When he arrived at UC Davis Children's Hospital last year as the new chief of pediatric cardiology and co-director of the Pediatric Heart Center, Frank Ing, M.D., instantly expanded the region’s options for minimally invasive pediatric cardiac interventions. Ing introduced a nonsurgical treatment for a common neonatal heart condition — a catheter-based procedure applicable to even the tiniest neonates — and is now working to expand local possibilities for in utero catheterization as well.
The internationally renowned catheterization expert is known for innovation and pioneering new techniques, and also for keeping an open mind about even the most complex or stubborn cases. The Society for Cardiovascular Angiography and Interventions (SCAI) presented him with its Master Interventionalists designation in May, noting achievements in "the development of transcatheter techniques, delivery systems and cardiovascular devices to treat congenital heart disease from the fetus to the elderly." Ing came to Sacramento from Children’s Hospital Los Angeles, where he served as chief of cardiology, co-director of the Heart Institute, and director of the cardiac catheterization laboratory. At UC Davis he codirects the multidisciplinary Pediatric Heart Center with surgeon Gary Raff, M.D., providing expanded opportunities for both hybrid and nonsurgical procedures.
Q. You recently introduced the ability here to conduct nonsurgical patent ductus arteriosus (PDA) closures via catheterization for premature infants as small as 600 grams. Twenty to 60 percent of all preemies report having a significant PDA. What advantages does catheterization give these patients?
Compared to surgical ligation, catheterization reduces risks of a thoracotomy and the resultant need for healing the chest wall after surgery. While it does require general anesthesia, you’re looking at a much faster recovery – we see the lungs starting to clear by the next day, or even the same evening in most cases. We’re seeing immediate improvement. And there’s less pain.
Still, these are fairly precarious patients, so it takes a multidisciplinary approach that leans on the expertise of our entire team – the nationally ranked neonatology service and our anesthesiologists, respiratory therapists, cath lab staff and bedside nurses.
Advances in miniaturization over just the last couple years have given us the technology to tackle this in preemies this small – we’re now using delivery wires as thin as a hair. We’re constantly tracking these developments in the field, and one of my passions is helping to safely advance them as well.
Q. You’re also using catheterization for in utero fetal heart intervention?
We’re working to add fetal aortic valvuloplasty and atrial septal stenting as part of our in utero services at our Fetal Care and Treatment Center. I previously performed these procedures in L.A., and at Texas Children’s Hospital. The valvuloplasty can promote improved heart growth for patients with critical aortic stenosis at risk of hypoplastic left heart syndrome (HLHS), and help reduce need for procedures after birth.
When HLHS is already present and involves a restrictive atrial septum, we use the atrial septal stenting to help improve lung function, reduce overall morbidity and mortality, improve chances for successful delivery, and reduce future disability.
Q. At the Pediatric Heart Center you’re also pursuing hybrid approaches involving surgical and catheter-based procedures?
This allows us to be creative with unique challenges. One recent example involved an extremely large ventricular septal defect (VSD) diagnosed in utero by Dr. Jay Yeh, medical director of our peds echocardiography lab. For such a large defect, using a traditional approach to repair would create significant scarring and weakening of the healthy heart muscle. We asked ourselves if there was a better, safer way. After an initial neonatal procedure to band the pulmonary artery, the patient was given two years to grow, and then we used a hybrid approach to deliver a large VSD closure device.
Dr. Raff surgically removed the band and passed a needle followed by a catheter through the surface of the right ventricle across the VSD, and we proceeded to occlude the VSD using a special VSD plug. All of this was performed with ultrasound guidance and was another demonstration of strong teamwork. The hybrid technique allowed us to close the VSD without cutting open the muscular wall of the heart.
Q. You’ve had patients come from as far as Dubai for treatment, after their other physicians declined further procedures. In that particular case, you performed a successful catheterization for severe pulmonary atresia, on an outpatient basis.
I generally do welcome inquiries about seemingly difficult cases. Technology, and our skills with it, are constantly improving and providing us new opportunities.
In this particular case, the patient was told, “nothing more can be done” by their local physicians. The family sought me and flew to Sacramento for treatment. We were able to recanalize and rehabilitate the occluded pulmonary artery, restoring flow to the entire right lung. Previously, the patient was basically getting oxygen from only half of her left lung, and she was quite cyanotic. That was a very satisfying outcome.
Q. You currently chair SCAI’s Congenital Heart Disease Council. What are your thoughts on current trends in pediatric cardiology and catheterization, and how are they coming into play at UC Davis?
We see premature infant PDA occlusion as a real benefit for our region, so we’re working to expand awareness. I’m involved in development of new valves for transcatheter implant, and in work to secure FDA approval of new pediatric cardiac devices in general. We’re also involved in quality assurance projects, and in national registries outcomes data. I enjoy sharing at our Pediatric Heart Center’s annual congenital cardiac care symposium.
Q. What kind of experience can referring physicians and their patients expect from the center?
Expect the best care and the most up-to-date protocols. Besides our Sacramento and Roseville locations, we also provide consultation and evaluation at monthly outreach clinics in Redding, Chico, Marysville, Auburn and Stockton to serve the region.