Mount Sinai Heart's pediatric and congenital heart specialists offer a full spectrum of life-saving procedures. We provide everything from minimally invasive procedures to the most advanced and innovative surgeries. With some treatments, patients may even go home the same day, while others will need an overnight stay. More complex interventions may require a longer hospital stay. Some of the techniques we use are:
Our interventional cardiologists perform cardiac catheterizations on infants, children, and adults with a wide range of congenital heart diseases. In this minimally invasive procedure, our doctors insert a thin tube into a blood vessel and thread it to the heart, treating the problem directly without requiring open-heart surgery. We perform more than 400 pediatric catheterization procedures a year.
We treat a variety of conditions using minimally invasive cardiac catheterization, including atrial septal defect patent foramen ovale, patent ductus arteriosus, coarctation of the aorta, aortic stenosis, and pulmonary stenosis. We are also a leading center for newer techniques including transcatheter pulmonary valve replacement with the melody and sapien valves. We discharge most patients the same or the next day and they can typically resume normal activities quickly.
A catheter ablation is a procedure performed by an electrophysiologist or heart rhythm specialist designed to reduce and/or eliminate arrhythmias. In this procedure, we thread catheters into the heart's blood vessels, and create a computer-generated map of the heart’s electrical flow. This map pinpoints the area that is causing the abnormal rhythm and enables us to send use low-voltage radio waves or cooling treatments through the wires to eliminate the abnormal tissue. The rhythm problems we treat most often by ablation are supraventricular tachycardias such as Wolff-Parkinson-White syndrome, concealed accessory pathways, AV node reentrant tachycardia, and ectopic atrial tachycardia. We also treat ventricular tachycardias and atrial flutter using ablation.
Additionally, some infants and children have heart rhythms that are either too slow or too fast and require ongoing therapy. For these patients, our doctors can implant a device such as a pacemaker or an implantable cardioverter defibrillator (ICD). Doctors at Mount Sinai were the first to implant a new-generation ICD called a subcutaneous ICD or S-ICD, which does not require any contact with the heart muscle and eliminates many potential problems of ICDS as children grow.
Our Cardiac Catheterization Laboratory at The Mount Sinai Hospital has a dedicated room and staff for pediatric electrophysiology procedures.
Congenital Heart Surgery
Surgery for congenital heart malformations in infants and children has major clinical and technical challenges. The heart structures are extremely small, and there is a wide spectrum of abnormalities.
We have developed surgical methods specifically for pediatric patients that speed up recovery, decrease pain, and leave almost invisible scars. By accessing the heart through small incisions below the armpit, we can do many conventional heart operations including atrial septal defect repair, ventricular septal defect repair, and Tetralogy of Fallot repair.
Heart Transplantation and Ventricular Assist Devices
Mount Sinai Heart’s pediatric transplant program launched in 1990. We offer heart transplantation as a life-saving measure when all other strategies have failed. We use a multidisciplinary transplant team to evaluate and treat each patient, including surgeons, cardiologists, social workers, psychiatrists, dieticians, and infectious disease specialists.
For patients who cannot wait for a donor heart to become available, we use ventricular assist devices, mechanical pumps that support failing hearts. These devices act as a "bridge" to transplant for patients waiting for a donor.
The Mount Sinai Hospital was one of only 10 medical centers in the United States initially approved to use the Berlin Heart, which maintains blood flow in babies and small children with serious heart failure. This newer generation of artificial heart differs from adult ventricular assist devices in that it sits outside a child's small chest and is controlled by laptop computer.
We use other ventricular assist devices, including the Heartware, Heartmate, and the Syncardia Total Artificial Heart, to help bridge larger children and adolescents with failing hearts to heart transplant.
Treatment for Specific Conditions
At Mount Sinai Heart, we have experience treating a wide range of pediatric and congenital heart diseases. Below are our approaches for some of these conditions:
Atrial Septal Defects
Treatment for atrial septal defects depends on the size of the opening. We can close these defects surgically or with a catheter-delivered closure device such as the Amplatzer Septal Occluder and the Gore Cardioform Occluder. We have extensive experience with both these occluders and success rates for closure are excellent. After the procedure, we are typically able to discharge patients the following day.
We perform surgical atrial septal defect closure though a small incision under the armpit which makes the scar invisible. Patents have excellent outcomes and we are usually able to discharged them within two days after surgery.
Patent Foramen Ovale
Typically, patients with a patent foramen ovale (PFO) do not require treatment. If you have had a stroke and also have a PFO, we may be able to perform a PFO closure to reduce the risk of future stroke. At Mount Sinai Heart we have extensive experience in closing PFOs with a closure device and can typically discharge patients the same day.
Ventrical Septal Defects
The location and size of the ventricular septal defect helps determine the most appropriate treatment. Small holes require long-term monitoring and may close on their own while larger holes may require surgical treatment. Some ventricular septal defects may be closed in a catheterization laboratory.
Patent Ductus Arteriosus
We can usually treat patients who require treatment for patent ductus arteriosus (PDA) by closure in a cardiac catheterization laboratory using a variety of plugs specifically designed for this purpose. Our success rates for this procedure exceed 99 percent. For premature infants, we usually perform PDA closure surgically from a small incision in the side of the chest.
Complex Heart Disease
Patients with more complex forms of heart disease have their therapies individualized. Examples of complex conditions we commonly treat include:
- Tetralogy of Fallot
- Transposition of the Great Arteries
- Tricuspid Atresia
- Double Outlet Right Ventricle
- Mitral Atresia
- Hypoplastic Left Heart Syndrome
- Atrioventricular Canal Defect
- Pulmonary Atresia
- Single ventricle
Many treatment options for pediatric and congenital heart disease require the patient to be put under anesthesia. Our board-certified pediatric cardiac anesthesiologists are highly specialized in caring for children who undergo surgery for pediatric and congenital heart disease.
"Babies and children are not small adults," says Ingrid B. Hollinger, MD, Professor of Anesthesiology and Pediatrics and Chief of Pediatric Cardiac Anesthesia. "That is why there is subspecialty training in pediatric anesthesia."
At Mount Sinai Heart, our anesthesiologists use caudal anesthesia to ease a child's transition from the operating room to the intensive care unit. This spinal anesthesia bathes the nerve roots that lead to the chest. It combines short-acting anesthetic agents that leave the body quickly with a long-acting narcotic to diminish pain in the first hours after surgery. This approach enables us to remove mechanical ventilation while the patient is still in the operating room.
As a result, we can generally reunite parents with their child minutes after the end of a procedure. When they leave the procedures room, these children are not connected with pain or ventilator tubes.