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Cardiology

Specialty Programs

Pediatric Cardiomyopathy, Heart Failure, and Transplantation Program

The Comprehensive Pediatric Cardiomyopathy, Heart Failure, and Transplantation Program of Morgan Stanley Children's Hospital offers state-of-the-art pediatric cardiovascular care, beginning with a comprehensive evaluation that allows us to understand your child's heart problem fully. We take great pride in providing individualized management for our patients and their families. We recognize that family-oriented, comprehensive care and follow-up are critical to achieving a successful outcome. We understand that parents and caregivers are key members of the child's healthcare team, and we work closely with you and with your child's referring physicians to implement the best plan of care.

Our treatment plan takes advantage of the most advanced medical therapies, as well as cutting-edge interventions in cardiology and open-heart surgery procedures, including cardiac transplantation. Our transplant 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.

The goal of our program is to return children to their childhood. We provide our young patients and their families with the support and treatments necessary to lead as normal a life as possible. For more information, click on Cardiomyopathy, Heart Failure and Transplantation Program at right under Clinical Services.

Pediatric Cardiopulmonary Exercise Laboratory

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

Pediatric Cardiac Catheterization Laboratory

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.

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

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

ur 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.