By Wilson Lam, MD
1 Nov

Treating Adult Congenital Heart Patients at a Children’s Hospital

Wednesday, November 01, 2017

While it may sound unconventional, it is not uncommon for an adult patient to be treated at a children’s hospital. In the congenital heart disease community, this tends to be the case for a variety of reasons.

Below, Dr. Wilson Lam, a pediatric and adult cardiologist at Texas Children’s Hospital, discusses his patient, Jason, and his role in treating the tallest and oldest patient at Texas Children’s Hospital.

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When I first met Jason, he was seeking answers to a health condition which was affecting his everyday life. Jason shared with me that he was reaching the “too winded to go on” feeling faster and faster during his gym workouts. This translated into his soccer games as well, with a feeling of never being able to get enough air.

By the time Jason was referred to me, he had pretty much done all of his homework and had this uncommon diagnosis all but figured out. Fatigue and shortness of breath associated with low blood oxygen levels worsen with position and exercise? The next step for me would have been to do an echo bubble study, which had already been performed by his referring physician. In a bubble study, saltwater (saline) mixed with a little air is injected into a vein during the echo. If there is a hole between the upper heart chambers, some bubbles will go through the hole. Reviewing this test, I could see the hole between the heart’s upper chambers that sealed the deal. The diagnosis was platypnea-orthodeoxia syndrome. Translation – symptoms with standing up due to blue blood shunting across an often normal hole between the atria. Solution – closure of that hole.

After diagnosis, my most important concerns were letting Jason know what he was up against, and making sure he really understood what was happening and how we could quickly and effectively address the issue. 

Taking care of adult patients with congenital heart disease is my primary job and the high volume of consultations allows us to see these conditions and hear the stories again and again, so we are less taken by surprise. It may sound strange caring for adult patients in a children’s hospital, but it can be done right and it can be done well. Accreditation from the Adult Congenital Heart Association (ACHA), which we were recently very proud and excited to receive here at Texas Children’s, is important to see if the key elements are available –  facilities, providers, technology, and strategy. Beyond that, communication and collaboration between the key team members are paramount.

From a cardiac standpoint, having offices of Texas Children’s Heart Center (ranked no. 1 in the nation for pediatric cardiology and heart surgery by U.S. News & World Report) all within proximity allows for discussions between our ACHD team and structural/interventional cardiologists, electrophysiologists or imaging experts, congenital heart surgeons and CV anesthesiologists. Our collaboration with other on-site hospital services connects us with adult subspecialists such as maternal fetal medicine, intensive care, infectious diseases, neurology and nephrology. In addition, cutting edge technology is at our disposal for this growing population.  

In Jason’s case, this proximity and collaboration helped for a quick diagnosis and fast treatment to get him back on his feet and back to his active lifestyle as soon as possible. After diagnosis, I was able to refer Jason to my colleague, Dr. Athar Qureshi, to complete the hole closure. On the day of surgery, Jason was officially deemed the “tallest and oldest patient in Texas Children’s” that day, which he got a kick out of.

As a physician and care provider, it is wonderful to hear about Jason’s successful recovery. Dr. Qureshi did a perfect job and Jason didn’t suffer much down time before he was playing with his children again. We are blessed and proud to be part of the team that restored his quality of life by treating a congenital heart condition.

You can read Jason’s full story here.

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The opinions expressed by ACHA bloggers and those providing comments on the ACHA Blog are theirs alone, and do not reflect the opinions of the Adult Congenital Heart Association or any employee thereof. ACHA is not responsible for the accuracy of any of the information supplied by the ACHA bloggers.

The contents of this blog are presented for informational purposes only, and should not be substituted for professional advice. Always consult your physicians with your questions and concerns.

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