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SUNDAY, SEPTEMBER 7, 2014
HEALTH CARE
Dr. Jeremy Archer, a pediatric cardiologist at Billings Clinic, reviews the results of Amanda Langve’s fetal echocardiogram that showed her baby’s heart defect.
JAMES WOODCOCK/Billings Gazette
Billings Clinic builds team of pediatric specialists keeping families close to home By CINDY UKEN cuken@billingsgazette.com At 22 weeks pregnant, Amanda Langve’s obstetrician recommended she get a fetal echocardiogram, an ultrasound that evaluates the baby’s heart for problems before birth. There was good reason. Given Langve’s age — 36 — and the fact that her 3-year-old daughter has a ventricular septal defect, commonly known as a hole in the heart, Dr. Maureen Lucas recommended the test out of an abundance of caution. It paid dividends. The fetal echocardiogram is similar to that of a pregnancy ultrasound and is usually done during the second trimester of pregnancy. After reading the results, Dr. Dana Damron, a maternal fetal medicine specialist, diagnosed Langve’s unborn child with tetralogy of Fallot, a rare condition caused by a combination of four heart defects that are present at birth. These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and into the rest of the body. It is often diagnosed during infancy or soon after. However, it might not be detected until later in life, depending on the severity of the defects and symptoms. With early diagnosis followed by appropriate treatment, most children with tetralogy live relatively normal lives, though they will need regular medical care. Tetralogy of Fallot can be genetic, but most of the time, the cause is unknown. It’s named after the French physician Étienne-Louis-Arthur Fallot, who first described the condition in 1888. Tetralogy of Fallot occurs in about five out of every 10,000 babies and affects boys and girls equally. The four defects that make up tetralogy of Fallot are a thickening of the right ventricle of the heart, a hole in the wall that separates the lower two ventricles, a shifting in the position of the aorta, called an “overriding aorta,” and a narrowing of the pulmonary artery. It is considered one of the most common complex types of congenital heart disease. Damron referred Langve to Dr. Jeremy Archer, a pediatric cardiologist who joined Billings Clinic in August 2013, but not without first sug-
JAMES WOODCOCK/Billings Gazette
Amanda Langve, right, with her infant son, Thorin, listen as Dr. Maureen Lucas, Billings Clinic ob/gyn, and Dr. Jeremy Archer, Billings Clinic pediatric cardiologist, discuss how they worked as a team to have Thorin delivered at Billings Clinic despite his complex heart defect.
gesting that she and her husband, Seth, might need to travel out of state to Seattle, Salt Lake or Denver for the proper medical care. Archer confirmed Damron’s diagnosis. “I immediately began praying,” Langve said. Archer performed three fetal echocardiograms, each confirming that nothing had changed. He was confident that the Langve’s child could be born in Billings, specifically at Billings Clinic. “God just placed everyone together to create an amazing team that made it possible for our son to be delivered right here,” she said. Thorin Langve was born on July 13, weighing 6 pounds 2 ounces. Those responsible for helping Thorin make his debut on the world stage was a team of pediatricians, pediatric specialists, obstetricians and gynecologists that Billings Clinic has quietly, methodically and strategically building for at least a decade.
The team, their specialty and their length of service at Billings Clinic include: Archer, pediatric cardiologist, one year; Lucas, OB/ GYN, seven years; Dr. Kristen Day, pediatrician, two years; Damron, maternal fetal medicine specialist, 11 years; and Dr. Nadine Seger, neonatologist, six years. All are housed under one roof, which makes it easy to communicate, consult and collaborate. That’s not the case in all places, Archer said. “We’re incredibly blessed that we have everyone we need to take care of Thorin and they all communicate so well,” Langve said. “God has a purpose for him.” Without the team of specialists, Langve might have had to go out of state to give birth. And, without the availability of the fetal echocardiogram the heart defect likely would not have been detected until after he was born. Knowing the situation from the outset has allowed physicians to treat Thorin accordingly from the
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outset. He will likely need surgery before he turns 1. “The real value of the interdisciplinary team is in preparing Seth and Amanda for the birth and what to expect afterward,” Archer said. “The thing I am most proud of is the ability to collaborate and reach the conclusion that she could deliver at home — safely. That’s the goal.” As for Thorin, he burns energy like a coal furnace. To fatten him up, Mom feeds him a diet of breast milk, formula and a combination of both. The prognosis is excellent, according to both the mother and her doctors. “He’s doing really well,” Langve said. “We definitely expect him to be a normal little boy.” To illustrate her point, Langve points to Shaun White, the American professional snowboarder, skateboarder and two-time Olympic gold medalist. He was born with tetralogy of Fallot. She smiled at the possibilities for her own little boy.