Pediatric and Congenital Heart Disease Treatment
Mount Sinai Heart's pediatric and congenital cardiac specialists offer a full spectrum of life-saving procedures. We provide every possible approach, from minimally invasive procedures to the most advanced and innovative surgeries available for the treatment of congenital heart disease.
Cardiac Catheterization and Percutaneous Intervention
Pediatric cardiologists, surgeons, and interventionists tend to be innovators by nature. Because these physicians need to devise therapies specifically for children, cross-pollination is common.
"We need to invent and borrow concepts from other specialties," says Barry Love, MD, Assistant Professor of Cardiology and Director of the Pediatric and Congenital Catheterization Laboratory and the Pediatric Electrophysiology Laboratory. "The collaborative and supportive environment at Mount Sinai Heart makes this possible."
Our interventionists perform cardiac catheterization on infants, children, and adults with a wide range of congenital heart diseases. In this minimally invasive procedure, doctors insert a thin tube into a blood vessel and thread it to the heart, treating the problem directly without requiring open-heart surgery.
The Mount Sinai Heart Cardiac Catheterization Laboratory performs 375 pediatric catheterization procedures a year. The lab has a dedicated pediatric room and staff.
Common congenital heart disease treatments include:
- Atrial septal defect (ASD). Closing a hole between the heart's upper chambers.
- Ventricular septal defect (VSD). Repairing a hole between the heart's lower chambers.
- Patent ductus arteriosus (PDA). Sealing a blood vessel that did not close on its own after birth.
- Coarctation of the aorta. Widening a narrow artery by balloon angioplasty and stent placement.
- Valvular stenosis. Widening constricted heart valves, such as the aortic, mitral, pulmonic, and tricuspid valves.
Mount Sinai Heart has a success rate of more than 97 percent for procedures such as atrial septal defect closure. Our physicians maintain accuracy by using sophisticated imaging technologies during interventional procedures. Most patients undergoing procedures in the catheterization lab receive local anesthesia, spend one night in the hospital, and quickly resume normal activities.
Treatment of Arrhythmia in Children
Children can experience abnormal heart rhythms (arrhythmias) whether or not they have congenital heart disease. Dr. Love performs about 75 electrophysiology procedures annually.
Mount Sinai Heart cardiologists perform a procedure called catheter ablation to permanently eliminate arrhythmias. In this intervention, catheters are threaded into the heart's blood vessels. A computer produces a detailed map of its electrical flow, pinpointing the area causing the abnormal signals. Doctors then send a barely noticeable burst of low-voltage radio waves or cooling treatments through the wires to destroy the tissue at fault.
Some infants and children have heart rhythms that are either too slow or too fast and which require ongoing therapy. For these patients, our doctors can implant a device such as a pacemaker or an implantable cardioverter defibrillator. The Mount Sinai Heart Cardiac Catheterization Laboratory has a dedicated room and staff for pediatric electrophysiology procedures.
Advances in Pediatric Cardiac Surgery
Mount Sinai Heart has developed a revolutionary new surgical method for pediatric patients. By accessing the heart through small incisions below the armpit, we enable children to recover faster, experience less pain after surgery, and have virtually invisible scars. Khanh Nguyen, MD , Associate Professor of Cardiothoracic Surgery and Chief of Pediatric and Congenital Heart Surgery, created this new approach. Read more about Mount Sinai's watershed advances in cardiac surgery.
Mount Sinai Heart operates on roughly 250 children with congenital heart disease every year. Our surgeons repair or replace defective heart valves, re-route blood vessels to the correct destinations, and close holes in the heart's walls. For patients with heart conditions that cannot be treated with surgical repair, we place mechanical assist devices or perform heart transplant surgery.
Our surgeons operate on patients with many different heart conditions. For many patients, we can offer ministernotomy, a technique using an incision significantly smaller than that usually required for open-heart surgery.
Helping Patients Get Home Faster
"Mount Sinai Heart has been quite successful at getting patients home, where they can sleep better, eat better, and heal better," says Dr. Nguyen. "We use innovative protocols to modify surgical techniques and the recovery process."
Mount Sinai Heart employs board-certified pediatric cardiac anesthesiologists, physicians who 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."
Mount Sinai Heart anesthesiologists use caudal anesthesia to help 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. Short-acting anesthetic agents that leave the body quickly are combined with a long-acting narcotic to diminish pain in the first hours after surgery.
This method allows for removal of mechanical ventilation in the operating room. Parents can be reunited with their child minutes after the end of most procedures, and children are unencumbered by pain or ventilator tubes.
Average Lengths of Stay Following Selected Operations:
On average, parents can expect the following lengths of stays for their children:
|Atrial septal defect closure:||1.5 days|
|Aortic coarctation repair:||2 days|
|Aortic stenosis surgery:||2.3 days|
|Atrioventricular canal defect repair:||2.6 days|
|Ventricular septal defect repair:||2.8 days|
|Tetralogy of Fallot repair:||3.3 days|
|Complex ventricular septal defect repair:||3.6 days|
|Transposition of the great arteries surgery:||4.7 days|
|Heart transplant:||5.5 days|
Heart Transplantation and Ventricular Assist Devices
Mount Sinai Heart has performed an average of five pediatric heart transplants per year since our pediatric transplant program began in 1990. Heart transplantation is offered as a life-saving measure when all other strategies have failed or a defect cannot be repaired. We use a multidisciplinary transplant team to evaluate each patient. This team includes surgeons, cardiologists, social workers, psychiatrists, dieticians, and infectious disease specialists.
For patients who cannot wait for a donor heart to become available, Mount Sinai surgeons use ventricular assist devices — mechanical pumps that support failing hearts. These devices act as a "bridge" to transplant for patients waiting for a donor.
Mount Sinai was one of only 10 medical centers in the United States initially approved to use the Berlin Heart. 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.
World Class Heart Valve Surgery
Mount Sinai Heart is home to some of the most respected and innovative valve surgeons in the world. Surgery for congenital valve malformations in infants and children has major clinical and technical challenges. The valves are extremely small, there is a wide spectrum of abnormalities, and valve defects are sometimes associated with other heart abnormalities.
Until recently, damaged valves could be treated only by replacement using either a donor or mechanical valve. Today, there is a trend toward repairing rather than replacing valves.
David H. Adams, MD, Professor and Chair of Cardiothoracic Surgery and Director of the Mitral Valve Program at Mount Sinai Heart, has an international reputation as an authority on valve repair. He has an outstanding success rate and an unparalleled performance record in achieving durable repair.
Dr. Adams's groundbreaking techniques and inventions have been adopted by surgeons around the world. Dr. Adams has collaborated with Dr. Khanh Nguyen to operate on adolescents and young adults in need of valve repairs.
Paul Stelzer, MD, Professor of Cardiothoracic Surgery, is one of only a handful of physicians in the world who have performed more than 450 Ross procedures, including some in older adolescents. The Ross procedure removes the diseased aortic valve and replaces it with the patient's own healthy pulmonary valve, which is anatomically very similar.
The procedure is designed to be a long-term solution for younger, active patients with aortic valve disease, making it ideal for children. Very young patients whose hearts have not yet grown to adult size can be treated with balloon valvuloplasty until their valves are a suitable size, usually around the age of 10.