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January 20, 2010
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3:03 pm
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UMHealthSystem:
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Follow #heartdefectschat today tfrom 12 - 2 p.m. to find answers to your questions on Congenital Heart Defects http://ow.ly/YAql |
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4:50 pm
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UMHealthSystem:
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We're about to begin our tweet chat on congenital heart defects #heartdefectschat You'll be seeing a lot of tweets between now & 2 p.m. |
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4:52 pm
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litebulb11:
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RT @UMHealthSystem: We're about to begin our tweet chat on congenital heart defects #heartdefectschat You'll be seeing a lot of tweets b ... |
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4:53 pm
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MLibraryHealthy:
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RT @UMHealthSystem: We're about to begin our tweet chat on congenital heart defects #heartdefectschat You'll be seeing a lot of tweets b ... |
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4:59 pm
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UMHealthSystem:
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@chicpea73 Be sure to search #heartdefectschat to get all the tweets :) |
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5:00 pm
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UMHealthSystem:
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For today's chat, I want to welcome Dr. John Charpie, head of the U-M Pediatric Cardiology ... #heartdefectschat |
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5:01 pm
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UMHealthSystem:
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Pronounced Sharpee like my favorite markers! #heartdefectschat |
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5:01 pm
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jcharpie:
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@UMHealthSystem Good morning. I'm happy to be here and answer whatever questions we can. #heartdefectschat |
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5:02 pm
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UMHealthSystem:
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And welcome Dr. Richard Ohye, head of Pediatric Cardiovascular Surgery at the U-M Congenital Heart Center! #heartdefectschat |
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5:03 pm
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UMHealthSystem:
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We're discussing congenital defect surgeries, in particular new research (read abou tit here): http://ow.ly/YBXa #heartdefectschat |
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5:04 pm
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UMHealthSystem:
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read about it I mean! OK, here are a few details about the chat: We will post a series of questions, one every 5 minutes. #heartdefectschat |
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5:05 pm
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rohye:
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@UMHealthSystem Thanks, good to be here. #heartdefectschat |
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5:05 pm
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UMHealthSystem:
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Schedule: 12 ? 12:45 chat, 12:45 ? 1 p.m. break, 1 ? 2 p.m. chat #heartdefectschat |
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5:06 pm
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UMHealthSystem:
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Please give Ohye and Charpie time to respond. There will be plenty of time for follow-up questions. #heartdefectschat |
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5:07 pm
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UMHealthSystem:
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Thank you for following this chat and here we go!
#heartdefectschat |
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5:07 pm
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UMHealthSystem:
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Q1: How many babies are born with defects each year? #heartdefectschat |
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5:08 pm
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rohye:
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@UMHealthSystem Almost 1 in 100 kids are born with some type of CHD #heartdefectschat |
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5:08 pm
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BigLoveLtlHrts:
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RT @UMHealthSystem: Thank you for following this chat and here we go!
#heartdefectschat |
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5:09 pm
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UMHealthSystem:
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Q2: What is the most common severe birth defect? #heartdefectschat |
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5:09 pm
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rohye:
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@UMHealthSystem Of course all are not severe and don't need operations, but it is the most common type of birth defect #heartdefectschat |
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5:12 pm
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jcharpie:
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@UMHealthSystem The most common form of severe congenital heart disease is hypoplastic left heart syndrome. #heartdefectschat |
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5:13 pm
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RDESK:
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@UMHealthSystem Can I ask about repair to coarctation of the aorta? I had mine done in '65. #heartdefectschat |
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5:13 pm
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UMHealthSystem:
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@jcharpie That's HLHS right? #heartdefectschat |
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5:13 pm
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UMHealthSystem:
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Q3: What causes congenital heart defects? #heartdefectschat |
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5:14 pm
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jcharpie:
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@UMHealthSystem That's HLHS correct! #heartdefectschat |
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5:14 pm
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chicpea73:
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How common is HRHS, Hypoplastic Right Heart Syndrome? My daughter has this. #heartdefectschat |
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5:14 pm
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UMHealthSystem:
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@RDESK What is your question? :) #heartdefectschat |
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5:15 pm
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jcharpie:
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HRHS is often classified as either pulmonary atresia and/or tricuspid atresia. Both defects together are quite rare. #heartdefectschat |
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5:16 pm
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UMHealthSystem:
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Can you clarify what atresia is?
#heartdefectschat |
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5:17 pm
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chicpea73:
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@jcharpie She was diagnosed with HRHS,Pulmonary Stenosis & Tricuspid Stenosis and has had all 3 surgeries @ Duke. #heartdefectschat |
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5:18 pm
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jcharpie:
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@UMHealthSystem Atresia usually refers to a vessel or a heart valve that is absent from birth. #heartdefectschat |
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5:18 pm
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RDESK:
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@UMHealthSystem I hope that made sense... :) #heartdefectschat |
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5:18 pm
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rohye:
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@UMHealthSystem Can be seen w exposures (e.g. drug), genes can contribute, infections can be assoc, but usually don't know #heartdefectschat |
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5:20 pm
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jcharpie:
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@chicpea73 OK. This is a form of tricuspid and pulmonary valve abnormalities that makes the right heart small. #heartdefectschat |
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5:20 pm
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UMHealthSystem:
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@RDESK I don't see your question. Please feel free to ask it and make sure it includes the hash tag #heartdefectschat |
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5:20 pm
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UMHealthSystem:
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Q4: Do most parents today know before the baby is born that there?s a defect? #heartdefectschat |
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5:21 pm
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rohye:
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@UMHealthSystem About 20-40% are diagnosed before birth by ultrasound #heartdefectschat |
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5:22 pm
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chicpea73:
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@jcharpie Thank you! #heartdefectschat |
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5:22 pm
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UMHealthSystem:
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Q5: What surgeries are performed to treat the various defects? #heartdefectschat |
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5:23 pm
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DElibrarian:
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my daughter (now 10 yrs old) was not diagnosed with HLHS until almost two weeks after her birth. #heartdefectschat |
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5:23 pm
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RDESK:
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@UMHealthSystem Sorry forgot the hash tag #heartdefectschat As an adult with CHD, has there been an increase in re-repair surgeries? |
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5:24 pm
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jcharpie:
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@UMHealthSystem It depends on the lesion... for example for HLHS, there is a 3-stage operation or heart transplantation. #heartdefectschat |
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5:25 pm
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jcharpie:
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@DElibrarian This isn't uncommon because most of these babies look good at birth and may not show up until 2 wks or so. #heartdefectschat |
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5:26 pm
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rohye:
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@RDESK Not an increase, the rate depends on original type of repair. Most re-rep can now be done in the cath lab w/o surg #heartdefectschat |
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5:27 pm
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chicpea73:
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U may not get 2 this, but do u c a lot of CHD kids that r petite & underweight, even after surgical corrections? My kid is #heartdefectschat |
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5:27 pm
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DElibrarian:
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she had a 3 stage repair (by Dr. Norwood) & has gone from strength to strength. She's it and healthy - has a normal life. #heartdefectschat |
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5:28 pm
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jcharpie:
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@DElibrarian Sounds great! She is an example of what we try to accomplish with these surgeries. #heartdefectschat |
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5:28 pm
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UMHealthSystem:
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Twitter is slower than usual, but rest assured we will get to your questions. :) #heartdefectschat |
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5:28 pm
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rohye:
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@chicpea73 Yes, many are small, esp early, but have catch up growth #heartdefectschat |
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5:30 pm
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chicpea73:
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@rohye She will b 6 n May & has always been very small. She is just 34lbs now & is otherwise healthy. We worry about it. #heartdefectschat |
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5:30 pm
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UMHealthSystem:
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Q6: What is a shunt? #heartdefectschat |
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5:30 pm
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DElibrarian:
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Lucy was in the 5th % for first couple of years for weight (barely) but once her repairs were completed, caught up fast. #heartdefectschat |
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5:31 pm
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RDESK:
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@rohye Thank you. Mine was a repair to a coarctation in '65. I've had two more OHS since. Anticipating a repair soon #heartdefectschat |
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5:31 pm
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jcharpie:
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@UMHealthSystem A shunt is a tube that connects the systemic (body) circulation and the pulmonary (lung) circulation. #heartdefectschat |
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5:32 pm
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chicpea73:
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@DElibrarian Sydnie has HRHS & had her 3rd in series surgery last June and is still so tiny, hoping she catches up soon! #heartdefectschat |
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5:32 pm
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rohye:
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@chicpea73 She may still have some catch up #heartdefectschat |
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5:32 pm
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rohye:
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@RDESK All for re-coA? #heartdefectschat |
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5:33 pm
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UMHealthSystem:
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Q7: OK, so tell us about this new study. #heartdefectschat |
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5:34 pm
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jcharpie:
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@DElibrarian This is a typical course for catch-up growth. Sometimes we help by giving more calories for a period of time. #heartdefectschat |
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5:34 pm
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rohye:
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@UMHealthSystem It was 4 HLHS, comparing two types of shunts for the Norwood, the 1st or the 3 stages of repair #heartdefectschat |
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5:35 pm
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RDESK:
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@rohye '93 for left ventricular hypertrophy; '04 Bentall Procedure to fix 8.8cm aortic root aneurysm. #heartdefectschat |
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5:36 pm
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chicpea73:
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@rohye Thank you! We hope she will. #heartdefectschat |
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5:37 pm
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rohye:
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@RDESK Whats coming up. Sounds like you've had more than your share already. Those are not usually assoc with CoA. #heartdefectschat |
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5:37 pm
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UMHealthSystem:
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@rohye What is the Norwood for those who may not know?
#heartdefectschat |
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5:39 pm
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rohye:
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@UMHealthSystem HLHS kids have 1 rather than 2 ventricles or 1/2 a heart. The Norwood is the first operation of 3. Cont... #heartdefectschat |
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5:40 pm
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rohye:
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@UMHealthSystem We build a new aorta (main art out of the hrt) which is underdev & place a shunt to get blood to the lungs #heartdefectschat |
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5:41 pm
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UMHealthSystem:
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So the study compared what? #heartdefectschat |
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5:43 pm
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chicpea73:
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R there any studies for children who have other CHDs? I know our HRHS.Org website family would welcome studies on HRHS. #heartdefectschat |
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5:43 pm
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RDESK:
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@rohye Anticipating re-repair of CoA, since mine was done when I was 3mos old. I'm 45 now. #heartdefectschat |
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5:43 pm
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rohye:
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@UMHealthSystem A shunt from the aorta to pulm art (art to lungs) or from hrt to pulm art. Looked @ death/trpt rate @12 mo #heartdefectschat |
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5:45 pm
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UMHealthSystem:
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Q9: Survival rate was better with the shunt, but what about complications? #heartdefectschat |
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5:45 pm
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jcharpie:
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@chicpea73 There are relatively few studies in children with individual lesions because there aren't enough (cont...) #heartdefectschat |
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5:46 pm
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UMHealthSystem:
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@UMHealthSystem which shunt, I guess would be a better question. #heartdefectschat |
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5:46 pm
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jcharpie:
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@chicpea73 patients with similar heart defects at any one institution to do studies. We are now trying to combine (cont..) #heartdefectschat |
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5:47 pm
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jcharpie:
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data from multiple institutions in order to better study these rare defects. #heartdefectschat |
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5:47 pm
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rohye:
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@RDESK Nowadays re-CoA rate is about 5% at experienced centers. In 65 they did a # of types of repair, some w higher rates #heartdefectschat |
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5:47 pm
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UMHealthSystem:
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Break time! Be back at 1 p.m. ... please stay tuned. #heartdefectschat |
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5:49 pm
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chicpea73:
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@jcharpie I would LOVE 2 participate in 1 & 1 day have some answers for my child & 4 other children. Thank you very much! #heartdefectschat |
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5:49 pm
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rohye:
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@UMHealthSystem The hrt to PA was better at 12 mo, but the results were similar by 2 years and more. Cont... #heartdefectschat |
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5:50 pm
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rohye:
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@UMHealthSystem The most important thing is we need further follow-up to know for sure which is better in the long run #heartdefectschat |
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5:52 pm
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UMHealthSystem:
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@jcharpie What resources do we have for people who want to get involved in studies? #heartdefectschat |
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5:53 pm
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RDESK:
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@rohye That's encouraging to hear. Mine was done in London, Ontario. Thank you to @UMHealthSystem for hosting #heartdefectschat |
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5:53 pm
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DElibrarian:
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I'm interested in the transition of care from pediatrics to adult- are there many specialists in this #heartdefectschat |
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5:54 pm
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UMHealthSystem:
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@RDESK You are very welcome! #heartdefectschat |
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5:55 pm
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jcharpie:
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@UMHealthSystem The best bet is to talk to your cardiologist and find out what resources are available nearby. #heartdefectschat |
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5:56 pm
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jcharpie:
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@DElibrarian Most large centers have adult CHD specialists who are trained in medicine and pediatrics. Talk to your doctor #heartdefectschat |
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5:56 pm
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UMHealthSystem:
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If anyone is interested in participating in clinical trials at U-M, you can register online at UMengage.org #heartdefectschat |
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5:59 pm
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chicpea73:
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@UMHealthSystem do you need to live nearby or be a patient? We are in NC and go to Duke, Dr. Camitta/Dr. Jaggers. #heartdefectschat |
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5:59 pm
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UMHealthSystem:
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Q10: What are the downsides for parents to consider if given the choice between the two shunts? #heartdefectschat |
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6:01 pm
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jcharpie:
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@chicpea73 No, u can participate anywhere...but it is usually easiest for families to participate locally (cont...) #heartdefectschat |
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6:01 pm
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UMHealthSystem:
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@chicpea73 Duke has a clinical trials resource online too: http://www.dukehealth.org/clinicaltrials #heartdefectschat |
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6:01 pm
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jcharpie:
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@chicpea73 Duke has a large clinical research program. #heartdefectschat |
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6:02 pm
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rohye:
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@UMHealthSystem Both have up & downsides, jury still out on which is superior. Best to discuss w your MD and tailor to pt #heartdefectschat |
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6:04 pm
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UMHealthSystem:
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Q12: What questions should parents be sure to as their doctor when they learn their child needs heart surgery? #heartdefectschat |
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6:05 pm
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chicpea73:
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@jcharpie, @UMHealthSystem Thank you, I'm going to look into it today! #heartdefectschat |
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6:06 pm
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rohye:
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@UMHealthSystem The experience of surg and cardiol @ managing this problem, esp 4 complex lesions. The overall case volume #heartdefectschat |
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6:06 pm
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jcharpie:
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@chicpea73 You're welcome. #heartdefectschat |
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6:07 pm
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rohye:
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@chicpea73 Duke actually participated in the HLHS shunt trial #heartdefectschat |
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6:07 pm
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UMHealthSystem:
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@chicpea73 That's great to hear. Clinical trials is key to developing treatments for illness and disease. #heartdefectschat |
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6:08 pm
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UMHealthSystem:
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@rohye Is it easy for parents to find info on number of cases a doc has performed? #heartdefectschat |
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6:09 pm
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chicpea73:
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@UMHealthSystem Thanks, I love my girls & I want answers & I want to improve CHD kids' outcome in life. Anything I can do. #heartdefectschat |
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6:10 pm
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UMHealthSystem:
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Q13: Why aren?t there more clinical trials on these surgeries? #heartdefectschat |
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6:10 pm
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rohye:
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@UMHealthSystem It is often on their website. Parents should not B shy about asking or asking 4 2nd opinions if they want #heartdefectschat |
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6:11 pm
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jcharpie:
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@rohye I would add the pre- & post-op care and support services for CHD patients including nutrition, pharmacy, PT, etc. #heartdefectschat |
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6:11 pm
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chicpea73:
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@rohye We asked for 2nd opinion & actually switched hospitals & doctors. We r so happy now. #heartdefectschat |
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6:12 pm
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rohye:
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@UMHealthSystem It is a HUGE task and req $$ (e.g. millions), we (& families) would luv 2 do more but funding is limited #heartdefectschat |
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6:13 pm
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rohye:
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@chicpea73 Jim Jaggers is a good guy. #heartdefectschat |
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6:14 pm
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UMHealthSystem:
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Q14: How many congenital heart defect surgeries does U-M perform annually? #heartdefectschat |
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6:15 pm
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jcharpie:
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@UMHealthSystem We perform approx. 1,000 total cases (650 open heart), 1,000 caths, 10,000 echos. #heartdefectschat |
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6:16 pm
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UMHealthSystem:
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@jcharpie And are these all children? #heartdefectschat |
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6:18 pm
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jcharpie:
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@UMHealthSystem Nearly all are children, but approx 10% of our cases are in adults over 18 y/o. #heartdefectschat |
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6:19 pm
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UMHealthSystem:
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Q15: If a baby ends up needing a transplant can U-M perform that too? #heartdefectschat |
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6:19 pm
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DElibrarian:
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do you find that adults with CHD have difficulty accessing health insurance? Are they eligible for state assistance? #heartdefectschat |
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6:20 pm
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KTChavez:
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@rohye I am just joining. 5yo son has scimitar syndrome/PAPVR. #Tallahassee has no ped hrt spec. We go 2 UF Cngtl Hrt Cntr #heartdefectschat |
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6:22 pm
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rohye:
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@UMHealthSystem Yes, we do about 10/year, a pretty lg program considering there are only about 350/yr worldwide #heartdefectschat |
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6:22 pm
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jcharpie:
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@DElibrarian We do have some issues with health insurance in adult CHD patients, but as far as I know they are eligible #heartdefectschat |
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6:23 pm
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rohye:
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@KTChavez That's a pretty good drive! Has he been repaired? #heartdefectschat |
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6:25 pm
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chicpea73:
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What do cardio's c 4 CHD kids n the future since some of the surg's they had have only been successful 4 a small # of yrs. #heartdefectschat |
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6:25 pm
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UMHealthSystem:
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We're clipping along nicely and I'm adding some of the pre-submitted questions now. #heartdefectschat |
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6:25 pm
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KTChavez:
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@rohye Yes, when he was 27 mnths b/c sympotomatic. Mark Bleiweis did an intra-atrial baffle. He's dg very well. #heartdefectschat |
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6:27 pm
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rohye:
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@chicpea73 Depends on the lesion, we certainly have HRHS pts w Fontans in their 50's. #heartdefectschat |
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6:28 pm
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UMHealthSystem:
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Q17: Re: ToF is it psble 2 have PVR via cath if u don?t yet have a conduit placed if OHS left you no valve? If so, where? #heartdefectschat |
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6:28 pm
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rohye:
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@KTChavez That's great! I know Mark, we peds hrt surgeons have a pretty small club. #heartdefectschat |
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6:28 pm
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KTChavez:
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@rohye UF Cngtl Hrt Ctr is abt 2.5 hrs for our CHD parents. How many PAPVR kids does UM see? #heartdefectschat |
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6:28 pm
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jcharpie:
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@rohye Some concerns include exercise intolerance and rhythm disturbances. #heartdefectschat |
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6:30 pm
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jcharpie:
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@UMHealthSystem No, the current transcatheter pulmonary valve is only approved with a conduit in place, but hopefully soon #heartdefectschat |
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6:31 pm
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chicpea73:
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@rohye Wow! That's the first time I've heard that. So, the future can look bright! #heartdefectschat |
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6:31 pm
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rohye:
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@KTChavez PAPVR probably a 1-3/month, Specifically Scimilar, prob 1-2/year. #heartdefectschat |
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6:31 pm
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UMHealthSystem:
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Q18: Are there recent advances in treatment of PLE? What is PLE anyway? #heartdefectschat |
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6:32 pm
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KTChavez:
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@rohye How cool is that? I know many of his families thru lcl support grp I help run. We all love & admire Dr. B vry much. #heartdefectschat |
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6:33 pm
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jcharpie:
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@UMHealthSystem PLE is protein-losing enteropathy which is a condition that may rarely occur in patients with HLHS (cont.. #heartdefectschat |
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6:34 pm
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rohye:
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@chicpea73 Other thing 2 remember, when shes 50, medicine will be far more advanced, so anything she needs will B better! #heartdefectschat |
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6:34 pm
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KTChavez:
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@rohye Sme use PAPVR & Scmtr Synd synonymsly. Can you clarify difference? Is it due to rt lung issues? I shld know by now. #heartdefectschat |
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6:34 pm
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jcharpie:
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There are no new proven therapies, but some pts respond to dietary changes, steroids or heparin. #heartdefectschat |
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6:35 pm
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rohye:
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@KTChavez Don't know him as well as some others, but hear good things about him. #heartdefectschat |
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6:35 pm
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UMHealthSystem:
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Q19: Is there an increased incidence of plastic bronchitis recently? #heartdefectschat |
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6:35 pm
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rohye:
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@KTChavez Scmtr is just a rare form of PAPVR #heartdefectschat |
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6:37 pm
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chicpea73:
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@rohye Yes, I pray she lives to see that. #heartdefectschat |
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6:38 pm
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rohye:
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@UMHealthSystem PB or protein casts clogging lungs is prob not really inc N incidence, but there R now more Fontans @risk. #heartdefectschat |
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6:39 pm
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rohye:
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@chicpea73 Sounds like she is doing well, and there is no reason not to hope for her to! #heartdefectschat |
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6:39 pm
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UMHealthSystem:
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OK last pre-submitted question ...
#heartdefectschat |
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6:40 pm
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UMHealthSystem:
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Q20: What precautions should we take w/our CHD kids who r school aged & have had their series of surgeries? #heartdefectschat |
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6:41 pm
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DElibrarian:
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my daughter's cardiologist is reluctant to limit her at all, but does caution against isometric exercize #heartdefectschat |
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6:41 pm
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chicpea73:
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@rohye Thank you. When she was born & taken 2 another hospital her chances were very grim, so it's hard 2 see that far. #heartdefectschat |
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6:42 pm
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KTChavez:
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@rohye Are there any CHDs that are considered "cured" after OHS? #heartdefectschat |
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6:42 pm
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jcharpie:
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@UMHealthSystem Generally we recommend that kids participate in activities that are heart healthy, but (cont...) #heartdefectschat |
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6:43 pm
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jcharpie:
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@UMHealthSystem they should avoid high impact contact sports. We hope otherwise that they live full normal lives. #heartdefectschat |
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6:44 pm
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UMHealthSystem:
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To those of you who are following this chat, please feel free to ask additional questions - we are here until 2 p.m. #heartdefectschat |
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6:44 pm
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jcharpie:
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@DElibrarian I would agree that high isometric exercise (significant weight lifting) may not be great, but some may be OK. #heartdefectschat |
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6:45 pm
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rohye:
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@KTChavez I'd consider most cured in that they should not need future surg, have basically norml hrts & sig no limitations #heartdefectschat |
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6:46 pm
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jcharpie:
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@DElibrarian Ped Cardiologists are working on consensus recommendations so that these issues are more clear in the future #heartdefectschat |
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6:47 pm
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KTChavez:
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@jcharpie How does significant weight lifting affect pple w/ severe CHDs, such as HLHS? #heartdefectschat |
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6:48 pm
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rohye:
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@KTChavez Hi blood pressure, Olympic powerlifters can get BP up to 400! Casual working out is fine. #heartdefectschat |
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6:49 pm
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DElibrarian:
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@jcharpie that's good to hear. Where do u think the gdlines might be published? #heartdefectschat |
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6:50 pm
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RDESK:
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@UMHealthSystem Since you offered: Does there exist collaboration with the Canadian hospitals for research information? #heartdefectschat |
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6:50 pm
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jcharpie:
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Most likely through a joint effort between the Amer Heart Assoc and Amer Coll of Cardiology; some already exist #heartdefectschat |
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6:51 pm
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KTChavez:
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@rohye WOW! That's incredible. #heartdefectschat |
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6:52 pm
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rohye:
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@KTChavez They did a study where they put arterial lines in powerlifters and measured BP. Amazing. #heartdefectschat |
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6:54 pm
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rohye:
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@RDESK Yes, in fact Sick Kids in Toronto is a member of the Ped Hrt Netwk, our main resch body, and was in the HLHS study #heartdefectschat |
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6:55 pm
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KTChavez:
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@rohye Spkng of studies: Is it safe 2 say that altho a stdy mght not B spcfc 2 CHD, thre may be info in it relative 2 CHD? #heartdefectschat |
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6:58 pm
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rohye:
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@KTChavez Not necessarily, CHD kids are special! Probably not a good idea in general from adult 2 kid, which is often done #heartdefectschat |
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6:58 pm
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DElibrarian:
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thanks for the chat- it was really innovative and informative- Please do it again! and good luck to all the CHD kids #heartdefectschat |
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6:59 pm
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UMHealthSystem:
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Thank to everyone who participated in this chat! #heartdefectschat |
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6:59 pm
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KTChavez:
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@rohye Ah, OK, I see what you mean: because children are not little adults. Thank you. #heartdefectschat |
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6:59 pm
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rohye:
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@DElibrarian You're welcome. Thanks for participating. #heartdefectschat |
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7:00 pm
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jcharpie:
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@DElibrarian Happy to participate, and I hope that we were helpful. #heartdefectschat |
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7:00 pm
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UMHealthSystem:
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We will post an archive of it online at http://www.med.umich.edu/mott/chc/tweet.html #heartdefectschat |
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7:00 pm
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chicpea73:
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Thank you all so much! Can't wait 2 share this info w/our Mended Hearts Chptr @ Duke & my friends/family & Drs, if its ok. #heartdefectschat |
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7:01 pm
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rohye:
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@chicpea73 You're welcome and sure... #heartdefectschat |
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7:11 pm
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MattTheHearn:
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Contact AI. They have a program for it. @DElibrarian: I'm interested in the transition of care from pediatrics to adult #heartdefectschat |
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7:47 pm
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savhrts:
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RT @UMHealthSystem: Q14: How many congenital heart defect surgeries does U-M perform annually? #heartdefectschat |
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8:23 pm
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SomerLS:
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@jcharpie Have a friend go to London to get son a trans-cath PVR w/out conduit by dr. Boenhoffer (sp?) and was a success! #heartdefectschat |
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10:16 pm
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UMHealthSystem:
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Read today's tweet chat transcript here: http://ow.ly/YL8M #heartdefectschat |
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11:45 pm
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chicpea73:
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RT @UMHealthSystem: Read today's tweet chat transcript here: http://ow.ly/YL8M #heartdefectschat |
