Patrick D. Coon, RCCS, RDCS, FASE

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  Congenital heart disease (CHD) affects about 1% of live births, or about 40,000 babies, each year in the United States of America.

  
  
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  Twenty-five percent of the 40,000 patients afflicted with CHD have a “critical” defect.

  
  
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  Between one and two million people are living today with some type of CHD.

  
  
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  CHD is the leading cause of defect related infantile death.

  
  
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  About 97% of infants born with non-critical CHD are expected to live to adulthood.

  
  
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  About 69% of infants born with critical CHD are expected to survive to age 18.

  
  
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  Survival rates for infants born with CHD are improving.

  
  
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  Hospital costs associated with medical care adjusted to 2011 dollars are approximately $1.8 billion.

  
  
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  http://www.cdc.gov/ncbddd/heartdefects/data.html

One of the overlooked areas within cardiac sonography, in my opinion, has been congenital heart disease. While there have been registries for pediatric-specific cardiac imaging, these registries tended to be focused primarily, if not entirely, on pediatric and not congenital heart disease. The distinction between the two may not be clear at first. However, the need to obtain the skills to satisfactorily image the newborn patient with cyanosis is markedly different from the imaging of the 28-year-old patient with repaired tetralogy of Fallot who is in her thirty-first week of pregnancy. As such, I have always drawn the distinction between pediatric and congenital imaging. In addition, patients with CHD are facing better survival rates and are reaching adulthood only to face repaired and unrepaired CHD along with adult, rather than pediatric, medical issues. This is a reality many hearts centers and patients are beginning to face. Therefore, does the adult patient with CHD rely on care from a pediatric center with little experience in other, noncardiac related adult medical issues or do they rely on the adult centers with training that is not concentrated on CHD but with a vast array of knowledge to deal with the adult medical issues? This is the reason we are beginning to see many combined programs between adult and pediatric centers as more and more Adult Congenital Heart Disease centers begin to flourish. The next obvious question is this: how do we ensure the sonographers who image these patients are adequately able to provide the skilled assessment of these patients?

For the last five years, I have been very fortunate to be a subject matter expert volunteer involved with Cardiovascular Credentialing International (CCI) and its development and administration of a certification examination for professionals working in the area of congenital cardiac ultrasound. The RCCS (Registered Congenital Cardiac Sonographer) credential focuses on CHD (as opposed to strictly pediatric heart disease) and incorporates both the infant and adult. In the fall of 2015, the RCCS Exam Committee met in Denver as we sought to broaden the way the test items are presented. Rather than simply ask questions and have the test-taker choose from multiple-choice answer options, we are now able to utilize newer, more realistic and clinically relevant questions. For example, the exam will now incorporate multiple response questions where test-takers will be required to select a specific number of responses to a question. Another type of question incorporates hot-spot functionality and requires the candidate to identify the most appropriate location on an image. For example, “Click on the coarctation on this image of a patient with hypertension.” After leaving the meeting, I feel that the new item types we added will make for a much more relevant examination for the test-taker. CHD imaging tests tend to lend themselves to this new format simply because the subject matter isn’t always simply a matter of black and white but rather, shades of gray.

Over the past year, I have been asked many times about the need for an adult congenital heart disease registry along with resources to ensure we will be able to provide competent and appropriate care for this expanding segment of our patient population. Care for the infant with CHD continues to improve and as such, we will begin to see more and more adults with CHD in our daily practice. The RCCS exam is an excellent method to show our colleagues and our patients that we are not only competent in this field, but also that we are the leaders and experts in the field of imaging this complex, yet rewarding group of cardiac patients.

Scan on!

Patrick D. Coon, RCCS, RDCS, FASE is currently the charge sonographer at the Gagnon Cardiovascular Institute, Morristown Medical Center, Atlantic Health Systems in Morristown, New Jersey.