Bring two brilliant physicians together with shared interests, and the light bulbs go off. That’s what happened when Martin Chavez, MD, and James Nielsen, MD, delved into the issue of the fetal heart. Dr. Chavez is Chairman of Maternal-Fetal Medicine and Fetal Surgery at NYU Winthrop, while Dr. Nielsen works at both campuses and is now serving as the Interim Chief of Pediatric Cardiology at NYU Winthrop. Together, they are forging new paths for diagnosing congenital heart defects (CHD), the most common type of birth defect, utilizing pediatric cardiac MRIs and fetal ultrasound technology.
In terms of pediatric cardiac MRIs, Dr. Nielsen brings with him from NYU Langone advanced skill sets in utilizing these diagnostic tests to detect holes in the heart, abnormal heart chambers, inflammation of heart muscle, and more. Traditionally, an echocardiography (a cardiac ultrasound) is the main method for investigating congenital heart problems – especially in young children. That echo test uses sound waves to create pictures of the heart's chambers, valves, walls, and blood vessels attached to the heart including the aorta. While echo tests can help determine about 90 percent of diagnoses, a cardiac MRI – especially when utilized for diagnosing older children with CHDs – can provide a clinician with important information with regards to the heart’s anatomy and function.
“Cardiac MRI for congenital and pediatric heart disease has become an essential tool for clinical centers of excellence,” says Dr. Nielsen. “Cardiac disease in children is much different than adult heart disease and special tools and expertise are needed.”
Dr. Nielsen refers to the oft-repeated phrase, “The child is not a small adult.”
“A child’s heart rate is much faster and the heart conditions are unique, so we have to modify the way we obtain and interpret images of the heart,” explains Dr. Nielsen. “The heart is moving fast, which is a big challenge. It’s not like taking a portrait photo; it’s as though we’re taking a picture of a sprinter – one needs to optimize the camera’s shutter speed. Years of experience and deep understanding of both the MRI machine and children’s heart diseases are essential for success.”
The heart of the unborn baby poses its own set of challenges, but there, Dr. Chavez and Dr. Nielsen collaborated to develop an Early Fetal Cardiology Program.
“We were looking for additional ways to advance our field,” said Dr. Chavez. “We had the right resources, technologies, and our interests were aligned.”
Detecting issues with the fetal heart, Dr. Chavez explained, typically occurs when a fetus is 18 to 22 weeks of age. Dr. Chavez wanted to push the envelope – to detect issues even earlier on, at 11 to 12 weeks. At that age, however, the organ is no bigger than an M&M.
The two physicians, Chavez and Nielsen, decided to combine two approaches to collect more information. They began using the traditional transdominal ultrasound, which is a long-established standard of care for pregnancies, together with a transvaginal ultrasound, which is less typical. Ultrasound imaging uses sound waves to produce pictures of the inside of the body, in this case, the fetal heart. By utilizing the transvaginal approach, the physicians were able to get closer to the M&M-sized heart and detect the sound waves more clearly. When combined with the traditional transdominal method, they could detect heart issues much earlier – in the first trimester, rather than in the second.
“There are a few centers in the U.S. utilizing this new protocol, but NYU Winthrop is certainly among the first in the New York-metro region,” said Dr. Chavez.
Dr. Chavez points to his “patient hero,” as he calls one woman who was the beneficiary of this new program. The woman had lost her first baby to heart disease and soon, had become pregnant again. Under the new Early Fetal Cardiology Program, she received testing during her first trimester, at about 11 weeks – and was thrilled to learn the baby had no congenital defects. “An enormous burden had been lifted from her shoulders,” said Dr. Chavez. “She said she could now enjoy her pregnancy – as so many other women do – without fear of a catastrophic outcome.”
The two specialists are now exploring video-sharing their groundbreaking pediatric cardiac MRIs and fetal ultrasounds in real time, enhancing the mother’s experience as well as their own diagnostic capabilities.
Matters of the heart, no matter how big or small, will continue to be at the forefront of this unique collaboration between Maternal-Fetal Medicine and Pediatric Cardiology at NYU Winthrop.