Pediatric Cardiology Clinics Take Services On The Road

Dr. Luther Williams examines three-year-old Mary Ashley Robinson of Turbeville, while her mother, Becky, observes.

Mary Ashley’s aortic valve opening was enlarged using a balloon catheter when she was two months old. While the procedure improved the stenosis, it did not change the fact that the valve didn‘t form properly, and she needs to be followed medically throughout her life. With only 15 pediatric cardiologists in South Carolina, her parents could have been burdened with almost an hour and a half trip to Columbia for each doctor‘s appointment. Yet because of a pediatric cardiology clinic established by the Department of Pediatrics, the Robinsons only need to make a 25-mile trip to Sumter for their daughter’s checkups.

The clinic in Sumter was the first of four that serve rural areas of South Carolina. Since it opened almost ten years ago, additional clinics have been set up in Orangeburg, Lancaster, and Aiken. A team from the Department of Pediatrics provides on-site care in Sumter and Orangeburg on a monthly basis, and in Aiken and Lancaster once every other month. Two cardiologists are accompanied by two nurses, an echocardiography technician, a clerical employee to do charting, and usually a pediatric resident and medical student.

To Dr. Luther Williams, a professor in the Department of Pediatrics, education is an important component of the team’s role. He makes it a point to assure that parents thoroughly understand their child’s condition. “If a child has a significant defect, the parents hear almost nothing during the first visit other than the fact that their child has a heart problem,” he said. As parents learn to live with their child’s diagnosis, he stressed that, “It behooves us to repeat, repeat, repeat what needs to be done and what to expect in the future.”

As for Mary Ashley’s future, it’s not certain if another procedure may be required in the years ahead. “The doctors told me they would just have to keep watching her. It would depend on how the valve grew with her and if it stayed open,” said her mother, Becky Robinson. For the time being, the little girl exhibits no symptoms of a heart abnormality and enjoys the rambunctious pursuits of a three-year-old. “In fact, she’s the wildest child I have,” her mother said about the youngest of her three children. “She’s wide open; nothing stops her.”

Mary Ashley Robinson has an echocardiogram done during her annual cardiology exam in Sumter.

Not all of the children referred have serious problems. “We see many kids with heart murmurs that need to be evaluated, and are determined to have no abnormalities,” Dr Williams said. And while patients of the clinics range from newborns on up, some adults are seen as well. “We have a number of patients with congenital heart disease we have been following since they were kids who are just comfortable staying with us,” he said.

Dr. Williams believes that the clinics are particularly helpful to younger pediatricians who are starting out in practice. “As they are training, they are used to having pediatric subspecialists on the scene. Then they set up their practice in a rural area and realize there isn’t a pediatric cardiologist nearby.” The four clinics in the state provide rural physicians with expertise that’s in increasing demand. What started with six or eight patients in Sumter in 1995 has grown so much that a fourth pediatric cardiologist will be joining the department this summer.

The service is also a welcome relief for families like the Robinsons who have been spared the time and expense of numerous trips to Columbia for Mary Ashley’s follow-up care. What does the active three-year-old think about the clinic that has been such a benefit to her parents? “The only thing she knows is that we are going to the doctor and he is going to listen to her heart,” Robinson said.

Reprinted from Connections newsletter, February 2006

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