A world first at the Toulouse University Hospital: a miniaturized probe to better manage heart defects in children
The Toulouse University Hospital Children’s Hospital has had a miniaturized 3D probe for the past month. It makes it possible to carry out very precise echocardiograms of the heart passing through the esophagus and to further improve the management of heart defects in small patients. Toulouse was the first site in the world to use this device.
To manage heart defects that can affect children (8 children per 1,000 births in France), a new tool is now available to teams at the Toulouse Children’s Hospital. Last September, the Toulouse University Hospital was the first site in the world to use the miniaturized 3D probe since the end of August 2022 by General Electric.
Thanks to this tool, it is now possible to perform 3D echocardiograms of the heart passing through the esophagus of small patients. Until now, due to the size of the device, this technique was reserved for adults. “Several years of development and six months of tests were necessary. This product has generated a lot of expectation because the anatomy of cardiopediatric patients is complex”, summarizes Carolina Bonilla, research and development engineer at General Electric, a company currently alone in propose this solution for children from 5 kg.
For the cardiopediatrics team, imaging has for many years been part of the essential tools for the management of heart defects. “Ultrasound has existed for forty years, the great revolution is to be able to introduce this probe into the esophagus, even on small sizes, and to see the images. In our most performed interventions, we deal with ” holes” in the heart and it is important to know the size to adjust the gesture. When we pass through the vessels (catheterization), the heart is still beating, we have to see what we are doing live, ”underlines Professor Philippe Acar, pediatric cardiologist at the Toulouse University Hospital.
“The images give the impression of being in the heart”
In the catheterization room, all eyes converge on the screen. The one used by the sonographer, Dr Khaled Hadeed, who handles the miniature probe, and the giant screen scrutinized by Dr Clément Karsenty, pediatric cardiologist, head of the pediatric cardiologist medical team, to follow his gesture to the heart of the little patient. “We are more precise during the intervention, probably faster, but above all even more confident in our gestures and our procedure. 3D does not change our working environment but, for the whole team, it is a precious help in understanding of what is going on. At first glance, you have the impression of being in the heart, of seeing everything. The quality of the image is extraordinary, we have been waiting for a very long time this development”, explains Dr Clément Karsenty.
In one month, the probe has been used for the benefit of a dozen children from the Toulouse University Hospital and will optimize the care of 400 patients, from a weight of 5 kg, who will obtain a cardiac intervention. (by surgery or by catheterization) every year in Occitania. “There are many requests to acquire this probe costing several thousand euros, adds Zacaria Zaraoui, General Electric engineer. About ten are currently in service in Europe. We are going to do what is necessary so that it can remain in Toulouse where the cardiopediatrics team is a reference for its involvement and its dynamism”. European pilot center in 2002 for the use of a 3D probe in consultation, the cardio-pediatrics teams also made the Toulouse University Hospital the first center to test the fusion 3D images (Echonavigator, Philips) in 2015.
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General Electric is also continuing its research on the development of this miniaturized 3D probe in order to assess the benefits of use in adults to reduce levels of anesthesia.
Kalista, 6, had a 2cm hole between the two atria of the heart
Six-year-old Kalista was one of the first patients to develop miniaturized 3D probe technology at the Children’s Hospital (Toulouse University Hospital). The little girl, who lives in the Aude, had an inter-auricular communication, a common congenital heart defect. “She had a 2 cm hole between the two atria of the heart that had to be closed. To be able to perform the intervention, we had to wait for it to grow. Thanks to the miniature probe, the surgeon was able to be even more precise” , summarizes his mother, Ophelia. Supported at the beginning of September by interventional catheterization (passage through the vessels to reach the heart), Kalista ultimately only missed two days of school. “She doesn’t realize anything and that’s very important. She can live like all children,” says her mother, carrying the same malformation for which she was provoked two years earlier.