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Cardiology

Our Expertise

The Division of Pediatric Cardiology provides care for a wide range of conditions and diseases that affect newborns, infants, children, adolescents and young adults. These conditions include:

• acquired heart disease
• adult congenital heart disease
• arrhythmias
• cardiomyopathy
• congenital heart defects and anomalies
• heart failure
• pulmonary hypertension
• single ventricle anomalies, including Tetralogy of Fallot

Diagnostic Services

Morgan Stanley Children's Hospital has one of the few dedicated pediatric cardiopulmonary labs in the metropolitan area. Cardiopulmonary exercise testing is used to study the heart, lungs, and muscles at rest and during intense exercise. These tests may help to identify the cause of chest pain, evaluate cardiopulmonary fitness, assess post-operative heart function, detect arrhythmias, monitor drug efficacy within the child, or determine whether it is safe for a child to participate in regular activity. By observing the body's responses to exercise, physicians can also determine how best to use exercise to help maintain good health.

Through cardiac or pulmonary exercise testing or a combination of the two, our physicians can answer questions such as:

• Does the medicine improve heart rate and blood pressure?
• Did surgery treat the abnormal cardiac rhythm?
• Does the exercise cause changes in the patient's breathing that should be addressed?
• Is the child unable to exercise because the exercise induces asthma or causes other respiratory discomfort?
• Does the child do better with one type of exercise than another?

Exercise tests are administered by a physician and an exercise physiologist and are designed to provoke previously observed symptoms (i.e. chest pain or shortness of breath) in a controlled testing environment. These tests may include:

Cardiovascular stress test - performed on a treadmill while an electrocardiogram measures heart rate and blood pressure changes during a protocol that consists of an increase in speed and incline. Oxygen consumption can also be monitored.

Progressive exercise test - performed on a treadmill or cycle ergometer and involves three different types of breathing tests: slow vital capacity, forced vital capacity, and maximum voluntary ventilation, as well as heart and blood pressure monitoring

Studies are performed in the Hospital's Cardiac Catheterization Laboratory to evaluate patients with congenital and acquired cardiovascular disorders, pulmonary hypertension, cardiac arrhythmias, as well as cardiac and lung transplantation patients pre- and postoperatively.

Therapeutic Services

Our Division offers particular expertise in pediatric interventional cardiology, a unique specialty that involves the non-surgical treatment of congenital and acquired cardiovascular disorders. Our interventional cardiologists are specifically trained in pediatric procedures that require special attention to smaller anatomy, making access to the vascular system more challenging then those performed in an adult. Many of the pediatric interventional procedures that have become the standard of care worldwide have been developed by interventional cardiologists at Morgan Stanley Children's Hospital.

These procedures often only require one day of hospitalization and use catheter techniques that can prevent the need for open heart surgical repair. The Hospital's Pediatric Cardiac Catheterization Laboratory performs more than 1,200 cardiac catheterization procedures a year making it one of the largest cath labs in the tristate area.

They include:

• balloon valvuloplasty of the aortic and pulmonary valves
• balloon valvuloplasty for distal pulmonary artery narrowing (stenosis)
• angioplasty, including dilation and stent implantation, to open narrowed arteries and veins
• balloon atrial septostomy to improve mixing of oxygen-rich and oxygen-poor blood to ensure that the body's oxygen saturation remains in a safe range
• atrial septoplasty or blade septotomy to treat pulmonary hypertension
• pulmonary artery dilation and stent implantation
• coil and Amplatzer device closure of open ductus arteriosus;atrial septal defect;Fontan fenestration; and patent foramen ovale -- a defect in the wall between the two upper chambers of the heart
• closure of ventricular septal defect
• percutaneous pulmonary valve replacement -- a new approach for the management of pulmonary regurgitation and conduit obstructions

The Division's active arrhythmia management and electrophysiology service provides care for patients with complex cardiac arrhythmias. Our pediatric cardiac electrophysiologists manage one of the largest programs of its kind in the metropolitan region, performing more than 100 pediatric ablation and electrophysiology studies each year. They are specifically trained in performing pediatric procedures that require an in-depth knowledge of anatomical development and the use of smaller catheters and equipment, with a goal toward eliminating the need for chronic anti-arrhythmic therapies. For the safety and comfort of the child, the majority of studies are performed under general anesthesia by an outstanding and experienced pediatric anesthesia team that has managed hundreds of these procedures.

Procedures have been performed on children as young as five weeks old, with the average patient age of 10 to 12 years. In addition, our electrophysiologists participate in the care of fetal arrhythmias, either treating the mother with anti-arrhythmic medications or working with maternal-fetal medicine specialists to treat the arrhythmia prenatally.

Patients with suspected cardiac arrhythmias or syncope undergo non-invasive diagnostic procedures, which include electrocardiograms, 24-hour Holter monitors, event recorders, stress testing and tilt table studies. Should an arrhythmia be identified that requires therapy, the Division of Pediatric Cardiology has an unsurpassed reputation for performing electrophysiologic studies, ablation therapies, and managing the care of patients who have a cardiac pacemaker or defibrillator. These patients are followed both in the office and through transtelephonic checks of their devices. These include patients who have:

• hypertrophic cardiomyopathy
• dilated cardiomyopathy
• long QT syndrome, which predisposes patients to a life-threatening arrhythmia called Torsades de pointes
• catecholaminergic polymorphic ventricular tachycardia

In radiofrequency catheter ablation, electrical energy is used to destroy tissues in the heart that cause rhythm disturbances. Cryoablation-a catheter-based technology-is used to freeze tissue and correct rhythm when the origin of the problem is located in a particularly vulnerable section of the heart. The Hospital's electrophysiologists were the first in the tristate area to use cryoablation. Because the radiofrequency and cryoablation procedures produce different benefits, our service has the equipment readily available for both procedures as appropriate for each patient case.

Super ventricular tachycardia is by far the most common arrhythmia in children, and for many years was treated with medication only. In the past 15 years, ablation has become the treatment of choice given its safety profile and marked benefit to the patient. Super ventricular tachycardia includes a rare congenital heart disorder called Wolff-Parkinson White Syndrome that involves irregularities in the electrical system of the heart. Since a small possibility of sudden death exists with this condition, it is now recommended that patients who are entering adolescence and becoming active in sports should have formal electrophysiology testing to determine if the syndrome exists. If so, ablation would be recommended.

In patients with congenital heart disease, the most common arrhythmia treated is intraatrial reentrant tachycardia, also known as atrial flutter. It often presents in patients who have had congenital heart surgery. Our physicians use three-dimensional mapping to identify these arrhythmias, plot them, and successfully ablate them.

In patients with pulmonary atresia, a complicated condition in which the pulmonary valve is not formed properly, we utilize a new technology called ballast radiofrequency wire to perforate the valve and then perform angioplasty thus avoiding surgery.

A recently released report by the New York State Department of Health has shown that Morgan Stanley Children's Hospital is a leader in the state for best outcomes for surgeries performed on children with congenital heart defects. The report reviewed 5,466 pediatric congenital cardiac surgeries performed between 2002-2005 at the 15 New York State hospitals with approval to perform cardiac surgery on pediatric patients. Morgan Stanley Children's Hospital performed 1,802 procedures with a risk-adjusted mortality of 3.18. It was the only hospital in the state with a risk-adjusted mortality rate significantly lower than the statewide rate. Our pediatric cardiac team has expertise in all forms of congenital heart disease including neonatal cardiac surgery, valve repairs, single ventricle disease, and implantation of pacemakers and defibrillators using endocardial techniques. Morgan Stanley Children's Hospital also has one of the most active heart pediatric transplant programs in the nation.

Our Pediatric Heart Transplantation Program dates back to 1984, when the world’s first successful pediatric heart transplant was performed at Columbia Presbyterian Medical Center on a 4-year-old boy with complex congenital heart disease. Since then, our Pediatric Heart Transplant Program has continued to advance that proud tradition of leadership in pediatric heart transplantation. Our surgeons have performed over 265 heart transplants in children making NewYork-Presbyterian one of the largest pediatric heart transplant centers in North America and the world.

Our program specializes in transplanting children with end-stage congestive heart failure due to cardiomyopathy and children with complex congenital heart disease who are not candidates for palliative or corrective surgery. The program's surgeons have also successfully pioneered transplantations in high-risk patients who are not offered heart transplants elsewhere, including patients with severe, elevated pulmonary resistance.

Our multidisciplinary team approach has set the standard of care for children with end-stage heart failure-achieving 84 percent overall long-term survival after hospital discharge. Four pediatric cardiologists, two pediatric transplant nurses, two research nurses, an office manager, and an assistant are dedicated to serving this program and work closely with leading pediatric sub-specialists-including transplant surgeons, neurologists, psychiatrists, social workers, and physical therapists-to provide the most comprehensive care possible for complex conditions.

Patients who require both lung and heart transplantation benefit from a joint team effort of the cardiac and pulmonary groups to coordinate care of these very sick and complex children.

• Pediatric ECMO

  The Division of Pediatric Cardiology is one of the leading programs in the tri-state area to offer extended heart/lung life support via extracorporeal membrane oxygenation (ECMO). In selected children, this therapy substitutes for the heart and lung function until the child's organs recover. ECMO may also play a role in bridging children to transplantation while awaiting a suitable donor. Physicians at the Hospital participated in the earliest development of ECMO, making our facility one of the first in the world to use this life-saving modality successfully in children.

Pulmonary Hypertension Center

Established in 1987, the Pulmonary Hypertension Center is one of the largest in the world, serving both adults and children. Pulmonary hypertension, a condition in which blood pressure is elevated in the lungs, can have serious consequences if left untreated. Primary pulmonary hypertension has no known cause and can occur at any age; secondary pulmonary hypertension can be caused by another a condition or disease.

Children and their families who are facing this challenging condition can be assured of receiving help at our Center. Our physicians have been involved in all of the clinical drug trials to date for the development of new medical treatments for pulmonary hypertension, including the first drug approved for treatment of the condition in 1995. Today, new therapies with IV Prostacycline and other agents are improving quality of life and long-term outcome.

Pediatric patients who come to the Pulmonary Hypertension Center have access to all approved therapies, the possibility of enrollment in current clinical trials of new medications, and, if necessary, the availability of our world-renowned heart-lung transplantation program.

Adult Congenital Heart Program

Cardiac surgery in childhood has resulted in an ever-increasing number of adults living with congenital heart disease-estimates suggest some 750,000 Americans. With more than 30 different forms of congenital heart disease, patients often search to find cardiologists familiar with their particular anatomy and problems. With a long history of providing specialized care for these patients, Morgan Stanley Children's Hospital has developed the Adult Congenital Heart Program, the first and only one of its kind in New York State.

Congenital heart disease refers to any type of malformations of the heart, heart valves or major blood vessels that are present at birth. Defects can range from simple to complex and can occur alone or in groups, depending on how the heart has developed. Many of these adults underwent heart surgeries as children to repair complex lesions. Our program's team of dedicated cardiologists and surgeons manage the entire spectrum of complex adult primary or post-repair congenital heart disease.

The most common congenital heart disorders affecting adults are:

• congenital valve defects
• atrial and ventricular septal defects
• patent foramen ovale

Our pediatric cardiologists are specifically trained in adult congenital heart disease with expertise in fetal echocardiography, echocardiography, interventional cardiac catheterization, and interventional electrophysiology. Related care by specialists in high-risk pregnancy, genetics, digestive and liver diseases, pulmonary hypertension, and hematology is readily available. When necessary, our program also draws on the extensive medical and surgical resources available at the Hospital for complex congenital heart surgery, heart and lung transplants, assist devices, and complex re-operations.

Preventive Cardiology Program

The Preventive Cardiology Program offers comprehensive services for both hypercholesterolemia and hypertension. The program is administered and staffed by experts in pediatric cardiology, pediatric gastroenterology, and nutrition, all of whom oversee the care of patients with abnormalities in lipid metabolism. This includes patients with both hypercholesteremia and hyperlipidemia. They also evaluate patients with unexplained systemic hypertension.

The program primarily operates on an outpatient basis to advise families on the evaluation and management of children with these problems. However, children with severe lipid disorders, particularly with elevated cholesterol, may be admitted to the hospital for treatment to control their cholesterol levels.