Real-Time Remote-Mentored Echocardiography in Management of Newborns with Critical Congenital Heart Defects

Background: The management of suspected critical congenital heart defects (CCHD) relies on timely echocardiographic diagnosis. The availability of experienced echocardiographers is limited or even non-existent in many hospitals with obstetric units. This study evaluates remote-mentored echocardiography performed by physicians without experience in imaging of congenital heart defects (CHD). Methods: The setup included a pediatric cardiologist in a separate room, guiding a physician without experience in echocardiographic imaging of CHD in the examination of a symptomatic newborn. This remote-mentoring pair was blinded to the diagnosis of the newborn and presented with a simplified patient history. The echocardiographic images were streamed to the laptop of the mentor, along with a webcam feed showing the probe position. The task was to identify CCHD in need of immediate transfer to a pediatric cardiac surgical center. The result was compared to the previously completed echocardiographic report and the clinical decision of the patient-responsible pediatric cardiologist. Results: During 17 months, 15 newborns were recruited. All six newborns with CCHD were correctly labeled by the remotementoring pair. One newborn with Tetralogy of Fallot was erroneously labeled as needing immediate transfer. Eight newborns without CCHD were correctly labeled. Conclusions: Remote-mentored echocardiography performed by examiners without experience in imaging CHD identified all newborns with CCHD in need of immediate transfer for specialist care. The setup shows promising results for improving the management of CCHD in hospitals without continuous pediatric cardiology service.