Children's heart ailments handled with care on 'ER'

"ER"

NBC, Thursday, March 26, 10 p.m.;

Episode: "I Feel Good"

The premise

At a winter reunion of a summer camp for children who've had open heart surgery, camp veteran Vera befriends a first-time camper, Emily, whose parents prefer that she avoid exertion in the wake of several surgeries and finally a heart transplant for an underdeveloped heart.

In contrast, Vera is very active at the camp. She was born with the congenital heart problem known as tetralogy of Fallot -- defined by a hole in the heart, a thickened pulmonic valve, a thick right ventricle and an abnormal, or overriding, aorta. She reports having had a "Blalock-Taussig shunt" (a procedure used to shunt arterial blood to the lungs in babies who are born not breathing). Amid a high-speed game of ball, Vera collapses and her implanted defibrillator fires six times, causing her to jerk several times and black out.

At County General Hospital, doctors determine that her defibrillator fired simply because of the higher heart rate associated with exercise. The camp supervisor, known as Big Kahuna, is also chief of pediatric cardiology at County General. Although he wants to keep Vera in the hospital, she wants to return to camp. Kahuna agrees to reset the device's range to allow heart rates up to 200 per minute before firing as long as Vera agrees not to overexert herself during the remainder of the camp.

The medical questions

Can children participate in vigorous exercise after open-heart surgery? Are tetralogy of Fallot and its repair and subsequent course described accurately? Does a defibrillator fire because of a rapid heart rate (sinus tachycardia), and can this be adjusted? Can someone else be shocked by touching a person when their defibrillator is firing? Is a hypoplastic (underdeveloped) heart treated with temporary procedures, followed by heart transplant? What is the prognosis for children who've had transplants?

The reality

In this episode, reality and unreality combine rather effectively. The children's program -- Camp del Corazon -- actually exists, as do similar camps around the country. This one was founded in 1995 by pediatric cardiology nurse Lisa Knight and Dr. Kevin Shannon (the real-life Big Kahuna), director of pediatric electrophysiology at UCLA.