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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Moriah Muhammad, writer and moderator with Becker's

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Healthcare, and I'm thrilled to have with me

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today 3 special guests. Doctor Sunita Ferns, director

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of pediatric and adult invasive electrophysiology,

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doctor Harma Turbendian,

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pediatric cardiac surgeon, and last but not least,

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doctor Mark Plunkett, chief of pediatric and congenital

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heart surgery,

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all from OSF Children's Hospital of Illinois.

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Doctors, welcome to the podcast. We're very excited

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to have you join us today. Today, we

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are going to be discussing the story of

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how a 2 year old, child suffered sudden

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cardiac arrest at home,

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and how your hospital dealt with it, and,

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specifically, doctor Firms playing a huge part of

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it.

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So if you all wouldn't mind, let's kinda

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go to the beginning of the story and

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get, some background information.

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Doctor Turbendian, like I stated, this is the

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story of care for the toddler really started

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at home. So can you tell us a

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bit about the parents' quick actions and how

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we got to the procedure?

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Right. So,

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this was a young, otherwise healthy child who

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is at home, and,

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the parents

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realized

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at home that he was having a cardiac

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arrest and

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started

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CPR

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and and called 911.

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And, really, it was,

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it was amazing that the parents acted,

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so quickly and knew what to do and

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knew how to get the child further help.

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So they were essentially able

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to perform CPR, keep them alive until EMS

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got there. They continued CPR

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and resuscitation

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and got them over to the, intensive care

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unit,

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here at Children's Hospital of Illinois.

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Wonderful. Thank you so much for giving us

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that that,

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important information to the story.

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Doctor Ferns, kinda going to you next. What

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diagnosis did you give the child,

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and, what plan of care came next?

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So,

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you know, initially, the trial presented with cardiac

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arrest of, unknown origin, and the clock was

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ticking for us to

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pin down a diagnosis.

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And so we we had a a host

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of diagnostic tests we do in the ICU.

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We send off genetic testing and, a host

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of antiarrhythmic

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medications. Those are medicines that are specifically used

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to treat these arrhythmia syndromes.

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And, because this child's presentation,

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was a bit unusual,

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he did not fit into any of the

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usual categories. The diagnosis was, was initially somewhat

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challenging and, through a method of trial and

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error, we were finally able to pin down

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a medication that would work for this child.

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So ultimately, the diagnosis was something called Brugada

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syndrome.

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And, the drug that we used to treat

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it was something that was invented for malaria.

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It's a drug called quinidine,

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and it worked, exquisitely well for this child.

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But, of course, he also had to get

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a defibrillator because once you try to die

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once, we don't let that happen again, and

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that's when the surgeons were involved.

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Got it. Got it. Thank you so much

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for giving us that information.

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Doctor Plunkett, going to you next, can you

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tell us about the magnitude

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of doing such a procedure on a child

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this young and small?

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The magnitude of implanting this, device,

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in this, child is huge. This is the,

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smallest and youngest

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patient to have,

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this device implanted.

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This is relatively new technology and was designed,

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for adults or adult sized

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patients.

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And the fact that we've,

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shown that we can safely,

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and effectively,

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implant this device,

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in a a small child,

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expands its application,

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immensely.

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Now,

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this device will be used

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in children,

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with a similar

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rhythm, issues,

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in addition to its adult application.

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Wonderful. Yeah. I'm I'm very happy to hear

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this device is now being able to help,

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you know, such young people.

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Doctor Ferns, you're now in charge of this

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child's post procedure

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care. What is this family's journey going to

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look like from here on out, and what

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are you keeping an eye on, during his

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treatment time?

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That's an excellent question. So, you know, once

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the child's been diagnosed with the malignant arrhythmia

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syndrome,

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we encompass not just the child, but also

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our screening and determination of other people at

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risk in the family extends to the immediate

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family members. And then if that comes back

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as positive, also the extended family members. So

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what we start doing is extending the genetic

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testing,

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to the rest of the family. But for

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this child specifically,

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we have to make sure that he gets

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his medications on a very,

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regular regime because even missing a dose here

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and there could be catastrophic and could lead

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to a life threatening arrhythmia.

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He, of course, has

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the

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implanted defibrillator

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to help him, but our aim of giving

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him an implanted defibrillator

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is not so much to let him keep

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getting shocks, but to be

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able to determine

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a life threatening arrhythmia and get on top

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of it before the device actually shocked him.

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So,

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the implications for this child going forward, I

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would say, you know, you need a normal

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life like any other 2 year old growing

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up and,

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knowing that,

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he needs to take his medications regularly.

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And,

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at some point in the future, about

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12, 13 years from now, the battery for

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that defibrillator will need changing. So he will,

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come back for battery replacements,

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but

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I don't, anticipate him

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leading anything,

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short of a normal life.

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That's really, really good to hear. That is,

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you know, kinda high stakes, but,

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I'm sure everything is going fine right now

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and will continue to to go fine.

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Doctor,

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Turbendian, going back to you, can you take

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us to the operating room a little bit?

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What kind of team effort was needed to

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do this procedure?

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Yeah. There was a there was a decent

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amount of coordination

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that went into it. You know, after the

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child presented and and

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doctor Ferns and the team

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sorted out what was what was going on,

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what the diagnosis was, and what the child

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needs were gonna be.

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When

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she came to us, you know, asking about

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the feasibility of the device

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being implanted in a child this small, and

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we had to talk to and coordinate not

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only our

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operating room and operating room staff down here,

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but,

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along with doctor Ferns, we also had to,

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coordinate with the manufacturer,

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as this was gonna be, you know, the

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first time this was implanted in a in

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a channel this young. So we had

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to put a bunch of teams together to

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to make it happen in a in a

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relatively rapid fashion.

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And I think it was

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exciting and reassuring to see how,

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enthusiastic

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people were to,

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give this child the the opportunity

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to get this device.

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Yeah. Yeah. Definitely. Well, I'm glad that, you

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know, everything was able to work itself out,

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with all those different people coming together.

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Doctor Plunkett,

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can you talk a little bit about the

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EVICD

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a bit more?

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Before this was available, what other treatment options

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what a surgical team have considered?

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Yeah. Well, what we have to keep in

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mind is,

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traditionally, like, transvenous systems were were only applicable

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to,

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older

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children and adults.

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As you got into the younger age ranges,

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the

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ICDs,

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that we had to implant,

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required,

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sternotomies or thoracotomies.

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There were epicardial

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patches that you would actually, sew on the

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surface of the heart or around the heart.

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There were coils and even what were called

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subcutaneous

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arrays.

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But all of these technologies

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had their limitations,

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and

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this newer

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EVICD

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seems to be a great advancement,

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in technology.

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And, the fact that we can implant it,

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with such a minimally invasive approach, if you

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will,

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and have a higher level of technology

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is, is really great because now we can

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avoid,

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all those, much larger procedures,

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for these children.

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Yeah. Yeah. Definitely. Especially because they are just

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so young. You know?

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Doctors, thank you all for being here. Before

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I close out,

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do any of you have any ending thoughts

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for anything we discussed today,

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and about what the surgery means for the

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world of medicine?

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Doctor Ferns, do you have any final thoughts?

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Well, I think this is a groundbreaking.

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As doctor Plunkett mentioned earlier,

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the

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ability to do this in a child is

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young, minimally invasively,

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has huge implications going forward.

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And,

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I I think a lot of the centers

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are going to follow suit didn't adopt this

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fairly rapidly.

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And I think, you know, this

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procedure,

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and the way it was done will help

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reduce disparities

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in,

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the availability of, care

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across the globe.

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To give you,

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a reference,

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this was a relatively

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straightforward procedure for doctors, Taubenian and Plunkett on

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a scale of what they do.

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They do very complex cardiac surgery because they're

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specialized pediatric congenital cardiac surgeons.

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And on a scale of 1 to 10,

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this would be a one for them and

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ten is the most complex surgeries they're doing.

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So the ability to do this in a

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minimally invasive way would mean that this procedure

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could be made available to patients

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across the globe where they don't have the

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experience of experienced cardiac surgeons,

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and patients may not need to be transferred

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to a congenital heart center. And this could

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be done

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in a relatively straightforward way by a a

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general surgeon, a thoracic surgeon, and,

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I think it has

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a way it's a means to reduce, disparities

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in accessing health care across the globe.

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Yeah. Yeah. Definitely. Doctor Plunkett, did you have

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any final thoughts as well?

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I I would just add that,

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in the world of of pediatric

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medicine and and surgery,

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it's not uncommon for us to, take,

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what's been designed or developed, for adults

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and,

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apply it,

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or or use it in the treatment of

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of children. This is the

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the way a lot of our pediatric, devices

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and a lot of our technology is is

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developed. So

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I think this, is just one more example

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where we've

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been able to take what, what exists and

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what's been designed for the adults

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and, and prove that it, is effective and

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and safe, to be used in children.

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Yeah. Yeah. Absolutely.

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And doctor, Taubindian,

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did you have any final thoughts as well?

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Yeah. I think,

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none of this would have happened if it

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wasn't for the parents'

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quick actions and their and

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the fact that they knew how to do

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CPR.

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And so I think it's just, you know,

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from a

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kind of public health perspective, it's just another

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reminder of, you know,

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people have some basic knowledge of CPR.

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You can definitely save a life. And like

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I said, we wouldn't have done this if

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it wasn't for,

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the quick actions of the of the parents

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at the at the onset of this whole

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story. Mhmm.

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And just to reiterate,

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the novelty of the procedure and what doctor

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Plunkett and doctor Ferns have referred to, we,

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in order to spread the word about

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the possibility of doing this, we actually,

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just published the report

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regarding the child in the,

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Annals of Thoracic Surgery short reports.

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And so that's,

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really available to,

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any provider to

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read about what we did.

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Yeah. Absolutely.

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Thank you all so much for those final

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thoughts. This has definitely been a very informative

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discussion.

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I know I definitely learned a lot,

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through this story. Again, I wanna thank you

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all so much for coming on Becker's HealthCare,

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and I look forward to connecting with you

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again soon. Thank you.

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Thank you very much.