Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T22:18:54.364Z Has data issue: false hasContentIssue false

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Van Der Linde, D, Konings, EEM, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 22412247. doi: 10.1016/j.jacc.2011.08.025 CrossRefGoogle ScholarPubMed
Mahle, WT, Newburger, JW, Matherne, GP, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120: 447458. doi: 10.1161/CIRCULATIONAHA.109.192576 CrossRefGoogle ScholarPubMed
Chelo, D, Nguefack, F, Menanga, AP, et al. Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon. Cardiovasc Diagn Ther 2016; 6: 1019. doi: 10.3978/j.issn.2223-3652.2015.11.04 Google Scholar
Spencer, KT, Kimura, BJ, Korcarz, CE, Pellikka, PA, Rahko, PS, Siegel, RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26: 567581. doi: 10.1016/j.echo.2013.04.001 CrossRefGoogle ScholarPubMed
Shah, SP, Shah, SP, Fils-Aime, R, et al. Focused cardiopulmonary ultrasound for assessment of dyspnea in a resource-limited setting. Crit Ultrasound J 2016; 8. doi: 10.1186/s13089-016-0043-y CrossRefGoogle Scholar
Spurney, CF, Sable, CA, Berger, JT, Martin, GR. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr 2005; 18: 313319. doi: 10.1016/j.echo.2004.10.016 CrossRefGoogle Scholar
Yacoub, S, Lang, HJ, Shebbe, M, et al. Cardiac function and hemodynamics in Kenyan children with severe malaria. Crit Care Med 2010; 38: 940945. doi: 10.1097/CCM.0b013e3181cd114a CrossRefGoogle ScholarPubMed
Sable, CA, Cummings, SD, Pearson, GD, et al. Impact of telemedicine on the practice of pediatric cardiology in community hospitals. Pediatrics 2002; 109: e3e3. doi: 10.1542/peds.109.1.e3 CrossRefGoogle ScholarPubMed
Sekar, P, Vilvanathan, V. Telecardiology: effective means of delivering cardiac care to rural children. Asian Cardiovasc Thorac Ann 2007; 15: 320323. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007441301.CrossRefGoogle ScholarPubMed
Martinez Garcia, D, Bonnardot, L, Olson, D, et al. A retrospective analysis of pediatric cases handled by the MSF tele-expertise system. Front Public Health 2014; 2: 266. doi: 10.3389/fpubh.2014.00266 CrossRefGoogle ScholarPubMed
Zachariah, R, Bienvenue, B, Ayada, L, et al. Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia? Trop Med Int Health 2012; 17: 11561162. doi: 10.1111/j.1365-3156.2012.03047.x CrossRefGoogle Scholar
Hinton, RB, Ware, SM. Heart failure in pediatric patients with congenital heart disease. Circ Res 2017; 120: 978994. doi: 10.1161/CIRCRESAHA.116.308996 CrossRefGoogle ScholarPubMed
Wootton, R, Bonnardot, L. In what circumstances is telemedicine appropriate in the developing world? JRSM Short Rep 2010; 1: 37. doi: 10.1258/shorts.2010.010045 CrossRefGoogle ScholarPubMed
Graham, LE, Zimmerman, M, Vassallo, DJ, et al. Telemedicine—the way ahead for medicine in the developing world. Trop Doct 2003; 33: 3638. doi: 10.1177/004947550303300118 CrossRefGoogle Scholar
Engelman, D, Kado, JH, Reményi, B, et al. Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: A study of diagnostic accuracy. Lancet Glob Health 2016; 4: e386e394. doi: 10.1016/S2214-109X(16)30065-1 CrossRefGoogle ScholarPubMed
Hinton, RB, Ware, SM. Heart failure in pediatric patients with congenital heart disease. Circ Res 2017; 120: 978994. doi: 10.1161/CIRCRESAHA.116.308996 CrossRefGoogle ScholarPubMed
Da Silva, VM, De Oliveira Lopes, MV, De Araujo, TL. Growth and nutritional status of children with congenital heart disease. J Cardiovasc Nurs 2007; 22: 390396. doi: 10.1097/01.JCN.0000287028.87746.11 CrossRefGoogle Scholar
Batte, A, Lwabi, P, Lubega, S, et al. Wasting, underweight and stunting among children with congenital heart disease presenting at Mulago hospital, Uganda. BMC Pediatr 2017; 17: 17. doi: 10.1186/s12887-017-0779-y CrossRefGoogle ScholarPubMed
Tantchou Tchoumi, JC, Butera, G, Giamberti, A, Ambassa, JC, Sadeu, JC. Occurrence and pattern of congenital heart diseases in a rural area of sub-Saharan Africa. Cardiovasc J Afr 2011; 22: 6366.CrossRefGoogle Scholar
Nkoke, C, Balti, E, Menanga, A, et al. Trends in pediatric echocardiography and the yield for congenital heart disease in a major cardiac referral hospital in Cameroon. Transl Pediatr 2017; 6: 4045. doi: 10.21037/tp.2016.11.01 CrossRefGoogle Scholar
Hwang, I-C, Sisavanh, M, Billamay, S, et al. Congenital heart disease at Laos children’s hospital: two year experience. Pediatr Int 2017; 59: 271279. doi: 10.1111/ped.13156 CrossRefGoogle ScholarPubMed
Shub, C, Dimopoulos, IN, Seward, JB, et al. Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: Experience with 154 patients. J Am Coll Cardiol 1983; 2: 127135. doi: 10.1016/S0735-1097(83)80385-4 CrossRefGoogle ScholarPubMed

Muhame et al. supplementary material

Muhame et al. supplementary material 1

Download Muhame et al. supplementary material(Video)
Video 69.2 KB

Muhame et al. supplementary material

Muhame et al. supplementary material 2

Download Muhame et al. supplementary material(Video)
Video 72.2 KB

Muhame et al. supplementary material

Muhame et al. supplementary material 3

Download Muhame et al. supplementary material(Video)
Video 13.4 MB