Children with a tumor near the heart. Children with a congenital heart defect who also have cancer. Children who have reduced heart function or increased blood pressure in the lungs due to side effects of cancer treatments. The similarity between these patient groups in the Netherlands is that they are treated in Utrecht. Doctors from Wilhelmina Children’s Hospital and Princess Máxima Center – the pediatric oncology center in our country – work together to provide the best possible care. “Without the proximity of pediatric cardiac surgery, we would not be able to offer the patient this high quality.”
Kim van Loon has a special sub-specialty. The pediatric anesthetist at Wilhelmina Children’s Hospital (WKZ) specializes in anesthesia for patients with heart defects. At the pediatric heart center, she and her colleagues make sure that the boys and girls are sedated – given their reduced state of consciousness – or anesthetized before surgery. During the treatment itself, you are in close contact with the surgeon to maintain patient safety as much as possible.
Great fit
This knowledge and skills are also very useful for some children who are seen in the Princess Máxima Center, the Dutch center for pediatric oncology. It concerns boys and girls for whom both the theme of ‘heart’ and the theme of ‘cancer’ are present.
An hospital
“These are relatively small patient groups that, just like other patients, we want to provide the best possible care,” says Marc Wijnen, pediatric surgeon and professor of pediatric oncology surgery. “Every year we treat about twenty children with a tumor near the heart. We see the same number in children with a congenital heart defect who also have cancer. In addition, every year we help about fifty boys and girls who suffer heart or lung damage due to cancer treatments. The best possible care is only possible in these three categories by working closely together as Máxima and WKZ. The little patients and their parents experience, so to speak, that they are dealing with a hospital”.
Evaluate the risk
Good teamwork starts with good preparation. For example, when a child has a tumor in the chest cavity, near the heart. Ideally, a surgeon can remove the tumor tissue, a chest operation, but due to the vulnerable location this is not always possible. Kim van Loon: “Together we estimate the risk of anesthesia and surgical treatment. How much damage can the child suffer? Let’s make an assessment as careful as possible. If we consider the risk justified, we advise the parents and the child to undergo surgery. So let’s discuss the approach up front to keep the damage as limited as possible. If, on the other hand, the risk is too great, treatment with drugs is the first choice.”
Happy
Marc: “With this type of complex problem, we organize consultations where the patient is seen from the point of view of various medical specialties. It concerns a pediatric surgeon from Máxima, a radiologist, an oncologist and a pediatric anesthesiologist with the cardiology subspecialty from the WKZ. This colleague, of whom Kim is one, goes by the full name: a pediatric cardioanesthesiologist. “We perform operations where it is very important for the anesthetist to understand children with a change in blood circulation. You can really only expect that knowledge from a pediatric cardio anesthetist. As a pediatric oncology center surgeon, I consider myself lucky to be so close to the WKZ Pediatric Heart Center. Without a pediatric cardiac center, there would be no pediatric cardio-anesthesiologists, and without pediatric cardio-anesthetists, there would be no optimal care for patients with problems at the interface between cancer and the heart.”
Blood and oxygen
In the operating room, a fine teamwork between the pediatric surgeon and the pediatric cardioanesthesiologist is also required. Kim: “Suppose a patient has a very large tumor mass in the chest. Anesthesia and surgical procedures can interrupt two so-called vital functions: no more air reaches the lungs or no more blood flows through the heart. As a pediatric cardio anesthetist, I constantly monitor breathing and circulation and make adjustments when a problem arises. Or even better: before a problem arises. I can do the latter due to close communication with the pediatric surgeon.
Precautions
He gives an example: “Marc or a colleague announces that he is about to take a certain action that will affect blood flow to the heart. So I will take precautions to ensure this vital function remains good in the future. What matters is that you both understand the effect actions have on the two main vital functions of the body.
Teamwork
Marc: “As members of the surgical team often work together, we are gaining more and more experience and becoming more and more in tune with each other. The team usually consists of one or two pediatric surgeons, one or two pediatric cardiac anesthetists, a critical care physician, an oncologist, and a radiologist.”
Forty anesthesia
For some patients it is necessary to undergo anesthesia forty times. They benefit from a different collaboration: that between pediatric cardio anesthetists from the WKZ and anesthesiologists from Máxima.
All in the same location
Kim explains: “The oncologist closely monitors the outcome of the treatment. For example, how big is the tumor after radiation therapy? There are various ways to get information about this, such as an MRI scan or another imaging technique. During such a session you have to remain motionless for quite some time. Many children, especially very young ones, cannot do this. That’s why they are put under anesthesia. During a treatment process at the Máxima, it may be necessary to review the state of affairs up to forty times; this also means going under anesthesia forty times. Thanks to the collaboration between Máxima and WKZ, all this can be done in the same place in Utrecht”.
Avoid taxes
Marc: “Without the readily available knowledge and skills of the pediatric cardio anesthetist at the WKZ, these children would have to go to another hospital to be examined all those times. All that travel would be very stressful and practically impossible for the patient.
This folder contains additional information by means of a video. Scan the QR code above with your phone to watch this video. Or watch the video at:
