During the month of February, we celebrate Heart Month at Children’s of Alabama by highlighting advancements in care and technology at the Pediatric and Congenital Heart Center of Alabama. This partnership between Children’s and the University of Alabama at Birmingham (UAB) brings together more than 250 team members who focus solely on the care of children with heart disease. From the time a baby is diagnosed, even before birth, a plan for that child’s care is developed.
As Division Director of Pediatric Cardiology, Dr. Yung Lau and his team follow patients from birth until the transition to adult care. Recent partnerships and advancements in technology help to save lives in schools, monitor patients from afar and operate using less-invasive techniques.
Selected Podcast
Heart Month Highlights Advancements in Technology & Family-Centered Care
Featured Speaker:
Yung Lau, MD
Dr. Yung Lau is a Pediatric Cardiologist at Children’s of Alabama and the University of Alabama at Birmingham (UAB). He completed his pediatric residency at UAB and his fellowship at the Medical University of South Carolina under Dr. Paul Gillette, who is recognized as the “Father of Pediatric Electrophysiology.” Clinically, Dr. Lau’s areas of special interest include cardiac rhythm abnormalities, sudden cardiac arrest in the young and congenital heart disease. Within the Pediatric and Congenital Heart Center of Alabama, Dr. Lau is most pleased with the multidisciplinary partnership that has developed among the cardiologists, cardiac intensivists, CV anesthesiologists and CV surgeons in the delivery of patient and family-centered care. Transcription:
Heart Month Highlights Advancements in Technology & Family-Centered Care
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics. A podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski and today we are talking with Dr. Yung Lau, who is a professor at UAB, the University of Alabama at Birmingham and Director of the Division of Pediatric Cardiology. Welcome Dr. Lau.
Dr. Yung Lau, MD (Guest): Thank you. Thank you for having me.
Tiffany: So, February is Heart Month in America and here at Children’s. Maybe let’s start with the difference between congenital heart disease in children and then the heart disease that we see in older adults.
Dr. Lau: So, the fields are quite different. In adults, most of the heart diseases seen are something that is – that develops during adulthood because of lifestyle and diet and exercise and things like that. In the pediatric population, heart disease is usually a defect that they are born with. And so, those defects can show up right as they are born, sometimes they are even diagnosed before they are born as part of the prenatal evaluation with ultrasound, they see a defect in the heart, and then they will come to a cardiac high-risk appointment where cardiologists and maternal fetal specialists get together and evaluate the patients together.
Tiffany: What happens next, after the defect is discovered?
Dr. Lau: The diagnosis is made and then a plan is made for when the child is born as to what interventions will be needed. And here at Children’s of Alabama, we are very fortunate because our unit is connected with the labor and delivery rooms as well as the high-risk nursery with a 40-foot bridge. And so, in other centers, around the country, it is not uncommon to be miles away between where the baby is born and where the child needs to go in order to get cardiac care.
Tiffany: So, it makes for a very seamless transition when they may need to have some type of intervention, some type of procedure.
Dr. Lau: Yes. And in fact, we have in our most sick patients, the patients that are very – need care right away, it is not uncommon that the care is initiated in the delivery room so within 15 minutes after baby is born, sometimes they are put on a machine that they need to be on and then brought to the catheterization lab or the operating room, where a more definitive procedure can be done.
Tiffany: Are there any warning signs that a pregnant woman might have that her unborn baby might have some type of heart problem or congenital heart problem?
Dr. Lau: Those are usually found with ultrasound. Ultrasound technologists around the country know to look for certain views of the heart. And if they don’t see that, then it is referred to a center that is capable of doing the more definitive diagnosis.
Tiffany: What kind of defects are you seeing in these children? What kind of problems are they having when they come to you?
Dr. Lau: The normal heart has four chambers in it and two big blood vessels that leave it that go to the lung and to the body. Some of our children are born with three chambers instead of four. Some are born with just two chambers instead of four. There are walls of tissue that separate the chambers and sometimes there are holes in that wall. Sometimes the blood vessels that leave the heart are narrowed, sometimes the valves in those blood vessels are narrowed or they leak a lot. So, there is all variety of different heart defects. Things have really advanced in the last 50 to 60 years. Dr. John Kirkland, who the Kirkland clinic here in Birmingham is named after, was the person that perfected or made great advances in the heart lung machine in the 1940s. And then brought that down to Alabama in 1966. Operations that were very high-risk when I was a fellow 25 years ago; are now fairly routine with very good results from it. And so, there are very, very few patients that we feel as though there is nothing that can be done. Most of them we are able to do operations or procedures on the heart that allow the child to go ahead and grow. Sometimes the patients are – receive an operation within the first week of life and of course at any age after that. Some of the most challenging patients are the premature babies that may be only a couple of pounds and having to get them to grow to a size in which an operation is possible is something that we are in partnership with our neonatal specialists, our neonatologists, to be able to get them to that point.
Tiffany: So, speaking of the age of the patients, we hear every now and then we will hear a story on the news about a high schooler or a teenager who is an athlete, star athlete, maybe they are out on the basketball court or maybe they are playing football or volleyball or whatnot; and they pass out and it turns out that they had a heart condition, no one ever knew. No one ever diagnosed. So, what do you do in that case? What kind of situation is that, really going on?
Dr. Lau: Those also very often are conditions that patients are born with. But they may not develop until later on in life. A prime example that is hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is where the muscle of the heart is not formed properly and that puts them at higher risk for having a dangerous heart rhythm another abnormality is something called long QT syndrome. Now those are due to an abnormality that at the cellular level where the channels that bring electrolytes in and out of the cell, are not normal. And they are prone to arrhythmias or dangerous heart rhythms and cardiac arrest. They are born with that, but it may not manifest itself until later in life. And so, as part of the screening and probably the most – one of the most important questions that we ask in the screening prior to participation in athletics is the family history. What is the family history like? Is there a family history of a member who has died before 50 years-of-age suddenly? Is there a history of seizures in the family because sometimes someone diagnosed with a seizure actually has one of these abnormal rhythms? Are there suspicious accidents like someone driving their car off the road in the middle of the day when they shouldn’t have been tired or drownings? Those are things that trigger our attention to want to look further. Is there a history of fainting? Because knowing the history of fainting and looking at how it happened, when it happened, will prompt us to do further evaluation that can help us determine if it is dangerous type of fainting or fainting that is seen very often.
Tiffany: That just brings to light the importance of getting a physical and talking with a doctor before you start a rigorous athletic program.
Dr. Lau: Yes, exactly. Because unfortunately, there are not any really good methods that we have even with EKGs and with echocardiograms that will be able to screen large numbers of athletes to be able to find this.
Tiffany: Wow. So, it’s incumbent upon the parents to if their kids are going to be participating in athletics go see a doctor, get that history and screening.
Dr. Lau: Get the history and the physical exam and pay attention to those questions that are on the questionnaire, the preparticipation questionnaire.
Tiffany: Right. And then you have been heavily involved in Alabama Life Start which aims to help schools be prepared in case there is an emergency like this involving a child with a sudden heart condition.
Dr. Lau: Because we don’t have good screening, we then have to put in mechanisms that can deal with an event if that terrible event should occur. And the most effective that we have found is these automatic external defibrillators. You see them more in more and more public places in parks and in government buildings. Alabama Life Start was started to get AEDs and prepare schools in case one of these things happened. And so, as of right now, there is at least one AED in every single public high school in the state of Alabama and in most middle schools and now we are targeting getting them into all the middle schools and maybe even into the elementary schools. Part of them getting an AED, is also that they have a robust training and practice of what to do in the event of a child collapsing. And it has been successful. I continue to follow a number of children who have been saved with AEDs and it is very rewarding to see them continue to grow and to thrive even after having a cardiac arrest. So, these incidents are very, very traumatic to the whole community, to the whole school, anyone who is there and thankfully, AEDs have saved a number of children here in Alabama.
Tiffany: And so, if a school does not have an AED but say one of your patients is going to school, do you guys work with that school to see if – I mean would an AED help one of your patients that may end up having problems?
Dr. Lau: Absolutely. So, when I make a diagnosis of a patient with a potential life threatening event, like a patient who has long QT syndrome or like a patient who has hypertrophic cardiomyopathy; who has not yet had an event; one of the things I always tell the parents is check with the school, check with them every couple of years, make sure that they have looked at the AED, make sure they know where the AED is, make sure that their personnel that were trained to use the AED and know how to do CPR are still at that school. And if they are not, to get the proper authorities to make sure that the new personnel are trained on them and make sure that the AED pads are up to date. Make sure that the battery is still up to date. All those things and it probably won’t be your child that needs it but because of your diligence, you might actually save someone else’s life or an adult’s life who happens to be at the school.
Tiffany: Dr. Lau, what are some other advancements in cardiac care that have really helped patients, helped physicians like yourself?
Dr. Lau: There are advances really all over across a broad spectrum. Our surgeons continue to do innovative operations. They are constantly looking at new ways of doing things and improving it. We have very complicated hearts, some that we have never really seen before, that we are having to deal with using techniques we already have. Within the field of interventional cardiology; valves are a big part of what has advanced. Now patients no longer have to undergo an open heart operation to get a new valve in certain positions. That will get better. It will become applicable to more and more valves within the heart. Within the field of heart failure and heart transplantation; there are always new devices out to help bridge a patient as their heart fails and as they wait for a heart transplant to occur or to become available that help to sustain life and also sustain the quality of life. Patients with some of the new devices, are able to leave the hospital. So, that is something that I think is a big advance.
Tiffany: Really, you guys are doing some amazing things with lots of state of the art technology.
Dr. Lau: The smart phone has revolutionized all of our lives. And one of the programs we use is something called Airstrip which allows us to look at any child connected to a monitor within the cardiac units and also the other intensive care units in the hospital with a ten second delay. I have helped to manage patients from Europe, looking at their rhythm and seeing – and we are able to look 24 hours in the past. So, it is not uncommon that one of my colleagues in the ICU will call me up and say heh, would you look at the rhythm from 2 a.m. last night and tell us what you think.
Tiffany: Let’s talk about family-centered care and this has been a big buzz word, buzz phrase throughout hospitals in the United States; but how do we do it here at Children’s?
Dr. Lau: Family-centered care, when you look at it, is a broad experience. It comes from the beginning of when they first have contact with us, all the way to the follow-up appointments that occur. So, that we have tried in many different ways within cardiovascular medicine, to make things as frictionless as possible. Whether it be calling our office for appointments, seeing the patients in a timely manner, making sure that their experience in the office is fast and efficient. When they come for their preoperative screening; they come to a single place that they then come to again on the day of the operation and that is the same place we also use if they need additional procedures after an operation like heart catheterizations or electrophysiology studies. It is the same place that the patient has to come to if they need additional consultation with nutritionists or with the occupational therapists or physical therapists. We want the patient to come to a single place, the place that they know, the place that they are familiar with and then have our team members come to them. We have over 250 people on the team. We have dedicated social workers, dedicated chaplains, counselors, occupational therapists, speech therapists, physical therapists, the list goes on and on. And all these folks are concentrated on dealing with children with heart disease.
Tiffany: So, it’s really about that patient experience and the family’s experience as they go throughout this journey.
Dr. Lau: Exactly, and then while they are in the hospital, during this very stressful time of undergoing operations or procedures; the resources of Children’s is brought to bear to help them whether it be counselors, or physical therapists or child life folks to all come to them to make sure that they can advance as quickly as possible and get out of the hospital as quickly as possible. Our intensive care team rounds every day, goes bedside to bedside and the parents are involved in that. If the parents are there, it is not unusual as you walk through the ICU and you see the team rounding for that circle to include the parents so that the parents understand what is going on, the data that is being looked at, the plans that are being made for the day and the expectations of the day. So, family-centered care from our standpoint, is a broad, broad experience from the very beginning of their contact with us and as we watch the child grow up.
Tiffany: Very good. Well, thank you so much for joining us today Dr. Lau. We enjoyed it.
Dr. Lau: It’s been a pleasure. Thank you.
Tiffany: And happy heart month. Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics .
Heart Month Highlights Advancements in Technology & Family-Centered Care
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics. A podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski and today we are talking with Dr. Yung Lau, who is a professor at UAB, the University of Alabama at Birmingham and Director of the Division of Pediatric Cardiology. Welcome Dr. Lau.
Dr. Yung Lau, MD (Guest): Thank you. Thank you for having me.
Tiffany: So, February is Heart Month in America and here at Children’s. Maybe let’s start with the difference between congenital heart disease in children and then the heart disease that we see in older adults.
Dr. Lau: So, the fields are quite different. In adults, most of the heart diseases seen are something that is – that develops during adulthood because of lifestyle and diet and exercise and things like that. In the pediatric population, heart disease is usually a defect that they are born with. And so, those defects can show up right as they are born, sometimes they are even diagnosed before they are born as part of the prenatal evaluation with ultrasound, they see a defect in the heart, and then they will come to a cardiac high-risk appointment where cardiologists and maternal fetal specialists get together and evaluate the patients together.
Tiffany: What happens next, after the defect is discovered?
Dr. Lau: The diagnosis is made and then a plan is made for when the child is born as to what interventions will be needed. And here at Children’s of Alabama, we are very fortunate because our unit is connected with the labor and delivery rooms as well as the high-risk nursery with a 40-foot bridge. And so, in other centers, around the country, it is not uncommon to be miles away between where the baby is born and where the child needs to go in order to get cardiac care.
Tiffany: So, it makes for a very seamless transition when they may need to have some type of intervention, some type of procedure.
Dr. Lau: Yes. And in fact, we have in our most sick patients, the patients that are very – need care right away, it is not uncommon that the care is initiated in the delivery room so within 15 minutes after baby is born, sometimes they are put on a machine that they need to be on and then brought to the catheterization lab or the operating room, where a more definitive procedure can be done.
Tiffany: Are there any warning signs that a pregnant woman might have that her unborn baby might have some type of heart problem or congenital heart problem?
Dr. Lau: Those are usually found with ultrasound. Ultrasound technologists around the country know to look for certain views of the heart. And if they don’t see that, then it is referred to a center that is capable of doing the more definitive diagnosis.
Tiffany: What kind of defects are you seeing in these children? What kind of problems are they having when they come to you?
Dr. Lau: The normal heart has four chambers in it and two big blood vessels that leave it that go to the lung and to the body. Some of our children are born with three chambers instead of four. Some are born with just two chambers instead of four. There are walls of tissue that separate the chambers and sometimes there are holes in that wall. Sometimes the blood vessels that leave the heart are narrowed, sometimes the valves in those blood vessels are narrowed or they leak a lot. So, there is all variety of different heart defects. Things have really advanced in the last 50 to 60 years. Dr. John Kirkland, who the Kirkland clinic here in Birmingham is named after, was the person that perfected or made great advances in the heart lung machine in the 1940s. And then brought that down to Alabama in 1966. Operations that were very high-risk when I was a fellow 25 years ago; are now fairly routine with very good results from it. And so, there are very, very few patients that we feel as though there is nothing that can be done. Most of them we are able to do operations or procedures on the heart that allow the child to go ahead and grow. Sometimes the patients are – receive an operation within the first week of life and of course at any age after that. Some of the most challenging patients are the premature babies that may be only a couple of pounds and having to get them to grow to a size in which an operation is possible is something that we are in partnership with our neonatal specialists, our neonatologists, to be able to get them to that point.
Tiffany: So, speaking of the age of the patients, we hear every now and then we will hear a story on the news about a high schooler or a teenager who is an athlete, star athlete, maybe they are out on the basketball court or maybe they are playing football or volleyball or whatnot; and they pass out and it turns out that they had a heart condition, no one ever knew. No one ever diagnosed. So, what do you do in that case? What kind of situation is that, really going on?
Dr. Lau: Those also very often are conditions that patients are born with. But they may not develop until later on in life. A prime example that is hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is where the muscle of the heart is not formed properly and that puts them at higher risk for having a dangerous heart rhythm another abnormality is something called long QT syndrome. Now those are due to an abnormality that at the cellular level where the channels that bring electrolytes in and out of the cell, are not normal. And they are prone to arrhythmias or dangerous heart rhythms and cardiac arrest. They are born with that, but it may not manifest itself until later in life. And so, as part of the screening and probably the most – one of the most important questions that we ask in the screening prior to participation in athletics is the family history. What is the family history like? Is there a family history of a member who has died before 50 years-of-age suddenly? Is there a history of seizures in the family because sometimes someone diagnosed with a seizure actually has one of these abnormal rhythms? Are there suspicious accidents like someone driving their car off the road in the middle of the day when they shouldn’t have been tired or drownings? Those are things that trigger our attention to want to look further. Is there a history of fainting? Because knowing the history of fainting and looking at how it happened, when it happened, will prompt us to do further evaluation that can help us determine if it is dangerous type of fainting or fainting that is seen very often.
Tiffany: That just brings to light the importance of getting a physical and talking with a doctor before you start a rigorous athletic program.
Dr. Lau: Yes, exactly. Because unfortunately, there are not any really good methods that we have even with EKGs and with echocardiograms that will be able to screen large numbers of athletes to be able to find this.
Tiffany: Wow. So, it’s incumbent upon the parents to if their kids are going to be participating in athletics go see a doctor, get that history and screening.
Dr. Lau: Get the history and the physical exam and pay attention to those questions that are on the questionnaire, the preparticipation questionnaire.
Tiffany: Right. And then you have been heavily involved in Alabama Life Start which aims to help schools be prepared in case there is an emergency like this involving a child with a sudden heart condition.
Dr. Lau: Because we don’t have good screening, we then have to put in mechanisms that can deal with an event if that terrible event should occur. And the most effective that we have found is these automatic external defibrillators. You see them more in more and more public places in parks and in government buildings. Alabama Life Start was started to get AEDs and prepare schools in case one of these things happened. And so, as of right now, there is at least one AED in every single public high school in the state of Alabama and in most middle schools and now we are targeting getting them into all the middle schools and maybe even into the elementary schools. Part of them getting an AED, is also that they have a robust training and practice of what to do in the event of a child collapsing. And it has been successful. I continue to follow a number of children who have been saved with AEDs and it is very rewarding to see them continue to grow and to thrive even after having a cardiac arrest. So, these incidents are very, very traumatic to the whole community, to the whole school, anyone who is there and thankfully, AEDs have saved a number of children here in Alabama.
Tiffany: And so, if a school does not have an AED but say one of your patients is going to school, do you guys work with that school to see if – I mean would an AED help one of your patients that may end up having problems?
Dr. Lau: Absolutely. So, when I make a diagnosis of a patient with a potential life threatening event, like a patient who has long QT syndrome or like a patient who has hypertrophic cardiomyopathy; who has not yet had an event; one of the things I always tell the parents is check with the school, check with them every couple of years, make sure that they have looked at the AED, make sure they know where the AED is, make sure that their personnel that were trained to use the AED and know how to do CPR are still at that school. And if they are not, to get the proper authorities to make sure that the new personnel are trained on them and make sure that the AED pads are up to date. Make sure that the battery is still up to date. All those things and it probably won’t be your child that needs it but because of your diligence, you might actually save someone else’s life or an adult’s life who happens to be at the school.
Tiffany: Dr. Lau, what are some other advancements in cardiac care that have really helped patients, helped physicians like yourself?
Dr. Lau: There are advances really all over across a broad spectrum. Our surgeons continue to do innovative operations. They are constantly looking at new ways of doing things and improving it. We have very complicated hearts, some that we have never really seen before, that we are having to deal with using techniques we already have. Within the field of interventional cardiology; valves are a big part of what has advanced. Now patients no longer have to undergo an open heart operation to get a new valve in certain positions. That will get better. It will become applicable to more and more valves within the heart. Within the field of heart failure and heart transplantation; there are always new devices out to help bridge a patient as their heart fails and as they wait for a heart transplant to occur or to become available that help to sustain life and also sustain the quality of life. Patients with some of the new devices, are able to leave the hospital. So, that is something that I think is a big advance.
Tiffany: Really, you guys are doing some amazing things with lots of state of the art technology.
Dr. Lau: The smart phone has revolutionized all of our lives. And one of the programs we use is something called Airstrip which allows us to look at any child connected to a monitor within the cardiac units and also the other intensive care units in the hospital with a ten second delay. I have helped to manage patients from Europe, looking at their rhythm and seeing – and we are able to look 24 hours in the past. So, it is not uncommon that one of my colleagues in the ICU will call me up and say heh, would you look at the rhythm from 2 a.m. last night and tell us what you think.
Tiffany: Let’s talk about family-centered care and this has been a big buzz word, buzz phrase throughout hospitals in the United States; but how do we do it here at Children’s?
Dr. Lau: Family-centered care, when you look at it, is a broad experience. It comes from the beginning of when they first have contact with us, all the way to the follow-up appointments that occur. So, that we have tried in many different ways within cardiovascular medicine, to make things as frictionless as possible. Whether it be calling our office for appointments, seeing the patients in a timely manner, making sure that their experience in the office is fast and efficient. When they come for their preoperative screening; they come to a single place that they then come to again on the day of the operation and that is the same place we also use if they need additional procedures after an operation like heart catheterizations or electrophysiology studies. It is the same place that the patient has to come to if they need additional consultation with nutritionists or with the occupational therapists or physical therapists. We want the patient to come to a single place, the place that they know, the place that they are familiar with and then have our team members come to them. We have over 250 people on the team. We have dedicated social workers, dedicated chaplains, counselors, occupational therapists, speech therapists, physical therapists, the list goes on and on. And all these folks are concentrated on dealing with children with heart disease.
Tiffany: So, it’s really about that patient experience and the family’s experience as they go throughout this journey.
Dr. Lau: Exactly, and then while they are in the hospital, during this very stressful time of undergoing operations or procedures; the resources of Children’s is brought to bear to help them whether it be counselors, or physical therapists or child life folks to all come to them to make sure that they can advance as quickly as possible and get out of the hospital as quickly as possible. Our intensive care team rounds every day, goes bedside to bedside and the parents are involved in that. If the parents are there, it is not unusual as you walk through the ICU and you see the team rounding for that circle to include the parents so that the parents understand what is going on, the data that is being looked at, the plans that are being made for the day and the expectations of the day. So, family-centered care from our standpoint, is a broad, broad experience from the very beginning of their contact with us and as we watch the child grow up.
Tiffany: Very good. Well, thank you so much for joining us today Dr. Lau. We enjoyed it.
Dr. Lau: It’s been a pleasure. Thank you.
Tiffany: And happy heart month. Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics .