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

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 s uspected of having congenital heart disease were transmitted by a telemedic ine link across two integrated service digital network (ISDN) lines to a re gional paediatric cardiology unit for interpretation by a consultant paedia tric 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 gene ral hospital) and the regional paediatric cardiology department, Royal Belf ast 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%) (transmit ted images were unsatisfactory in two). Congenital heart disease was diagno sed in 42 patients. Fourteen patients with major congenital heart disease w ere accurately diagnosed within 24 hours of admission using the telemedicin e link and were transferred to the regional paediatric cardiology unit. A f urther 28 with less serious congenital heart disease continued to be manage d at the district general hospital. Congenital heart disease was excluded i n 19. Follow up consultation confirmed accurate diagnosis or exclusion of c ongenital heart disease in 57 (93%). There were four inaccurate diagnoses ( 6.3%; three undetected small ventricular septal defects and one pulmonary s tenosis). Conclusions-Transmitted images were of sufficient quality to allow confirma tion or exclusion of major congenital heart disease. The telemedicine link facilitated early diagnosis and initiation of appropriate management in pat ients with complex congenital heart disease and avoided the need for transf er in those where significant congenital heart disease was excluded.