Videoconference pediatric and congenital cardiology consultations: a new application in telemedicine

Background. - The relative rarity of congenital heart disease gives it an orphean disease status, requiring specialised centres. The present maturity of information technology allows telemedicine to be integrated into current medical practice. We report our experience of telemedicine between the cardiology department at St Pierre Hospital on the island of R6union and the pediatric cardiology department at the teaching hospital in Toulouse. Aims. - The aims of this work were to [1] verify the technical feasibility of transmitting echocardiographic images, [2] determine an optimal therapeutic strategy for each patient, and [3] deliver precise information live to patients and their families. Methods. - Five pediatric cardiology videoconference consultation sessions were transmitted between April 2006 and May 2007. The videoconference equipment, POLYCOM VSX 7000 (R), was used to relay information between the two centres, using six high-debit digital telephone lines, allowing a transfer rate of 384 kbits/s and an image frequency of 25 frames per second. The echocardiographic equipment at St Pierre Hospital was connected to the videoconference equipment by an S-VHS video output. The transmitted sources alternated between the echographic video output and the signal from a video camera, with continuous audio transmission. Results. - The telemedicine meeting was made up of three main elements: [1] a consultation with real-time echocardiographic acquisition and transmission, [2] a discussion between medical colleagues, and [3] a discussion with the family. Five videoconference consultation sessions were organised between April 2006 and May 2007. 22 patients were involved (median age 3 years, age range 7 days to 48 years). Heart disease was congenital in 20 patients, and acquired in 2 patients. The aim of the telemedicine consultation was to specify: [1] medical treatment in 7 patients, and [2] an indication for surgery or interventional catheterisation in 15 patients. There was no significant change in diagnosis, but in 2 patients with complex heart disease some anatomical clarifications were made. For 3 patients, the videoconference discussion was essential to get the extremely reticent families to accept the indication for surgery. Conclusion. - This is the first experience in France of telemedicine consultation for pediatric and congenital cardiology. These videoconferences allowed patients in the south of Reunion to benefit from a specialist opinion on optimal therapeutic strategy, with no delay or need to travel a tong distance. (c) 2008 Published by Elsevier Masson SAS.