Telemedicine in Congenital Heart Disease

Abstract

BACKGROUND: The primary rationale for the development of telemedicine has been to serve populations that have limited access to traditional, high quality medical services. These include those living in rural areas or other underserved areas, like islands, or even urban areas when a rare medical subspecialty, such as pediatric cardiology is not available.

OBJECTIVE: The aim of the present study was to present our results with use of telemedicine during the European project TELEREMEDY over a period of 26 months when adult cardiologists and pediatricians of our hospital communicated with pediatric cardiologists at the tertiary Children’s Hospital “Agia Sofia” in Athens and at the Royal Brompton Hospital in London, as well as with physicians at the “Venizelio” Hospital in Crete.

METHODS AND RESULTS: Over 26 months, 31 teleconference sessions were organized. During this period, 155 children with suspected congenital heart disease (CHD) underwent echocardiographic examination, which confirmed CHD in 83 (54%), acquired heart disease in 13 (8%) and normal anatomy in 59 (38%). Ventricular septal defect was diagnosed in 26/83 (31%), complex CHD in 20 (24%), atrial septal defect in 12 (14%) and patent ductus arteriosus in 8 (10%) children. Our hospital with the adult electrophysiology team was the expertise center for diagnosis and treatment of 30 children with arrhythmia.

During 23 sessions with the tertiary Children’s Hospital “Agia Sofia” in Athens, an immediate transfer to the pediatric intensive care unit of the tertiary center was decided for 27 cases (17%). During 3 sessions with one participating hospital we provided consultation for 10 cases with arrhythmias. During 6 sessions with the Royal Brompton Hospital in London, rare cases of CHD, both adult and pediatric, were discussed. Two multilane conferences were organized among all participants and the systems capabilities in each hospital were discussed.

CONCLUSION: Telemedicine systems, like the one used herein in the context of the TELEREMEDY program, facilitate a timely diagnosis and management of children with CHD in hospitals lacking pediatric cardiology service. In the present series, use of this program obviated unnecessary and costly transfers in 83% of cases. Thus, immediate access to specialists can guide patient management and may potentially alter the morbidity and mortality in this patient population.