Echocardiography

Echocardiogram
Transthoracic Echocardiography
Sedated Echocardiogram
Transesophageal Echocardiogram (TEE)
Fetal Echocardiography
Remote Access Echocardiography Program

FAQ about Pediatric Echocardiography
FAQ about Fetal Echocardiography
FAQ about Transesophageal Echocardiography

Cardiac Catheterizations

Valvuloplasty
Angioplasty
Coil Embolization
Stenting
Atrial Septal Defect (ASD) Closure
Patent Foramen Ovale (PFO) Closure

Electrophysiology

Electrocardiogram (ECG)
Holter Monitor
Event Monitor
Exercise Test
Electrophysiology Study (EP)
Catheter Ablation
Pacemakers
Implantable Cardioverter / Defibrillators (ICD's)

Echocardiogram

An echocardiogram is another name for an ultrasound of the heart.  This procedure is a non invasive and a non painful way of looking at the heart structure and function in children suspected of having heart disease. The procedure uses safe high-frequency sound waves to generate moving images of the heart.  A small transducer or probe produces these sound waves and is placed in different areas (called echo windows) on the chest wall and abdomen (transthoracic echocardiography).  A warm water based gel is applied to the transducer which makes it easier for sound waves to penetrate the chest wall and produces cleaner pictures.  The images are seen in real time on a monitor and are saved in a digital format for the doctor's review and possible later comparison.  This procedure does not utilize radiation and is considered very safe.  At the Northwest Center for Congenital Heart Disease clinic over 4400 outpatient echocardiograms are performed yearly.  All echocardiograms are performed by sonographers registered and experienced in pediatric, and adult congenital cardiac imaging.  An echocardiogram is a versatile tool and can be used in a broad range of settings, from fetal patients (fetal echocardiography) to adults with congenital cardiac abnormalities. There are also different applications of echocardiography that allow the procedure to be useful for patients undergoing heart surgery and other invasive procedures (transesophageal echocardiography).

Transthoracic Echocardiography

A transthoracic echocardiogram is the most common type of echocardiogram performed.  During this procedure the echo probe is placed on the chest wall.  Because children are generally small and thin, visualization of cardiac structures is usually excellent.  With new technology most adults can be assessed well with a transthoracic echocardiogram as well.  An echocardiogram is the single best way to evaluate a the anatomy and function of the heart.  When the cardiologist thinks an echocardiogram is necessary, this test is typically performed on the day of your clinic visit.  Our echo staff is extremely child friendly and very experienced in dealing with infants, children and young adults.  Occasionally children, particularly toddlers, can be frightened or uncooperative during this procedure. In many cases they can be easily distracted with the help of a favorite video, DVD, or toy but at times may require a sedated echocardiogram in order to effectively perform the procedure.  In adults or older children, visualization of the heart from the chest is not adequate due to the larger body mass and a transesophageal echocardiogram (TEE)  is warranted.

Click Here to View Video Clip

Sedated Echocardiogram

There are times when it is difficult for a child (usually between 6 months to 2 1/2 years) to be still enough to complete or even attempt an echocardiogram.  In those instances, and especially when the information is important for medical decision making, outpatient oral sedation may be warranted.  In many cases, this can be less stressful for the anxious patient and provides a more complete and accurate assessment of the child’s anatomy and physiology.  This procedure is typically scheduled in advance at your cardiologist request and performed at Sacred Heart Children's Hospital sedation / surgical center.  Most children receive chloral hydrate, which is a common and safe oral sedative given by trained sedation personnel in a proper setting for cardiac and respiratory monitoring.  Special instructions regarding an empty stomach are sent to the family prior to the scheduled procedure.

Transesophageal Echocardiogram (TEE)

The transesophageal echocardiogram (TEE) is performed by placing a long and flexible echo probe into the esophagus.  The esophagus is the tube connecting the mouth to the stomach. The esophagus is located immediately behind the heart and there is little in the way to obstruct visualization of the heart structures  An adult probe is no larger than the size of the index finger.  A pediatric probe is no larger than a pencil. The transesophageal echocardiogram is performed by the cardiologist. Intravenous sedation or general anesthesia must be utilized to perform this type of echocardiogram. It must be performed at the hospital where sedation, provided by trained staff, can be safely used and the patient safely monitored. It is typically an outpatient procedure but is often performed in conjunction with other surgical or catheter based procedures. There are several common reasons for a transesophageal echo:

• Inadequate or incomplete transthoracic echocardiogram:

• chest wall abnormalities
• post-operative patients with significant chest wall scarring or bandages
• lung disease resulting in interference of echocardiographic pictures
• large body mass/obesity

• Intraoperative TEE to assess cardiac anatomy and function before and after a cardiac surgical or a catheter based procedure (example: ASD device placement).
• Need for improved visualization of structures such as the atrial septum, transcatheter devices, pulmonary veins or mitral valve.
• Better evaluation of the cardiac chambers and valves for small blood clots and assessment of possible causes for stroke.

Fetal Echocardiography

Fetal echocardiography is an examination of the fetal heart using ultrasound.  Advances in ultrasound technology have enabled us to evaluate the baby's heart as early as 16 to 18 weeks gestation.  The fetal echocardiogram provides information regarding:

1. fetal cardiac anatomy & function
2. fetal heart rhythm
3. fetal heart failure & distress

Most congenital heart defects can be diagnosed as early as 16 to 18 weeks gestation.  Early diagnosis of fetal cardiac abnormalities is beneficial in many ways.  Knowledge of fetal cardiac abnormalities allows families ample time to learn more about their child’s heart condition and its implications prior to birth.  A fetal cardiac diagnosis can often assist in the confirmation of genetic syndromes.  Rarely, early diagnosis of specific cardiac problems may warrant a referral for highly specialized in utero intervention.  Most importantly fetal diagnosis of congenital heart malformations helps caregivers prepare for the delivery of the infant.  Certain heart malformations require intensive support in the first few hours after birth.  Having a firm prenatal diagnosis allows for calm and coordinated planning of the delivery at a center proficient at congenital heart surgery and pediatric cardiac support.

Abnormalities in fetal heart rhythm can be mild and intermittent or severe enough to result in fetal distress and heart failure.  Excessively fast heart rates (tachycardia) are treatable in the womb using medications given to the mother.  The diagnosis and response to therapy are best assessed by fetal echocardiography.

When performed by a trained and experienced pediatric cardiology staff, the fetal echocardiogram has excellent ability to provide an accurate diagnosis of a fetal heart condition.  There are certain heart problems that are not always easy to diagnose in the fetus as they are a normal part of the fetal circulation (ASD and PDA).  Coarctation of the aorta, total or partial anomalous pulmonary venous return, and some ventricular septal defects can also be difficult to identify due to fetal physiology.  The quality of fetal images obtained can also vary depending on the baby’s position, movement, gestational age, and the mother’s body habitus.

Indications for fetal echocardiogram include:

1. Abnormal cardiac findings on a screening radiology, obstetric or perinatal ultrasound
2. Fetal heart rhythm concerns
3. Suspicion of possible chromosomal abnormality or genetic syndrome
4. Previous child with congenital heart disease
5. Maternal or paternal diagnosis of congenital heart disease
6. Maternal chronic conditions such as Lupus or diabetes.
7. Maternal exposure to potentially toxic medications (anticonvulsants, Accutane)
8. Finding of another serious congenital defect (kidney, brain, bowel or bone)

Remote Access Echocardiography Program

Interpretation of the pediatric and congenital echocardiogram is a highly specialized skill.  It requires extra effort and training. Through digital technology we have established access to surrounding hospitals to aid in the diagnosis of and care for patients with congenital heart disease.  Direct links from hospitals to our office for remote echocardiography reading have been established with:

Sacred Heart Children¹s Hospital and Medical Center, Spokane WA
Deaconess Medical Center, Spokane WA
Lourdes Medical Center, Pasco WA
Kadlec Medical Center, Richland WA
Othello Community Hospital, Othello WA
St. Maries Hospital, Walla Walla  WA
Kennewick General Hospital, Kennewick  WA
St. Joseph's Medical Center, Lewiston  ID

We are in the process of adding more hospitals to this list.  Having these links allows for important management decisions to be made without moving the patient from their home hospital. If need be, the patient is transported to Sacred Heart Children’s Hospital/Medical Center for care and intervention.  It is a terrific advantage to transport an infant with knowledge of the diagnosis. This enables the transport team to have an appropriate plan for transport.

Electrocardiogram

An electrocardiogram is commonly performed at your visit with Northwest Center for Congenital Heart Disease.  ECG testing is routinely used to assess heart rhythm, to screen for certain types of congenital heart disease, and to track known existing congenital heart disease. 

The first human electrocardiogram was performed by A. D. Waller in 1887, and was further developed by Dr. Willem Einthoven.  Electrocardiogram is often abbreviated ECG and EKG, but they are the same thing.  ECGs remain probably the most effective, noninvasive diagnostic tool for cardiac arrhythmias, even into the 21st century. 

Pacemakers

Pacemaker therapy is indicated for heart conditions resulting in a slow heart rate, either associated with significant symptoms, significant structural heart disease, or if there is risk of sudden death related to a slow heart rate, even in the absence of symptoms. 

The most common indication for pacemaker implantation in the young person is a condition called AV block.  Many children born with congenital heart disease have anatomical irregularities that may make pacemaker implantation technically more difficult.  Dr. Anderson is experienced in implantation of transvenous pacemakers in patients with congenital heart disease.  For those patients where anatomic considerations warrant implantation of an epicardial pacemaker (which is an open-chest procedure), our cardiac surgical team is experienced in pacemaker implantation in these patients. 

Northwest Center for Congenital Heart Disease is experienced in pacemaker followup and offers routine transtelephonic pacemaker followup (pacemaker interrogations performed over the telephone).  Your cardiologist will advise you regarding restrictions for patients who have a pacemaker, routine pacemaker followup procedures, and any other questions you may have about living with a pacemaker.

Implantable Cardioverter / Defibrillators (ICD's)

Implantable cardioverter/defibrillators, or ICDs, are indicated for treatment of specific types of tachyarrhythmias (fast heart beats) that predispose patients to sudden arrhythmic death.  The most common indication is sustained ventricular tachycardia or ventricular fibrillation.  Many types of heart disease can predispose one to have ventricular tachycardia including repaired congenital heart disease, cardiomyopathy, and long QT syndrome (LQTS).  The team at Northwest Center for Congenital Heart Disease is experienced in managing all of these conditions, as well as in the implantation of cardioverter/defibrillators. 

Often, patients with an ICD will also be taking medications, and follow-up will be important, even after implantation of an ICD.  Your doctor at Northwest Center for Congenital Heart Disease will outline the routine follow-up procedures after ICD implantation, which will include regular office visits with ICD interrogations, and sometimes Holter monitoring and exercise testing.  In many cases, ICDs can be interrogated over the telephone.  Ask you doctor at Northwest Center for Congenital Heart Disease if transtelephonic ICD interrogation is available for you or your child.