Skip to main content
PMC home page
Heart logoLink to Heart
. 1999 Aug;82(2):217–221. doi: 10.1136/hrt.82.2.217

Application of a low cost telemedicine link to the diagnosis of neonatal congenital heart defects by remote consultation

H Mulholland 1, F Casey 1, D Brown 1, N Corrigan 1, M Quinn 1, B McCord 1, J Rogers 1, B Craig 1
PMCID: PMC1729129  PMID: 10409539

Abstract

OBJECTIVE—To determine whether accurate remote echocardiographic diagnosis of congenital heart disease could be achieved using a low cost telemedicine system.
DESIGN—Echocardiographic images obtained by a paediatrician from neonates suspected of having congenital heart disease were transmitted by a telemedicine link across two integrated service digital network (ISDN) lines to a regional paediatric cardiology unit for interpretation by a consultant paediatric cardiologist. The "tele-echo" diagnosis was verified by the paediatric cardiologist on direct consultation and echocardiography.
SETTING—Neonatal unit of Altnagelvin Hospital, Londonderry (a district general hospital) and the regional paediatric cardiology department, Royal Belfast Hospital for Sick Children.
MAIN OUTCOME MEASURES—Accuracy of the diagnosis made using the telemedicine link; impact on patient management.
RESULTS—Between September 1995 and September 1997 echocardiographic images were transmitted on 63 patients. A diagnosis was made in 61 (97%) (transmitted images were unsatisfactory in two). Congenital heart disease was diagnosed in 42 patients. Fourteen patients with major congenital heart disease were accurately diagnosed within 24 hours of admission using the telemedicine link and were transferred to the regional paediatric cardiology unit. A further 28 with less serious congenital heart disease continued to be managed at the district general hospital. Congenital heart disease was excluded in 19. Follow up consultation confirmed accurate diagnosis or exclusion of congenital heart disease in 57 (93%). There were four inaccurate diagnoses (6.3%; three undetected small ventricular septal defects and one pulmonary stenosis).
CONCLUSIONS—Transmitted images were of sufficient quality to allow confirmation or exclusion of major congenital heart disease. The telemedicine link facilitated early diagnosis and initiation of appropriate management in patients with complex congenital heart disease and avoided the need for transfer in those where significant congenital heart disease was excluded.


Keywords: congenital heart disease; telemedicine

Full Text

The Full Text of this article is available as a PDF (106.8 KB).

Figure 1  .

Figure 1  

Open in a new tab

Diagrammatic summary of telemedicine link.

Figure 2  .

Figure 2  

Open in a new tab

Study protocol.    

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Batnitzky S., Rosenthal S. J., Siegel E. L., Wetzel L. H., Murphey M. D., Cox G. G., McMillan J. H., Templeton A. W., Dwyer S. J., 3rd Teleradiology: an assessment. Radiology. 1990 Oct;177(1):11–17. doi: 10.1148/radiology.177.1.2204957. [DOI] [PubMed] [Google Scholar]
  2. Binkhuysen F. H., Ottes F. P., Valk J., de Vries C., Algra P. R. Remote expert consultation for MRI procedures by means of teleradiology. Eur J Radiol. 1995 Jan;19(2):147–150. doi: 10.1016/0720-048x(94)00573-u. [DOI] [PubMed] [Google Scholar]
  3. Brown F. W. A survey of telepsychiatry in the USA. J Telemed Telecare. 1995;1(1):19–21. doi: 10.1177/1357633X9500100104. [DOI] [PubMed] [Google Scholar]
  4. Casey F., Brown D., Craig B. G., Rogers J., Mulholland H. C. Diagnosis of neonatal congenital heart defects by remote consultation using a low-cost telemedicine link. J Telemed Telecare. 1996;2(3):165–169. doi: 10.1258/1357633961930004. [DOI] [PubMed] [Google Scholar]
  5. Finley J. P., Human D. G., Nanton M. A., Roy D. L., Macdonald R. G., Marr D. R., Chiasson H. Echocardiography by telephone--evaluation of pediatric heart disease at a distance. Am J Cardiol. 1989 Jun 15;63(20):1475–1477. doi: 10.1016/0002-9149(89)90011-8. [DOI] [PubMed] [Google Scholar]
  6. Finley J. P., Sharratt G. P., Nanton M. A., Chen R. P., Bryan P., Wolstenholme J., MacDonald C. Paediatric echocardiography by telemedicine--nine years' experience. J Telemed Telecare. 1997;3(4):200–204. doi: 10.1258/1357633971931165. [DOI] [PubMed] [Google Scholar]
  7. Fisk N. M., Bower S., Sepulveda W., Garner P., Cameron K., Matthews M., Ridley D., Drysdale K., Wootton R. Fetal telemedicine: interactive transfer of realtime ultrasound and video via ISDN for remote consultation. J Telemed Telecare. 1995;1(1):38–44. doi: 10.1177/1357633X9500100108. [DOI] [PubMed] [Google Scholar]
  8. Loane M. A., Gore H. E., Bloomer S. E., Corbett R., Eedy D. J., Mathews C., Steele K., Wootton R. Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: is clinical management by realtime teledermatology possible? J Telemed Telecare. 1998;4 (Suppl 1):3–5. doi: 10.1258/1357633981931425. [DOI] [PubMed] [Google Scholar]
  9. Oakley A. M., Astwood D. R., Loane M., Duffill M. B., Rademaker M., Wootton R. Diagnostic accuracy of teledermatology: results of a preliminary study in New Zealand. N Z Med J. 1997 Feb 28;110(1038):51–53. [PubMed] [Google Scholar]
  10. Ong K., Chia P., Ng W. L., Choo M. A telemedicine system for high-quality transmission of paper electrocardiographic reports. J Telemed Telecare. 1995;1(1):27–33. doi: 10.1177/1357633X9500100106. [DOI] [PubMed] [Google Scholar]
  11. Sobczyk W. L., Solinger R. E., Rees A. H., Elbl F. Transtelephonic echocardiography: successful use in a tertiary pediatric referral center. J Pediatr. 1993 Jun;122(6):S84–S88. doi: 10.1016/s0022-3476(09)90049-x. [DOI] [PubMed] [Google Scholar]
  12. Wright R., Loughrey C. Teleradiology. BMJ. 1995 May 27;310(6991):1392–1393. doi: 10.1136/bmj.310.6991.1392. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES