease. His research and scientific findings are reflected in over 60 publications in national journals and textbooks. He has been designated as a Certified Cardiac Device Specialist by the International Board of Heart Rhythm Examiners and is certified in
the field of arrhythmia management and device implantation. Dr. Batra completed his internship and residency in pediatrics and a fellowship in cardiology at Children’s Hospital Los Angeles.

Dr. Batra’s philosophy of care: “For me it’s very simple: treat every child like they are your own.”

EDUCATION:
Ohio State University College of Medicine in Columbus, Ohio

BOARD CERTIFICATIONS:
Pediatric Cardiology
Pediatrics – General

More about Dr. Anjan Batra

This article was featured in the Orange County Register on July 14, 2014, and was written by Amy Bentley.

Preventing Sudden Cardiac Arrest in Children

Sudden_Cardiac_Arrest_CHOCSudden cardiac arrest, simply put, describes when a per
son’s heart suddenly stops beating and blood stops flowing to the brain and other vital organs. If the person isn’t treated within minutes, death results, a CHOC Children’s cardiologist says

Sudden cardiac arrest is usually caused by an irregular heartbeat, or a condition called arrhythmia, says Dr. Anjan Batra, medical director electrophysiology at CHOC.

During an arrhythmia, the heart can beat too fast, too slow or with an irregular rhythm. Depending on the type of arrhythmia, it can be relatively harmless, serious or life-threatening.

Many of these conditions can be treated and managed, he says.

“The message I would send to parents is to not be scared, but to be proactive,” he says. “There are often things we can do about it.”

Dr. Batra encourages families of young athletes or any young person with a family history of heart problems to contact their pediatrician, who can refer the child to a pediatric heart specialist for screening if necessary.

Families also should take their child to a doctor or the emergency department for care if the child shows symptoms of heart distress, like fainting, a racing heart or chest pains.

There are several causes of sudden cardiac death in young people, says Dr. Batra.

First, hypertrophic cardiomyopathy (HCM) is a hereditary disease in which the heart muscle becomes abnormally thick, making it harder for the heart to pump blood. While usually not fatal in most people, this condition is the leading cause of sudden cardiac death in young athletes in United States. HCM often is previously undetected, he says.

Second, long QT syndrome is another inherited heart rhythm disorder that can cause fast, chaotic heartbeats. The rapid heartbeats may lead to fainting, and can be life-threatening, Dr. Batra says.

Finally, supraventricular tachycardia (SVT) is common and worrisome. In these cases, a person suddenly feels his heart racing or beating very fast, Dr. Batra says.

“The good news is it’s a condition that is very easily treatable with a non-surgical, outpatient procedure called ablation,” he says. “We have a close to 100 percent cure rate. Families should seek care from someone who specializes in arrhythmias.”

Learn more about the CHOC Children’s Heart Institute.

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