Treatment of congenital heart defects A visit to the new parent-child centre on the Venusberg
Bonn · The paediatric heart specialists have been working in the new Parent-Child Centre on the Venusberg for six months now. We offer a look behind the scenes and show how high-tech medicine works there in a family-friendly atmosphere.
The infant who is being wheeled out of the operating theatre now has one year to undergo surgery on its perforated chamber septum, called "Swiss Cheese". Professor Boulos Asfour has constricted an artery in the lung, thus ensuring that the baby's lungs do not come under too much pressure. The team from the Children's Heart Centre at Bonn University Hospital performs many operations and cardiac catheters on newborns. The Parent-Child Centre (Elki) on the Venusberg has been offering optimal conditions for this for six months.
The coloured facade elements already indicate where the paediatric medicine is at home on the large hospital campus. In the paediatric cardiology and paediatric cardiac surgery departments, all the specialists of the university hospital work under one roof. As reported, paediatric cardiac surgeon Boulos Asfour, paediatric cardiologist Martin Schneider and more than 70 colleagues already moved from the Asklepios children's clinic in Sankt Augustin to Bonn last October. At the same time, Professor Ehrenfried Schindler was successful with his application for the position of head of paediatric anaesthesia, so that the former Augustinian doctors are once again united as a trio.
The atmosphere in the Elki is familiar, which is also transferred to the young patients and their parents. Large windows allow plenty of light to enter the surgical wing on the second floor. The open induction area, where the children are prepared for the operation, looks like a friendly corridor with colourful furniture, where people in blue operating clothes walk back and forth. From the waste bin to the emergency trolley to the radiolucent carbon table, everything here is on castors, practical and well thought-out.
"The architects' concept is that children need light. It is transparent and friendly in all rooms", says Schindler, who can show the little patients pictures or cartoons on a monitor while they are inducing anaesthesia. The large hybrid operating theatre for minimally invasive procedures is Martin Schneider's favourite place. "I'm sure I know about 200 heart laboratories, but this is one of the few that has a window. It's like a huge dance hall. And we have the surgical ORs right across the street." A second opinion is just a doorway away.
For Boulos Asfour, the spatial conditions at the Children's Heart Centre in Sankt Augustin were just as good as in Bonn. "My scalpel works everywhere." He particularly appreciates the fact that obstetrics is under one roof and the children are born in the house. The idea of treating congenital heart defects at the University Hospital from prenatal diagnosis through to adulthood is proving successful. There is also a lot of exchange between the disciplines. Schneider uses the materials of the neuro-radiologists, who have many small implants and which can be used, for example, as a stent on the heart of newborns. And when Asfour wants to operate on a tall 16-year-old, he simply moves over to the adult operating theatre.
Research on the voice of the mother
Anaesthetist Schindler is enthusiastic about the digital patient files and protocols. "I can concentrate fully on the patient while the data automatically flows in." But it's not just about state-of-the-art technology. Children are read aloud during the procedure, a current research project by Schindler: "We are investigating whether the mother's voice during sedation in the heart catheter has an additional positive effect on the child. This can be measured using stress hormones.
It is already known that mothers are calmer during a caesarean section if they can watch on a monitor how their baby is being cared for next door. "We need less blood pressure medication and less for nausea," says Schindler. All the practical experience and research work also benefits the students, who can watch live broadcasts from the operating theatres in the Elki lecture theatre.
Until they moved into the new building, the Augustinian paediatric heart specialists and their team were provisionally accommodated on the premises. The three professors agree that this time helped them to get to know their colleagues in Bonn and the huge clinic premises. "It was a charming chaos with many paths and five different locations for material," Schneider describes. Schindler got technical support: "There is an app for navigation here, optimised for pedestrians." He sees an advantage for everyone in the fact that the Elki was not yet ready in October: "Because everyone was in the temporary, we had to talk a lot to each other. Two large teams have grown together.“
Professor Johannes Breuer, Director of the Centre for Paediatrics and Director of the Department of Paediatric Cardiology, is pleased that patients no longer have to commute back and forth between the University Hospital on Venusberg and the paediatric clinic on Adenauerallee. 1600 to 1700 children and adolescents are to be cared for each year in the children's heart centre of the university hospital, with 900 to 1000 heart catheter interventions and around 500 operations.
"Every child who has undergone heart surgery has to be cared for in the intensive care unit and sometimes for a long time, due to the complicated heart defects. This is the eye of the needle," says Breuer. The university hospital also lacks nursing staff - as is the case everywhere in hospitals. "We have invested a lot in training and this is now bearing fruit," reports the director. However, it is difficult to make up for the mistakes made in health policy over the past 15 years. According to Asfour, over 200 patients are on the waiting list: "We can perform more operations here than in the last two years in Sankt Augustin.
Advertising for a crisis-proof job
The paediatric cardiology department has an inter-professional training ward, in which nursing students and students in their practical year, prospective physiotherapists and pharmacists temporarily take over the direction - accompanied by medical specialists. "The idea is that the young staff members are treating patients on their own responsibility, this promotes independence," says Breuer. In his view, nursing has an image problem, because the focus is mainly on shift work and staff shortages. That is why he wants to show "that it is a crisis-proof, responsible job where you deal with people“.
The team of the Children's Heart Centre is not only itself passionate about its work. On World Heart Day on 29 September, it wants to encourage people to engage in activities that are good for their hearts. This starts with the children. "In the past, people were very reluctant to engage in sports activities for children with congenital heart defects, but there is nothing to be said against it," explains Breuer. A study with patients with only one ventricle has shown that they are astonishingly resilient.
Now the physicians are investigating how high altitude air affects performance. The children do not have to go to the ski slopes for this, because the lower oxygen content of the air can also be simulated in a laboratory of the German Aerospace Center (DLR) in Cologne-Porz. In a few years' time, the little boy with the perforated chamber septum should also be able to stand on skis for the first time or go hiking on a mountain without thinking about his heart operation
(Original text: Bettina Köhl / Translation: Mareike Graepel)