Inside Lurie Children's Cath Lab with Dr. Conor O'Halloran

Many patients and families may be unfamiliar with what happens inside the cardiac catheterization (cath) lab at Lurie Children’s and the specialized procedures performed there. In this episode of Precision, Dr. Conor O’Halloran, a pediatric cardiologist at Lurie Children's who specializes in catheter-based procedures, offers a detailed explanation of what to expect during a cath lab procedure, the innovations in technology enhancing patient care, and Lurie Children's collaborative approach with cardiac care teams. 

Show Notes

• Dr. O’Halloran’s passion for combining scientific rigor with meaningful, long-term patient relationships led him to specialize in pediatric interventional cardiology. 
• The cath lab at Lurie Children’s treats newborns to adults living with congenital heart disease with minimally invasive tools to evaluate and treat their conditions. 
• The lab includes cardiologists, nurses, anesthesiologists, and technicians - all focused on safety, precision, and collaborative care to support children and families. 
• Contributing to surgical planning and sometimes replacing the need for open-heart surgery, the cath lab often co-manages long-term care in collaboration with surgical colleagues. 
• The welcoming and attentive staff walk families through details prior to the procedure and give real-time updates during interventions.  
• The team frequently performs diagnostic studies, closes abnormal heart connections, opens narrowed blood vessels, and is able to replace more pulmonary valves today than it did 10 years ago due to advancement in technology. 
• The lab works closely with their imaging colleagues to use cross-sectional imaging from CT scans and MRIs to precisely plan ahead of time for safer procedures that use less radiation.  
• The cath team is actively engaged in research, including national trials and work on rare conditions like pulmonary vein stenosis - efforts that directly shape and improve bedside care. 
• The team performs over 1,000 procedures annually, approaching each with great care and expertise.  
• Looking to the future, Dr. O’Halloran is interested in seeing the development of  using imaging tests like MRIs to help plan the procedures ahead of time.

Transcript

[00:00:00] Erin Spain, MS: This is Precision Perspectives on Children's Surgery from Ann & Robert H. Lurie Children's Hospital of Chicago. I'm your host, Erin Spain. On this podcast, we introduce you to surgeons at one of the country's most renowned children's hospitals to find out how they are transforming pediatric medicine. Today we're taking you into one of the most critical and innovative areas of pediatric heart care, the cardiac catheterization lab. Here at Lurie Children's the cath lab is where babies, just hours old, children with congenital heart disease, and sometimes adults with structural heart disease receive minimally invasive, often lifesaving procedures that compliment or even replace heart surgery. Joining me today is Dr. Connor O'Halloran,, a pediatric cardiologist at Lurie Children's who specializes in catheter-based procedures to diagnose and treat heart conditions and his patients. He's part of a nationally recognized team performing more than 1000 such procedures each year. I welcome him to the show today to talk about the care and expertise this team provides and what parents and loved ones need to know about the cath lab while navigating a new or ongoing heart diagnosis for their child. Welcome to the show. 

[00:01:25] Dr. Conor O' Halloran: Thanks. I'm really happy to. 

[00:01:26] Erin Spain, MS: Well, wonderful to have you here. I'd like to start off by you telling me a little bit about your background and your path to pediatric cardiology and Lurie Children's. What made you want to specialize in cardiology and interventional cardiology specifically? 

[00:01:40] Dr. Conor O' Halloran: Yeah, I think many people in the medical field, it's not like I went to medical school knowing that I wanted to do pediatric interventional cardiology. So it really was sort of an iterative process of learning more about different fields as I progressed through my training. But I think in the end, what really attracted me to pediatric cardiology and pediatric interventional cardiology. Is the Sort of a unique blend of the human connection and the scientific thinking that you get in these fields. In pediatric cardiology, we really have the opportunity to develop really long-term, often lifelong relationships with our patients throughout childhood and into adulthood and so that human connection is really special. But at the same time, it's a field that's very quantitative and scientific and getting to sort of blend those two aspects is one of the parts that's really special for me about pediatric cardiology. 

[00:02:21] Erin Spain, MS: For a lot of people, even folks who work at Lurie Children's, parents and patients, the cath lab is sort of this mysterious place. It's a very specialized place within Lurie Children's. Explain the Cath lab to me and how do you explain it to families? 

[00:02:35] Dr. Conor O' Halloran: You're right that we're kind of this mysterious place that people might not have so much exposure to or experience working with. So at a really basic level the cath lab is a place where we evaluate and treat the heart sort of from the inside. The way we do this is we access the major blood vessels that lead to the heart, either the veins or the arteries most commonly in the leg, but sometimes in other places as well. And then, through those access sites, we can pass catheters, which are specially designed small tubes. And those can be passed in different chambers of the heart and the surrounding blood vessels. And with that, we can measure pressures and oxygen saturations, and then do some fancy calculations to better understand how the heart's performing. Another big part of a catheterization is injecting dye or contrast inside the heart of the blood vessels. And then we use our x-ray cameras during the procedure to better define those structures and again, sort of, develop a better understanding of how the heart's performing and any issues that might need to be addressed. And then finally, and probably most importantly, we can perform a number of structural interventions inside the heart or in the surrounding structures like the blood vessels around the heart. And, you know, we'll talk more about specific interventions, I'm sure, later in the podcast. But in general some of the things that we would do would be to close holes that shouldn't be there. So some patients are born with holes in their heart that need to be closed. Some patients don't have holes in places that they're supposed to be holes. So we sometimes create holes. And then a big part of what we do is to work with the blood vessels around the heart. So sometimes those can be narrowed for a variety of reasons, and so we can have different tools that we can use to open up narrowed blood vessels. And then we do a fair bit of work on heart valves. Most commonly the pulmonary valve where we can either open it up if it's narrowed, or sometimes if the valve is leaky, we can place a new heart valve inside the existing heart valve. So that's just sort of like a taste of what we do, obviously there's a lot of different procedures that are performed in the cath lab, but sort of the common elements are that we work on the heart from the inside, accessing through those major blood vessels. 

[00:04:16] Erin Spain, MS: And people come to Lurie Children's four procedures in the cath lab from all over the region, even all over the country. 

[00:04:23] Dr. Conor O' Halloran: Fortunately congenital heart disease in children although it's the most common congenital malformation that children experience, it's not all that common when in comparison to sort of adult heart disease. And for that reason interventional cardiology is like a very subspecialized field with a relatively small number of cath labs performing these procedures. I think the cath lab is a big team at Lurie Children's, there's four physicians, including myself in addition to a larger team of nurses and cath lab technicians as well as our cardiac anesthesia team. In thinking about sort of what sets us apart one of the things that I'm most proud of, of our team is sort of our cohesive workflow. We have a big team and we work really hard to make sure that anyone coming to our cath lab is benefiting from the collective experience and expertise of our entire team. We also are really committed to being as rigorous and as safe as possible in the cath lab. We realize that it's a big commitment or a big responsibility that families are entrusting us with to take care of their children. So we take that responsibility really seriously. Certainly we do things that are, you know, cutting edge or that might not be offered at other programs. But even in those, sort of more advanced or cutting edge procedures. Again, the focus is really about safety and trying to do these procedures as safely as possible by the way that we perform the procedures, but also by the way that we prepare for the procedures ahead of time. 

[00:05:30] Erin Spain, MS: You mentioned that some of these patients can be very young. Tell me about some of the youngest patients that you are able to care for in the cath lab. 

[00:05:38] Dr. Conor O' Halloran: One of the interesting things about the cath lab is that we really do take care of this full spectrum of age. It would be not uncommon at all for us to be performing procedures on newborn babies, including on their first day of life. Rarely some patients need interventions like immediately after delivery, and they might even come straight to the cath lab after delivery. But outside of that, we also take care of children in their first month of life, first year of life, but all the way up to adults that were born with congenital heart disease, but then need care later in life. 

[00:06:02] Erin Spain, MS: Yeah, tell me more about that. Do you really have 20, 30, 40 year olds coming in? 

[00:06:06] Dr. Conor O' Halloran: Yeah. You know, fortunately with advances in both things that we do in the cath lab and surgical care and ICU care, more and more kids that are born with congenital heart disease are living longer and growing up to be adults that have congenital heart disease. And so those patients still need care. And so we do a lot of procedures for adult aged patients. We do some of those procedures at our cath lab at Lurie Children's, and then we collaborate really closely with the team at Northwestern Memorial Hospital and we'll go over and do some combined procedures with the adult interventional team for some patients that are maybe even a little older. 

[00:06:35] Erin Spain, MS: Okay, so have you personally seen some of your patients transition from that pediatric to adult care and go back and forth? 

[00:06:43] Dr. Conor O' Halloran: Yeah absolutely. Having that close collaborative relationship with Northwestern is really important. 'Cause again, that's the goal. The goal is that we have children with congenital heart disease and we want them to be transitioning to the adult hospital 'cause we want them to be doing well when they get to that age and being able to transition to the adult hospital and then working with the team there. 

[00:06:58] Erin Spain, MS: From the moment that the family walks through the doors at Lurie Children's until they leave, can you just walk us through that process and what it looks like for the family and the child. 

[00:07:08] Dr. Conor O' Halloran: the cath labs on the fifth floor of Lurie Children's downtown. So families come in and they check in. Then we have like a pre-procedural room where they'll be, you know, put into a gown to get their vital signs and an ECG and things like that, and have an opportunity to meet myself and the rest of the cardiac catheterization team. The nurses and the cardiac anesthesia team. Once we've had a chance to talk and everyone sort of understands what we're doing and why we're doing it then the patient gets brought back to the procedure room. Generally, for most kids, they might be a little nervous about coming back to have a procedure. So many of them receive what's called a pre-medication, where they get a little bit of medicine that they take by mouth, just like you might give a child Tylenol at home, but they take that little bit of medicine by mouth so that they can be a little bit more calm and not be anxious when they're rolling back to start the procedure. For the vast majority of procedures, particularly in smaller kids, the patient is then put completely asleep just like they would be for a surgery where they're put to sleep and have a breathing tube placed for the procedure. And then once that's all done, then I start my procedure. What the room looks like is that it looks basically like an operating room. If you were to look at it from the outside, you know, there's obviously the table or bed that the patient lays on. But the difference between the cath lab and an operating room is that the cath lab has x-ray cameras, which we call fluoroscopy. So two cameras to look at, at any moment, we can look at things from two different angles, and that allows me to work inside the heart without opening the chest or being able to physically look at the heart. I look at the heart using the x-ray cameras. Then the way the procedure works is that I put a sheath, which is like a fancy IV into the vein and or the artery, most commonly of the leg, but could be of different sites. And that again is like a fancy iv, but it has a diaphragm. The diaphragm allows me to pass other equipment into the blood vessel and therefore up into the heart. But it prevents any blood from coming out. So it's like a very basic but important tool for doing my job. The procedure then is extremely variable in terms of what we're doing, but generally we're passing catheters, which are specially designed tubes into different parts of the heart to either measure pressures, take pictures, and then perform interventions. When we're done with the procedure, sometimes there's something left in the heart, like of course, if we're closing a hole, there might be a device left in the heart. Sometimes there's nothing left if we're just, you know, opening up a blood vessel with a balloon or if we're just getting diagnostic information. But then generally, all the rest of the equipment, aside from maybe the device that's left in the heart on purpose, all the rest of the equipment is taken out and the sheath of that fancy IV comes out of the leg. And so when a family sees their child after the procedure, they'll basically look the same as it did before the procedure. There's nothing different about the chest or anything like that. You can't see anything different when you look at them from the outside. They'll just have a bandaid on their leg if that's the site that we accessed or on their neck or their arm if we use that site. And then recovery from the cath lab, again, depends on what the patient was like before the procedure, but presuming the patient came in from home, from an outpatient setting they have to lay flat for a few hours, but then after a few hours they can be up walking around and really feeling pretty back to normal by the next day. 

[00:09:47] Erin Spain, MS: The Heart Center at Lurie Children's is really renowned. Just talk about how the Cath Lab fits into the Heart Center and the Cardiac Surgery Program at Lurie Children's, and how you collaborate with all these colleagues at the Heart Center to give your patients the very best care. 

[00:10:01] Dr. Conor O' Halloran: The Heart Center is a you know, I mentioned the Cath Lab is a pretty big team, but the Heart Center is an even bigger team and the cath lab is of course an important part of the larger heart center. Working as part of the larger heart center is one of the things that I really enjoy about my job. It's a really collaborative atmosphere and you get the chance to work with subspecialists in different parts of cardiology, like cardiac surgery or cardiac imaging or the ICU teams. So that's a really great part of my job. I think obviously this is a very broad question, but the cath lab I think can be categorized into sort of three different ways that it might fit into like the larger heart center or specifically the cardiac surgical program. So the first is sort of the most straightforward, which is that some patients who are going to receive a heart surgery need to come to the cath lab just to get diagnostic information before the upcoming heart surgery. So again, to measure those pressures and saturations and maybe take some pictures to better understand how the heart's performing, and make sure that we're performing the right surgery at the right time. So that's sort of the first category that we might be involved in. The second sort of category is where we're sort of replacing heart surgery. So, this is a very exciting part of our job. There are a number of different relatively simple heart defects, like a hole in the heart, such as an atrial septal defect, where previously there would've had to be an open heart surgery to repair that defect. And now more and more we can close those in the cath lab without requiring open heart surgery. So that's sort of the second category. And of course that's always a collaboration because it's not always totally black and white. And so both surgery and a cath lab approach might be options. And so we often have sort of discussions with the surgical team about which might be best for a particular patient. And then the final category is our third category is taking care of our most complicated patients. In contrast to the prior example where somebody might just have a single issue or a hole in the heart that needs to be addressed. Some of our patients have more complicated heart disease that requires more ongoing lifelong care. And in those patients, we work really closely with our surgical colleagues to develop sort of a comprehensive plan, not just to address the current state or the current problem, but sort of a lifelong plan for those patients of trying to use both surgery and the cath lab to sort of optimize our care for the patient over the long term. 

[00:11:55] Erin Spain, MS: I know that no two procedures are the same, but for family members and patients who are about to have an appointment in the cath lab? What can they expect before, during, and after the procedure? 

[00:12:08] Dr. Conor O' Halloran: You're exactly right that no two procedures are exactly the same. And what the catheterization procedure looks like from the patient or family's perspective has a lot to do with what the patient statuses before coming to the cath lab. So we do a lot of procedures as an outpatient, meaning a patient comes from home, has a cath lab procedure, even an interventional procedure where we're closing a hole or something like that and might go home on the same day. So in terms of the actual recovery from the catheterization procedure, it can be very quick, particularly if the patient is coming in a healthy state. In contrast to that, we also do some procedures in patients that are really sick, that are already in the intensive care unit either before or after surgery. And so of course, the experience for those patients and families is gonna be a little bit different. You know, we're. Generally doing a catheterization to improve things so that the patient gets healthier over time but we would expect that immediately after the procedure that they might still need that high level of care. What it looks like really, again, depends a lot on what the patient's status is going into the procedure, but in general, a common element is that we try to be really transparent with families in our communication before the procedure. Make sure that they really understand why we're doing the procedure, what we're hoping to accomplish, what the risks of the procedure are. During the procedure, families get updates from our nurse practitioner team about how the procedure's going. And then of course, afterwards it's often a little bit of an involved conversation to explain what we found, what we were able to do, and what this means for the child moving forward. That process is basically the same no matter what type of patient or procedure we're doing. 

[00:13:26] Erin Spain, MS: And again, at Lurie Children's, everything is around the care of that child and the specialized pediatric care. So you have a lot of colleagues too who are in contact with the families throughout the procedure and they have the child life specialists. There's like a whole team that's supporting the family on the day of the procedure. Is that right? 

[00:13:43] Dr. Conor O' Halloran: Yeah, absolutely. That's honestly one of the most common questions that I'll get from a family is sort of like, what is that process gonna be like for the child leading into the procedure? And you're exactly right, that a combination of our anesthesia team and our child life team and then of course our cath lab, nursing team they do a really nice job of making that transition into the procedure as smooth as possible. And of course we have some sort of medical tricks, but also some behavioral tricks to try to alleviate any stress that the child might be having and make it as smooth of a transition as possible. 

[00:14:11] Erin Spain, MS: Now, you've mentioned a number of procedures already that take place in the cath lab, but what are some of the most common procedures you perform? 

[00:14:19] Dr. Conor O' Halloran: One of the things that I love about my job is that every case is completely different. Every child, even if they have, you know, on paper the same form of congenital heart disease, every child, everyone's heart is just slightly different. And so really every procedure is a custom job. There's no two procedures that are exactly the same, but in terms of sort of lumping them together in terms of categories of procedures. One of the more common ones would be just a diagnostic catheterization, again, where we're just measuring pressures and saturation data and maybe taking some pictures to understand how the heart's performing. In terms of interventions, some of our most common ones would be to close abnormal connections that exist. So a common example would be a patent ductus arteriosus which is an abnormal connection between the aorta and the pulmonary artery. This connection is needed before a baby is born. And so everyone is born with it, but it's supposed to close on its own, but sometimes in some kids, it doesn't close on its own. And then when that happens, that can cause problems both for the heart and for the lungs. And so this is a really common procedure that we're asked to do to close off that connection again, to improve the function of both the heart and the lungs. We do a number of other procedures that are similar to that. So another example would be an atrial septal defect, which is a hole within the heart itself. Which we can close with a device in the cath lab using echocardiographic guidance. And then we do a lot of procedures for narrowed blood vessels. Most commonly in the lung arteries, the pulmonary arteries that supply blood to the lungs, those can become narrowed for a variety of different reasons. And similarly, there can be narrowing in the aorta, which carries blood to the body. And so we have a number of tools in the cath lab that we can use to open up those narrowed blood vessels to improve, the function of the heart that has to, you know, pump through those narrowed blood vessels, but also, you know, the function of the body that's receiving blood from the aorta or the function of the lungs that are receiving blood from the pulmonary arteries. So that's a very common type of procedure for us. And then more and more a procedure that's becoming a bigger part of what we're doing is our more common procedure is to replace dysfunctional heart valves. And so the most common heart valve position that we do this for is the pulmonary valve. For a variety of different reasons, patients can have dysfunctional heart valves where the pulmonary valve is either narrowed, meaning it's hard for blood to get out of the heart, or it can be leaky where blood you know, exits the heart but then leaks back in. We have a number of different tools available to replace those valves so that the valves open fully and let blood out, but then also close to prevent blood from going backwards. We do a number of different procedures and even among the ones that I just listed there are many different variations on that type of procedure, but that gives you a little bit of a flavor for the type of thing that we do in the cath lab. 

[00:16:33] Erin Spain, MS: You just mentioned a lot of different tools that are in your kit here that you can use and the pace of progress and the new innovations coming out. It's just so fast. And in recent decades, like you said, there's just so many more tools in your kit. Can you share some of the latest innovations that are helping you provide exceptional care in the cath lab? 

[00:16:52] Dr. Conor O' Halloran: Yeah, absolutely. The interventional cardiology or the cath lab is a very technologically based field even at a very basic level, we're using X-ray cameras to see what we're doing. You know, we're not directly visualizing everything. Even x-ray camera technology or fluoroscopy technology has evolved over time to achieve better imaging and use less radiation. At a very basic level, everything we do is based on the technology that's available. Sort of zooming out or backing up in the past few decades some of the big advancements have been more devices have become available. So I mentioned atrial septal defect closure. So that's again, a very common procedure and the number of devices that are available and the quality of those devices have increased and improved over time, such that more and more atrial septal defects can be closed in the cath lab. Of course there are still some that based on their size or shape or where they're located they might still need a surgery. But as we get more and better devices, more and more of them can be closed in the cath lab. Along the same lines I mentioned pulmonary valve replacement. Similarly, even 10 years ago with the tools that we had available, we were only able to treat a very small number of people in that population, a very small percentage of people that needed a pulmonary valve replacement could have it in the cath lab. But in recent years, really in the last decade, we've had kind of an explosion in the number of available valves for that application that have allowed us to treat more and more of those patients. So again, some patients still need a heart surgery to replace that pulmonary valve, but more and more of them are able to be done in the cath lab again, because of the availability of that technology. So those are sort of like historical innovations. In terms of current things that we're excited about. We're working really closely with our imaging colleagues to be able to perform procedures safer and to use less radiation. So we're doing a lot of things with pre-existing imaging, like cross-sectional imaging, using CT scans or MRIs to really precisely plan our procedure ahead of time. Again, have a really precise plan going into the procedure and therefore do the procedure more safely and more quickly. And then we're also working really closely with our echocardiography colleagues to use more and more echocardiography in the cath lab, which again, cuts down on radiation that we have to use and just allows us to perform the procedures often in a more effective way. 

[00:18:49] Erin Spain, MS: You've said several times trying to minimize radiation and contrast dye is important. Why is that important? Especially in pediatric care. 

[00:18:56] Dr. Conor O' Halloran: Radiation is obviously an important consideration. We always try to minimize the amount of radiation that patients are exposed to. This is particularly important in patients that are gonna need multiple procedures. Patients with the most complex forms of heart disease that might need multiple catheterizations in their life. So there's a lot of things that we do to try to minimize the amount of radiation that patients receive. Of course, it's always a balancing act. We wanna first and foremost do the procedure safely, and there's some amount of radiation that's needed to do the procedure safely, but there's a lot of things that we can do to minimize that risk. A lot of that honestly comes down to the equipment. So obviously the recent upgrade we had in our cameras, we have a new fluoroscopy or x-ray video system in our labs, which just by itself really minimizes the amount of radiation that the patient receives. We also do some more innovative things with our imaging colleagues, with using imaging that we already have to be able to plan the procedures. Therefore, we have to spend less time on fluoroscopy or take less angiograms during the procedure. And then also using echo guidance in the cath lab can reduce the amount of fluoroscopy that's needed. So really a lot of different ways that we can use various technologies to minimize the amount of radiation that a patient experiences. 

[00:19:54] Erin Spain, MS: And again, if you're able to avoid an open heart surgery, what does that mean for the small patient and their family? 

[00:20:51] Dr. Conor O' Halloran: From a purely sort of outsider perspective, being able to avoid an open heart surgery just seems intrinsically to be a good thing that families are generally interested in doing. What I always tell families, because often I'm having discussions with families that are weighing options between surgery and having a procedure in the cath lab that even though cardiac surgery seems unbelievable that's something that we do and that patients do well afterwards. Most of the procedures that are done in the cardiac or are extremely safe and effective. So it's not like I view cardiac surgery as this thing that needs to be avoided at all costs. And very often that is the right decision for families. That said, the main benefit of a procedure that can be done in the cath lab compared to the operating room is the speed of recovery afterwards. So as I mentioned, the procedures are performed through access sites in the legs. most commonly, but sometimes in other sites like the neck or the arm. But there's really no cutting or sewing. There's no opening of the chest, so there's just a lot less recovery from the injury of the procedure itself. The other thing that's important is particularly for our patients that have more complex heart disease that might need multiple procedures and surgeries in their life, is that every time you do an open heart surgery, there's some scarring that forms around the heart. So if we can minimize those number of surgeries, we make it easier for the surgeons to do their job when a surgery is eventually needed. Those are some of the main reasons why catheterization procedures can sometimes be important or a good option for patients. 

[00:21:13] Erin Spain, MS: You have patients of all ages from newborn to adults, but the program is also going to start offering options for fetal surgery. Can you talk to me about that? 

[00:21:23] Dr. Conor O' Halloran: All congenital heart disease, all babies that are born with a problem with the heart basically starts in fetal life. And in certain circumstances we know that there's like a predictable sequence of how the heart disease develops in fetal life. And so that presents an opportunity where in some cases If we were able to intervene in fetal life, we might change the trajectory of that heart disease. One of my colleagues, Dr. Alan Nugent, is working with the Chicago Institute for Fetal Health at Lurie Children's to be able to offer these fetal cardiac procedures to again, that small subset of patients that will need that type of procedure.And so, this is a really exciting and innovative area. It is a very small area, so again. Even though all congenital heart disease has its origins and fetal life, it's only really a small subset that are gonna be eligible for that type of fetal interventional procedure. So we're really excited to be able to offer that procedure and I think it will be incredibly impactful for the patients that we're able to treat. But it will be a relatively small number of patients. 

[00:22:16] Erin Spain, MS: Yeah. Very few centers around the country offer that type of care, but this is something that Lurie Children's and the Heart Center is committed to kind of being on the cutting edge, not only of what procedures you offer, but research as well in interventional cardiology. Can you talk to me about that, about research in this area, the research that you do, and how this research impacts the care that you're able to provide at the bedside? 

[00:22:39] Dr. Conor O' Halloran: Obviously our primary focus is often taking care of the patient in front of us, but we also realize that by better understanding the disease processes and by better understanding the procedures and developing new options for patients that we can over time take even better care of patients. The cath lab, myself personally and the rest of the cath lab, are involved in a number of different sorts of research endeavors. One area that's been particularly active recently that I've mentioned a couple other times is our collaboration with the imaging team. And I think that's really a strength of our program. And so we've had a number of research initiatives about cath lab and imaging collaboration. Again, to try to understand how we can use different imaging modalities to perform the procedures more effectively. Safely and using less radiation. So that's an area of research, not a specific project, but just a group of projects that are all sort of focused on a similar thing. Another area that comes to mind is a specific disease process that we haven't really talked about yet, which is called pulmonary vein stenosis. This is narrowing in the pulmonary veins, which drain blood back to the heart that's coming back from the lungs. This is a relatively uncommon but extremely morbid condition that really can affect the quality and duration of a patient's life. And until recently, it was sort of thought to be a universally fatal disease and there wasn't really much that you could do about it. But over the last couple of decades, a few centers around the country have really started to take on this disease and really made some substantial strides in improving outcomes for this patient population. And our center is one of those centers. We're doing a number of different projects to try to better characterizes disease process, understand how our interventions are affecting these patients, and really trying to move the needle on this patient population, which really is in need of this because again, it's a relatively uncommon and poorly understood disease that we're really trying to get on top of. 

[00:24:11] Erin Spain, MS: That offers a lot of hope for families too to hear that type of work is taking place. 

[00:24:15] Dr. Conor O' Halloran: Yeah, absolutely. I think we view it as sort of a responsibility that we have when we have particular experience or expertise to try to share that with the larger community so that again, sort of collectively we can move the field forward. The other area that I'll mention is that we're involved in a number of national or international trials working with industry to bring new devices or technologies to market basically again, to be able to develop these technologies so that we can help more patients. One example that I'll just mention is a national trial evaluating the effect of PDA closure in the smallest premature babies. I mentioned PDA closures before, and we do them in all different sizes, but a common age group would be the premature babies that are in the neonatal intensive care unit. And we're part of the national trial, which is looking to understand how that intervention affects the child after the procedure and how it affects their lung health in the long term. That's just sort of one example of a project that involves not just our hospital, but hospitals across the nation. 

[00:25:05] Erin Spain, MS: What advice would you have for parents who are anxious about their child needing a cath procedure? 

[00:25:15] Dr. Conor O' Halloran: I have a 16 month old daughter myself. And since she was born, I have stopped trying to convince parents not to worry. I think it's completely normal and expected for parents to worry about their children all the time particularly when they're having to have a procedure on their heart. So it's never my job to try to convince a family that they shouldn't be worried about their child. But what I usually do tell parents is that we have an amazing team in the cath lab and we are all completely focused on performing the procedure as safely as possible. I also think that it's somewhat reassuring for families to know that even though this might be the first time that they're hearing about the cath lab, or knowing that cardiac catheterization is a thing, that this is what we do every day. We perform more than a thousand of these procedures a year. And so even though each procedure is unique and we bring our unique approach to each procedure, that this is our every day even though it might be a completely new thing for them. And again, we realize that it's a tremendous responsibility to take care of other people's children and that they're entrusting us with a lot of responsibility. And we take that really seriously in terms of the amount of rigor that we bring to each case.  

[00:26:06] Erin Spain, MS: What are some of the common questions that parents may ask before one of these procedures? 

[00:26:10] Dr. Conor O' Halloran: By far, the most common question that families ask is how long does the procedure take? Like without fail, no matter what the procedure is. They always ask that question. It's always, it's almost always their first question. And I think the reason why is because basically, people don't know anything about it. So like, if you don't know anything about something and you're trying to gauge like, is this a big deal? Or like not a big deal. The question that people ask is like, how long does it take? 'Cause if I said like, oh, 20 minutes, then they'd be like, oh, okay. Like, it's not that big of a deal. But if I say five hours, then they're like, okay, this is a big deal. So that's the most common question that families ask. And the answer basically is that the procedures are hugely variable. Some procedures only take 20 minutes and some procedures can be six or seven hour procedures. So It depends on the type of procedure. And what I like to tell families is that basically the procedure takes however long it takes to do the procedure, you know, properly. If it takes a long time, we'll take a long time to do it and really just try to take the time that's needed to, again, do the procedure safely and effectively. 

[00:27:02] Erin Spain, MS: So we've mentioned some exciting things on the horizon such as fetal surgery and some of the new tools and technology that are coming to the field. How do you see the field expanding or advancing in the years to come?  

[00:27:14] Dr. Conor O' Halloran: There are so many different ways I could answer this question. There's so many different things that I'm excited to see continuing to develop in the future. One area that comes to mind is interventional MRI. We've talked a little bit about how we are more and more using imaging tests like MRIs to help plan the procedures ahead of time. Meaning a patient might have an MRI before their catheterization. We can use that data to, plan the procedure, but moving forward there's great interest in actually performing catheterizations in the MRI scanner, which allows you to combine some of the data that you can only get by catheterization, like pressure data with data that you can get from MRI to better understand the function of the heart and to do that without any radiation. So that's a really exciting potential area for the field. I think as more and more children are doing well and surviving through childhood with congenital heart disease, there are gonna be more and more adults with congenital heart disease. And so that part of our job is going to continue to grow over time. And then lastly, I think we have a responsibility in pediatric interventional cardiology to continue to advocate for our patients to sort of the FDA and to industry. In comparison to adult interventional cardiology or adult cardiology in general. Pediatric cardiology, you know, fortunately is a smaller field. There's less children with heart disease than there are adults with heart disease. But sometimes that means that the needs of children with heart disease is sort of overlooked from an industry or FDA perspective. And so there's been some really great successes in recent years of developing specific tools for the pediatric congenital space. And so I'm really looking forward to seeing that continue moving forward so that again, we can have tools that are specifically designed for this unique patient population. 

[00:28:41] Erin Spain, MS: Thank you so much for coming on the podcast, sharing your expertise, and really educating all of us about what happens at the Cath Lab at Lurie Children's. We appreciate it. 

[00:28:48] Dr. Conor O' Halloran: Yeah, absolutely. Thanks for having me, appreciate you taking the time. 

[00:28:51] Erin Spain, MS: For more information, including how to make a referral or an appointment, visit luriechildrens.org. 

Search our blog Search

---