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Cardiac point of care ultrasound in resource limited settings to manage children with congenital and acquired heart disease

Published online by Cambridge University Press:  08 March 2021

Rugambwa M. Muhame
Affiliation:
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8 Division of Cardiology, Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Canada, M5G 1X8
Andreea Dragulescu
Affiliation:
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8 Médecins Sans Frontières Canada, 551 Adelaide St W, Toronto, ON M5V 0N8, Canada Division of Cardiology, Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Canada, M5G 1X8
Adi Nadimpalli
Affiliation:
Médecins Sans Frontières USA, 40 Rector St 16th Floor, New York, NY, 10006, USA
Daniel Martinez
Affiliation:
Médecins Sans Frontières Operational Centre, Geneva; 78 Rue de Lausanne, Case Postale 1016, 1211 Geneva 1, Switzerland
Marie-Claude Bottineau
Affiliation:
Médecins Sans Frontières Operational Centre, Geneva; 78 Rue de Lausanne, Case Postale 1016, 1211 Geneva 1, Switzerland
Raghu Venugopal
Affiliation:
Médecins Sans Frontières Canada, 551 Adelaide St W, Toronto, ON M5V 0N8, Canada
Kyle Runeckles
Affiliation:
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8
Cedric Manlhiot
Affiliation:
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8
Lynne E. Nield*
Affiliation:
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8 Médecins Sans Frontières Canada, 551 Adelaide St W, Toronto, ON M5V 0N8, Canada Division of Cardiology, Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Canada, M5G 1X8
*
Author for correspondence: Lynne Nield, MD, FRCPC, Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8. Tel: +1 416 813 6141; Fax: +1 416 813 7547. Email: lynne.nield@sickkids.ca

Abstract

Background:

In resource limited settings, children with cardiac disease present late, have poor outcomes and access to paediatric cardiology programmes is limited. Cardiac point of care ultrasound was introduced at several Médecins Sans Frontières sites to facilitate cardiopulmonary assessment. We describe the spectrum of disease, case management and outcomes of cases reviewed over the Telemedicine platform.

Methods:

Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist.

Results:

Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists.

Conclusion:

Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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