Spotlight on : Cardiology

MCH Cardiology head Dr. Marie Béland says that more and more people are living with congenital heart disease. And while that may not sound very positive, it is in fact good news. As Dr. Béland explains, “Thanks to great advances in cardiology more and more children who have been diagnosed with heart disease are moving on to full lives in adulthood.”

The Cardiology team at the MCH has over a dozen members including cardiologists, technicians, nurses and administrative staff. Most of their patients are children who are referred for assessment of murmurs. In most cases, a cardiac murmur is not a cause for concern but the Cardiology team works to discover or rule out congenital heart disease. Diagnostic services offered include echocardiography, electrophysiology services, both diagnostic and interventional cardiac catheterization, and cardiac magnetic resonance imaging. The minority of patients will need cardiac surgery or a procedure in the catheterization lab to repair or palliate their cardiac problem. Over the last decade, with the most recent technological and technical advances, including some pioneered by the MCH cardiology team, more and more such procedures are performed in the cath lab.

Cardiology also treats children with acquired heart disease / problems with rhythm. In fact, they often get involved in diagnosing a baby before birth. According to Dr. Béland, “Some foetuses have rhythm problems or congenital heart disease which can be life-threatening to the baby so a lot of our work is done antenatally to get ready for the birth.”

Two areas of particular note are the department’s telemedicine services for patients outside Montreal and the introduction last year of percutaneous pulmonary valve implants.

Founders in telemedicine
The MCH is one of the founders of the Réseau québécois de télésanté élargi (RQTe). MCH Cardiology has provided telemedicine services for the past decade and many of its consultations are done for patients living in Quebec’s northern communities.

A pediatric cardiologist visits Puvirnituq and Kuujjuaq once a year but at other times an MCH cardiologist can still provide consultation since the MCH is set up to receive transmissions of video images and real-time echocardiograms. If a baby has a heart murmur, the family can bring him or her to Puvirnituq or Kuujjuaq for a consult. The advantages are numerous and as Dr. Béland points out, “Not only does it simplify the process but it means the family doesn’t have to deal with the inevitable culture shock of a transfer to Montreal.” The cost savings of a telemedicine consult can be as high as $20,000 per child. The success in these two communities has led the MCH to explore setting this up for the Cree community in James Bay where Dr. Béland pays annual visits.

A Montreal first

The MCH Cardiology department is also an integral part of the centre of excellence for Congenital Heart Disease at McGill. The close collaboration with cardiologists from the adult sites at the McGill University Health Centre (MUHC) resulted in the first percutaneous pulmonary valve implant in Montreal, which was carried out in the cardiac catheterization and percutaneous coronary intervention (PCI) centre at the MCH by Dr. Adrian Dancea and Dr. Giuseppe Martucci.

The procedure involves replacing the valve that sits between the heart and lungs with an artificial one. It’s a minimally invasive procedure that can significantly delay the need for open-heart surgery and greatly reduce the life-long morbidity associated with some heart malformations.

Working with cardiologists at the adult site means that the MCH is at the forefront of offering a continuum of care for pediatric patients once they reach adulthood. As the number of adults with congenital heart disease surpasses the number of children who are being diagnosed with it, the needs for care throughout a patient’s lifetime are only just being defined. The advantage of having the centre of excellence within the broader community of the MUHC is that patients with complex multi-systemic problems can have access to other specialties such as obstetrics, neurology, nephrology and others. “We’re working towards the complete care of patients from the foetus to old age,” says Dr. Béland, “We’ll be spearheading the concept of comprehensive care for the patient with congenital heart disease in Canada”.

Cardiologists well known for research

The MCH cardiologists are also involved in various research areas. Dr. Charles Rohlicek holds numerous CIHR grants and has done research in the effect of low oxygen levels in early life and its future impact on the body.

Dr. Béland is well known internationally for her work on the international committee for standardization of nomenclature of congenital heart disease. Dr. Luc Jutras is highly regarded across Canada for his imaging skills in MRI and he recently published a research paper on virtual cardiac pathology, a technique that will have great benefits for teaching and research in the future.

The department will soon welcome its fifth cardiologist. In the coming weeks Dr. Tiscar Cavalle-Garrido will begin working at the MCH; her emphasis is on foetal cardiology and echocardiography.