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Probing Hearts In Real-Time

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PHILADELPHIA (Ivanhoe Newswire) - The crucial moments after a person has heart surgery can mean  the difference between life and death. Now, a first of its kind device is helping doctors monitor heart patients like never before.

For Vanessa Neely-Peterson, it's the little things like washing her own dishes that she doesn't take for granted anymore.

"I appreciate life. I look at life differently. I'm more humble," Vanessa told Ivanhoe.

Her son Rasheen remembers the night his mom almost died.

"She called me and fussed me out, saying why I didn't do the dishes and stuff like that," Rasheen Neely-Peterson said.

Soon after, Vanessa had a massive heart attack.

"Twenty doctors for five minutes a-piece pumped my heart so the blood would go to my brain," Vanessa said.

 After bypass surgery, doctors used a first of its kind device to monitor Vanessa's cardiac function right at the bedside, without an echo-cardiogram.

"This now really allows us a minute-to-minute evaluation of the patient as we change medical management," Dr. Nicholas Cavarocchi, M.D., Director of Surgical Intensive Care at Thomas Jefferson University Hospital said.

The hTee probe allows doctors to watch in real-time the heart's pumping function and volume, helping them decide whether to add or subtract IV medications in an instant. The monitor can be used on patients for up to 72 hours.

"So with the probe we were able to differentiate reasons for her low cardiac output syndrome, avoid a return trip to the operating room," Dr. Cavarocchi said.

"I'm so thankful that I have a second chance with my mom," Rasheen said.

A chance this family is happy to take advantage of.

The monitor can be used on patients for up to 72 hours. The doctor said it's changing how he practices medicine because it helps him make safer, more informed decisions when it comes to patient care.

RESEARCH SUMMARY

BACKGROUND: A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. If blood flow isn't restored quickly, the section of heart muscle begins to die. Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis, and the buildup of plaque occurs over many years. Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems. (Source: www.nhlbi.nih.gov)

SIGNS: The warning signs and symptoms of a heart attack aren't the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or very mild symptoms are called silent heart attacks. The most common heart attack symptom is chest pain or discomfort. This includes new chest pain or discomfort or a change in the pattern of existing chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. (Source: www.nhlbi.nih.gov)

NEW TECHNOLOGY: A new device is allowing surgeons at Thomas Jefferson University Hospital to view in real time the movement of blood and the amount of pressure in the veins, arteries and chambers of the heart and react quickly to any hemodynamic instabilities (compromised blood movement). The specialized probe, a hemodynamic transesophageal echocardiography (hTEE) device, is inserted into the patient's esophagus to visualize the cardiac chambers and allow for hemodynamic management—the continuous monitoring of the movement of blood and pressure in the veins, arteries and chambers of heart—for up to 72 hours. The probe captures images and sends them to a screen in the patient's room to monitor his or her response to fluid interventions and to help determine or re-direct the best course of treatment over an extended period of time. (Source: http://www.jeffersonhospital.org)

INTERVIEW

Nicholas Cavarocchi, M.D., Professor of Cardiothoracic Surgery and Director of the Cardiac Intensive Care Unit at Thomas Jefferson University Hospital, talks about a new device that is helping doctors monitor heart patients like never before.

Is this the first time you are able to monitor cardiac function right by the bedside?

Dr. Cavarocchi: We are able with this new probe, which is called the hemodynamic transesophageal echocardiogram, to monitor cardiac function instantaneously. The easier name would be HTEE probe, or the name of the company which is ImaCor. They make this device that is a disposable TEE probe that can be used at the bedside for minute to minute monitoring of cardiac function.

How did they have to do this before this probe came into effect?

Dr. Cavarocchi: Before this was the conventional echocardiogram which is done either on the surface of the chest or down through the esophagus. It is done by a technician or a staff attending to look at the function of the heart; that requires time, personnel, and people to come in after hours to do that procedure.

What is the advantage?

Dr. Cavarocchi: The machine is here in the intensive care unit, we can use it 24/7. It is a method that has been able to be taught to residents as well as staff physicians to do it and to get useful information.

Can you talk about Vanessa?

Dr. Cavarocchi: She has a very special case. She came in and had a massive heart attack, had a cardiac arrest in the catheterization lab and was placed on full ECMO support to resuscitate her, after which she went to the operating room. When she returned from the operating room, she had a low cardiac output syndrome and it was unclear of what that was about. With the probe we were able to differentiate reasons for her low cardiac output syndrome, avoid a return trip to the operating room, and to manage her with medical management.

Were you able to use it in another way when she first came in?

Dr. Cavarocchi: When she first came in we had placed her on full ECMO support and we were able to evaluate her heart function as her blood pressure and vital signs were maintained. We were able to have a better evaluation of her cardiac function in real-time.

How else can we use the Htee probe?

Dr. Cavarocchi: The machine has multiple uses. Here in the cardiac ICU, we use it for post open heart patients to manage their minute to minute management after surgery. We use it for ventricular assist device patients and the management of the devices, and we use it also for the management of patients on ECMO support. Particularly, it has become very useful in people on ECMO support, so we have been able to figure out when the best time to wean them off the support to get them back to medical management.

Can it catch any human mistakes?

Dr. Cavarocchi: Our traditional ways of monitoring patients after surgery have involved the use of monitoring pressures of the heart, whether it is a central line or a Swan-Ganz catheter; those are good monitoring devices, but they give you reflected information. This has allowed us to monitor their heart directly and to watch and to observe when we make changes exactly what it does to the heart muscle and its function. It augments about data and clinical evaluation at the bedside in real-time.
 

FOR MORE INFORMATION, PLEASE CONTACT:

Lee-Ann Landis
Media Relations
Thomas Jefferson University Hospital
(215) 955-2240

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