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DIAGNOSTIC EXPERTISE
Dr Khambadkone specialises in Echocardiography and Cardiac catheterisation. ECG and echocardiography will be performed by Dr Khambadkone during the outpatient consultation and reported at the same time. These are immensely valuable in providing a quick diagnosis in most cases. Other cardiac tests such as heart rhythm monitoring may be necessary.
ECHOCARDIOGRAPHY
An echocardiogram is one of the pivotal investigations to assess the heart. Dr Khambadkone performs all the echocardiograms personally and has extensive expertise in all basic and advanced aspects of imaging using this technique. This is a simple painless test that involves the use of a small camera (probe) with some jelly to provide good lubrication and image quality, that is connected to a computer. It involves use of soundwaves (ultrasound) to assess the heart structure and function. It also looks at blood flow within the heart and in the large arteries and veins. The machine is an advanced computer with special modifications. The camera or probe is moved over the chest, abdomen and neck in order to take pictures of the heart. Â It is a painless test without entering any part of the body and gives diagnosis of a large number of conditions. It may take anywhere between 15 to 45 minutes based on the conditions detected, co-operation of the child and ease of obtaining the images (echo windows). Sometimes, babies and infants prefer to be scanned on their parent's lap.
ELECTROCARDIOGRAPHY
Electrocardiogram or ECG is a test that records the electrical activity within the heart generating a tracing on a special paper. Every part of the trace represents a specific activity in the heart and is helpful in assessing the speed of heart beat, its rhythm, and points to thickness or size of the heart chambers. They can help in diagnosing certain electrical problems within the heart such as Long QT syndrome. Stickers are placed over the chest wall and on arms and legs. Your child would need to lie still for a couple of minutes. The process is quite painless, but the removal of stickers can be sometimes uncomfortable and need attention. The tracing is available immediately and is interpreted by Dr Khambadkone.
HEART RHYTHM MONITORING
Heart rhythm monitoring involves recording of the heart rhythm for longer periods of time than an ECG. It is important to carry on with normal physical activities barring some, to increase the chances of recording an abnormal heart rhythm that occurs randomly. 24 hour Holter monitoring involves recording the heart rhythm for a day. A monitor, the size of small box is attached to a few stickers that are placed over the chest. Clear instructions are given to replace the stickers if they come off. A diary sheet is very important to record the time when symptoms occur and the success of comparing the heart rhythm with symptoms depends on meticulous recording of symptoms and time. Event recorders are used for longer recordings of heart rhythms. For 3 – 7 days, external monitors can be used. This include the ZIO patch that is stuck on to the chest and does not have any wires. Implantable recorders could be used for longer periods and require a procedure.
DIAGNOSTIC CATHETERISATION
Dr Khambadkone specialises in cardiac catheterization and interventional cardiology. It is a very specialised procedure in which a long and flexible tube called a cardiac catheter is inserted into a vein or artery in the groin, limbs or the neck to achieve access to the heart chambers, large arteries and veins close to the heart. Dr Khambadkone offers interventional treatment for a large variety of common and rare cardiac conditions that provides a one stop shop for children and their families. Cardiac catheterization performed to measure pressure and oxygen levels and assess structure and flow within the circulation are called diagnostic procedures. ​Hybrid catheterization procedures are performed with another imaging modality such as Cardiac Magnetic Resonance Imaging. This allows for measurement of flows and volumes most accurately during the pressure measurements with a catheter at the same time. These are most helpful for certain complex circulation (Univentricular heart) or severe pulmonary hypertension. Dr Khambadkone performs these procedures in a Cardiac Catheterisation Laboratory. The team involved include a cardiac anaesthetist, specialist nurses, a physiologist - expert in monitoring the child during the procedure and specialist radiographers helping with acquiring images. The child lies on a specially designed table with two large cameras that take a video of X rays. The radiation exposure is meticulously controlled and monitored by the cardiologist and the radiologist. All children having cardiac catheterization would be given Heparin, a blood thinning agent to prevent clot formation in the circulation when catheters are inserted. This is closely monitored. Angiography involves injection of a dye (radio-opaque contrast) at a rapid rate into the circulation. This mixes with the blood and highlights its flow through the heart chambers, arteries and veins. The dye can highlight holes in the heart, narrowing or leaking of heart valves, narrowing of arteries and veins or missing parts of the heart chambers, arteries or veins. After the procedure, firm pressure is applied to the site of entry through the artery or vein to stop bleeding. Rarely, this may re-start after children wake up distressed after the anaesthetic or if they cough or cry incessantly. Bruising or haematoma formation (a collection of blood or clot in tissue space) is seen occasionally but they resolve completely over time.
CHEST X-RAY
If required to assess the heart and its impact on the lungs, a chest X -ray may be required. A chest X ray involves taking a picture of the chest including the heart and lungs using radiation. It is performed by a radiographer in the X ray department. Based on age, children may need help to remain still for a few seconds for accurate imaging. Although it does not look inside the heart, the shadow caused by the heart and lungs gives important information. Certain rules apply; pregnant women should avoid radiation.
CARDIAC CT ANGIOGRAPHY
Cardiac computerized tomography with a dye (angiography) provides a detailed imaging of the heart, blood vessels, and other structures (trachea or wind-pipe, oesophagus or food- pipe) within the chest. It provides 3 D images and is an excellent tool to look at relationships of various structures within the chest. It can be done in a very short time – within minutes. When a dye is injected, a cannula needs to be inserted in the vein, that is taken out soon after the investigation. The downside is ionizing radiation (like X rays) but with advanced scanners, the dose has reduced significantly.
MAGNETIC RESONANCE IMAGING
This technique involves using magnetic radiation and radio waves to assess structure of the heart and blood vessels and more importantly to accurately measure flow within the circulation. It can measure the chamber volumes and accurately assess function. It requires specialized equipment and personnel with expertise to perform it. It also requires a dye to be injected through a cannula. The test takes a longer time (about 45 minutes) and requires certain breathing techniques that younger children cannot co-operate with. Hence general anaesthesia may be required.