Paediatric (Ped) Cardiology

The science of paediatric cardiology includes understanding the anatomy and function of the normal heart, as well as the development of abnormalities during foetal life and those acquired after birth. When necessary, these abnormalities may be treated medically or repaired by surgical or non-surgical (percutaneous) intervention. The treatment of congenital heart disease can begin before birth and continue into adulthood. The reported incidence of congenital heart disease is 8-10/1000 live births, and 30-50% of these defects are critical, requiring intervention in the first year of life.

Current advances in treatment allow 85% of children with critical heart disease to survive.

The Paediatric cardiac program at Max Super speciality Hospital was started recognizing the pressing need for quality care for children with heart disease at a reasonable cost. The program is now recognised as one of the leading paediatric heart programs in India and is a preferred destination for patients from all over India and other countries. The program is known for the quality and range of services that are provided. A multidisciplinary team from Paediatric Cardiology, Cardiac surgery, and Critical care provide continuous care for children with heart disease.

Paediatric Cardiology Services :

Paediatric cardiology services at our Centre specialises in the diagnosis and management of all forms of congenital heart disease from prenatal cardiology to adulthood. We also specialise in the diagnosis and management of acquired heart problems seen in children, such as Rheumatic heart disease, Kawasaki disease, Multisystem inflammatory syndrome in Children (MIS-C), bacterial endocarditis, and systemic illnesses like liver disease, renal disease, anaemia, thyroid and diabetes mellitus etc. affecting the heart. At Max Hospital, we have a running advanced paediatric program; we get regular referrals for cardiac evaluation in various inherited/genetic diseases like Marfan syndrome, Long QT syndrome, Trisomy, and connective tissue disorders.

Our Paediatric Cardiology unit is committed to providing the highest quality of cardiac care to the patients by:

• Providing state-of-the-art medical care to our patients with congenital heart disease
• Educating and counselling our patients and families regarding their medical and emotional needs in a warm and compassionate way.
• Developing and maintaining a strong relationship with the physicians in the community and participating in activities that promote the health and well-being of children with heart disease.

Diagnostic Services

Comprehensive imaging:

• Echocardiography: The echocardiography laboratory evaluates patients ranging from the foetus to the adult with congenital heart disease, providing high-quality diagnostic services in a patient-friendly environment.
• Transthoracic Echocardiography
• Transesophageal echocardiography (TEE): We also have paediatric and neonatal TEE probe, which is mainly used during operation theatre during complex surgical procedures.
• Intra Operative echocardiography: There is an active intra-operative epicardial and transesophageal echocardiography service that provides diagnostic support for the surgical program.

Advanced cardiac imaging:

• Three-Dimensional echocardiography
• Multislice CT scan (slice CT)
• Cardiac MRI

Cardiac Catheterization services

• Diagnostic cardiac catheterization and angiography
• Catheter Interventions:

For the majority of congenital cardiac defects, surgery is the mainstay of treatment, and often this is an open-heart operation. Today newer developments in cardiac catheterization technology allow the treatment of heart defects in selected patients without an operation. This avoids the trauma of surgery and allows very rapid recovery and short hospital stays. The procedures are performed in the cardiac catheterization laboratory, and a needle prick in the groin is the access to the heart, so there is no visible scar.

Closure of defects

• Atrial septal defects (ASD)
• Patent Arterial Ducts (PDA)
• Ventricular Septal Defects (VSD)
• Coronary artery fistula
• Pulmonary arteriovenous malformation
• Aortopulmonary collaterals

Balloon dilatation:

• Aortic Valve, Pulmonary valve, Mitral valve, Coarctation of the aorta and pulmonary artery
• Balloon atrial septostomy

Stenting

• Coarctation of the aorta, pulmonary artery
• Ductal stenting in the neonate

Foetal cardiac program : Prenatal diagnosis and counselling of pregnant mothers with a suspected heart defect in the foetus, prenatal treatment for foetuses with cardiac rhythm disorders.

Foetal Echocardiogram: Foetal echocardiography is a detailed ultrasound of the foetal heart and is optimally performed at 18 -22 weeks of gestation. Some heart problems are correctable and require elective intervention after birth, while some are critical and may require immediate attention before or after delivery. Knowing about a potential heart problem prior to delivery gives the family a chance to prepare for the challenges they may face.

Paediatric Cardiac surgical program:

Surgical Procedures:

The open heart procedures include:

• Shunt Lesion: Closure of ASD, VSD closure, AVSD repair, Aortopulmonary window
• Cyanotic Heart disease
• Tetralogy of Fallot repair, Double outlet right ventricle (DORV)
• APVC repair
• Arterial switch operation, Senning operation
• Double switch operation
• Rastelli Procedure
• Repair of Truncus arteriosus
• Glenn and Fontan's operation
• Valve Repair and replacement for congenital and acquired heart disease

Others are

• ALCAPA repair
• Surgery for Ebstein's anomaly

The closed heart procedures include:

• PDA ligation
• Coarctation of Aorta repair
• PA banding
• BT shunt

Adults with CHD:

• Adults with unrepaired CHD
• Adult with repaired congenital heart disease

The most rapidly growing population of patients with congenital heart disease is the adult with repaired congenital heart disease. We provide coordinated and comprehensive care for such patients at our Centre.

Electrophysiology:

The program encompasses the full spectrum of paediatric electrophysiology. We perform invasive electrophysiology studies using standard and advanced techniques in patients with structurally normal hearts as well as in patients with congenital heart disease and offer both radiofrequency ablation and transcatheter cryoablation. Surgical mapping and intraoperative cryoablation are also available in patients with congenital heart disease. We perform autonomic testing using tilt table technology. The EP service also implants all transvenous pacemakers, including biventricular pacemakers and implantable cardioverter-defibrillators.

Review

Reviewed by Dr. Munesh Tomar, Director - Paediatric Cardiology on 30-Jan-2023.