Detecting defects in little hearts

Center helps parents, doctors plan strategy before baby is born

They haven't yet picked his name, but Camille and Gary Hood know a great deal about their baby boy, who is due in May. They know he has a complicated set of heart defects and his early future will include close monitoring and staged surgeries.

He has what's called tricuspid atresia, and his aorta and pulmonary artery are reversed. The tricuspid valve on the right side of his heart didn't form, so the blood doesn't flow as it should from the upper right chamber into the right ventricle, which is missing. The blood flow to his lungs is wrong, as well, but inside his mother's womb, little holes between chambers help him survive until his heart can be repaired.

Wednesday, the Hoods, who live in Woods Cross, went to Primary Children's Medical Center for a new ultrasound, then met with Dr. Michael Puchalski, a pediatric cardiologist specializing in imaging, to talk about what they can expect and what will be needed once the baby is born.

Puchalski, Dr. Jason Su, also a pediatric cardiologist, and nurse Kelly Kelso have established the Fetal Heart Center at Primary Children's Medical Center. It's a program that aims to detect heart defects before a baby is born to be sure immediate and appropriate care is available.

Many, but not all of the detected defects require urgent and immediate care. Knowing — and making plans — saves tiny lives, says Puchalski. Before they formed the center, he says, prenatal doctors in the Intermountain region were only detecting about one-third of heart defects prior to birth. That number has grown to about 55 percent, in part because of intensive outreach from the trio, who have worked with obstetricians and even invited sonographers up to train to recognize nuances of less obvious defects. They've done grand rounds at area hospitals and created handouts to raise awareness.

Puchalski says he'd like to see early diagnosis in at least 70 percent of cases.

Knowing about heart disease in utero "can prevent deaths," Puchalski says. Because the babies will be cared for at the children's hospital, some parents who expect their baby will require urgent care may choose to deliver nearby at University Hospital. For others, arrangements can be made for transport to Primary. What they're trying to avoid happens all too often: A child is not diagnosed until symptoms appear, sometimes after parents have taken home their "healthy" newborn, and they're faced with a huge shock and need for unexpected emergency intervention.

"It's given us more time to emotionally and financially prepare. We've had some time to get ready for what's coming," says Gary Hood, who is a nurse practitioner specializing in adult cardiology.

For Camille, a nurse at University Hospital, the Fetal Heart Center has also put all the consultations in one place, reducing stress and coordinating things.

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