Texas 6th-graders to get heart exams / Pilot program by TEA will look for deadly defects

By ALEXIS GRANT
Staff

Thousands of Texas sixth-graders soon will be among the first students in the nation tested for potentially fatal heart abnormalities that can strike children without warning during athletic events and even non-stressful activities.

But even the screening that will be offered in the Texas Education Agency's $1 million pilot program probably would not have caught the congenital defect that caused the deaths of two 13-year-old girls in the Houston area in the past week, doctors said Tuesday.

"It's so hard to identify congenital problems in kids that we need to do some screening before they go into high-endurance sports," said Dr. David McPherson, president of the Houston chapter of the American Heart Association and chief of cardiology at the University of Texas Health Science Center. "Because of our climate, our children in this part of the country are prone to developing problems."

By the end of January, the TEA plans to begin screening about 4,500 sixth-graders in Texas public schools.

The screening will include a physical exam, an electrocardiogram, or EKG, which tests the electrical activity of the heartbeat, and an echocardiogram, an ultrasound that shows the shape and size of various parts of the heart, according to TEA documents.

The agency has not decided which schools will be involved in the program, which state lawmakers approved last year. If the pilot is successful, the TEA will determine how best to expand the program to all sixth-graders in the state, which could cost tens of millions of dollars, McPherson said.

Dozens have died in Texas

Parents who want their children to participate will have to sign a consent form, he said.

Since 2001, about 60 primary school students in Texas have died from sudden cardiac death, which can be caused by various abnormalities, the TEA reported. Several students in the Houston area died last school year alone.

But while the most common cause of sudden cardiac death, a thickening of the heart muscle called hypertrophic cardiomyopathy, can be detected through an echocardiogram, the expensive test won't always catch other life-threatening abnormalities.

The two students who died in recent days while playing basketball suffered from a coronary artery anomaly, Galveston County's chief medical examiner, Dr. Stephen Pustilnik, said Tuesday. He conducted both autopsies.

Both Kailynn Boclair, a Crosby Middle School student in Hitchcock who collapsed and died Monday night, and Jocelyn Arias, who died Jan. 9 after collapsing at Sugar Land Middle School, had a defect that caused compression of the left coronary artery during exercise and cut off the blood flow to the heart, Pustilnik said.

That is a rare coincidence, doctors said, since coronary artery anomalies affect only about 1 percent of the population.

Both girls seemed healthy

"Unfortunately, none of that (screening) would have been of any use in these two cases," said Dr. Miguel Valderrabano, director of the division of cardiac electrophysiology at Houston's Methodist Hospital.

For that reason and the high cost of the tests, he said it's unreasonable to screen every student athlete.

"If we had a magic test to detect these conditions, we'd be using them," Valderrabano said.

Boclair and Arias were thought to be healthy, although Arias had collapsed the week before her death at basketball practice and had visited a doctor for an exam, Pustilnik said. Boclair showed no symptoms before she collapsed, he said.

Costly for parents

Many, but not all, of the abnormalities that cause sudden cardiac death are aggravated by physical exercise and dehydration. Anyone who experiences dizziness, chest pain or fainting should be examined by a physician before participating in sports, doctors say.

An echocardiogram, the more sophisticated of the two tests, usually costs about $2,000, said Dr. Jim Willerson, a cardiologist who is president-elect of the Texas Heart Institute at St. Luke's Episcopal Hospital and president of the University of Texas Health Science Center at Houston.

Insurance companies sometimes cover at least part of the test if it's ordered by a doctor, he said, but parents who want their seemingly healthy children screened before participating in sports likely would have to pay the full cost.

Some parents have been turning to Stephen Gimenez, a Champions resident who offers echocardiograms and EKGs for $150 through his business, Sports Fit USA.

Gimenez said the money isn't a concern. He said he and his wife began offering the screening about a year ago after one of their teenage son's friends suffered sudden cardiac death. So far, he said, they've paired mostly with local private schools to test about 400 young athletes, several of whom screened positive for a defect.

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DEADLY DEFECT

The two recent deaths of 13-year-old athletes have been linked to the same congenital heart defect, in which the left coronary artery becomes compressed between the aorta and pulmonary artery.