Operating on small children and babies with a congenital heart defect is very invasive. The WKZ of the UMC Utrecht has the very latest techniques available to treat even the smallest babies – under 1 kilogram – optimally. This takes place in the Center for Congenital Heart Defects. Patients outside the region can also count on the best care and treatment.
For example, annually around seventy patients come to Utrecht from the Máxima Medisch Centrum (MMC) Veldhoven. “In the MMC we see about 1,300 children per year with suspected heart defects,” says Christian Schroer, a pediatric cardiologist at the MMC with a partial appointment at the WKZ. “Largely these are congenital heart defects, from minor to the very severe, including Tetralogy of Fallot. This congenital heart defect involves four abnormalities of the heart: there is a hole in the septum of the left and right ventricles, the pulmonary artery is narrowed, the aorta is crooked and the right ventricle has a thickened heart muscle. We refer patients with this complex and profound heart condition to UMC Utrecht.”
“Heart defects are often located in the large vessels such as the pulmonary artery and body artery with many branches,” continued head of Children’s Heart Center WKZ Gregor Krings. “Then we want to know exactly what the anatomy of the heart looks like. Imaging techniques in 3D and 4D form the basis for this. A 2D image of the heart is like a picture of a tree. With a 3D image, you can walk around the tree and see crooked branches from all sides. Partly on this basis, we can plan a heart catheterization or heart surgery in a targeted way and perform it safely.”
One step further is 4D technology, which is a moving 3D image. This shows the pumping pattern of the heart and the flow of the vessels. “To determine whether or not an intervention is necessary, we look at the cross-sectional area of a pulmonary or coronary artery and the blood pressure difference when a narrowing occurs, among other things,” Gregor explains. “With the help of 4D techniques, we have an additional indication. This is because it allows us to visualize the degree of ‘turbulence’ of the blood circulation and its consequences. We are doing a lot of research on how to use computer technology to calculate the best position of a stent or heart valve. This offers added value, especially for severe congenital heart defects, such as Tetralogy of Fallot, a unicameral heart or stenosis of the body’s artery.”
It works like this. Gregor: “After the diagnostic examination in the cardiac catheterization room, we processed all the information into 3D data. We process this data with complex software. This allows us to experiment with different treatment techniques. We digitally try out stent placement and then see, again digitally, its effect on blood circulation. This gives us the ability to treat optimally for the long term as well.”
Major procedures such as heart surgery and cardiac catheterizations only happen in the four Dutch academic heart centers. Christian: “At MMC, we perform all care and diagnostic tests before and after interventions. Together with the WKZ colleagues, we have weekly patient meetings. The close cooperation not only radiates confidence to patients and parents, but also ensures better quality of care, faster treatment and a lot of job satisfaction. We work with uniform protocols and partly have the same equipment. For example, we also perform the most recent and advanced 3D and 4D ultrasound techniques at the MMC in Veldhoven. The advantage is that the children who come to the CAH in the WKZ for surgery do not have to be examined again, but can be treated there immediately.”
UMC Utrecht’s Center for Congenital Heart Defects focuses on children in its Children’s Heart Center and (young) adults in its GUCH (Grown Ups with Congenital Heartdisease) center. Máxima Medisch Centrum (MMC) Veldhoven and the Center for Congenital Heart Defects have been strong partners for years in the guidance and treatment of patients with congenital heart defects.
