Children’s Heart Program Brings Young Patients New Possibilities

When children are born, the future stretches before them, full of infinite possibilities. Perhaps she will grow up to pilot a mission to Mars, or he will be a marine biologist venturing into unexplored worlds beneath the sea.

But for children born with a heart malformation, the canvas for creating the life they want to live may be much smaller--unless the potential for a healthier future can be restored.

“Heart disease in children is usually very different than the cardiovascular problems we typically find in adults. Instead of the build-up of plaque blocking arteries and the effects of aging, the cases we see at Children’s Hospital are often related to congenital disorders,” pediatric cardiologist Yung Lau, MD, said. “Our patients may have been born with a heart that has only three chambers, or poorly functioning valves or an arrhythmia from problems with nerves that control their heartbeat.

“Some of these problems can be corrected surgically or in the cath lab, and we may be able to treat others medically. When the condition is too severe, or if a myopathy has left the heart too weak, a transplant may offer the best hope,” Lau said.

More than 450 cardiac surgeries are performed annually, along with about 700 heart catheterizations and more than 14,000 2-D and 3-D echocardiograms. The Advanced Heart Failure and Transplant Team has performed 33 heart transplants in the past five years, including 10 in 2013.

The pediatric cardiovascular program moved from UAB across the street to its new home at Children’s Hospital in October of 2012, following the opening of the $400 million Benjamin Russell Hospital for Children, the third largest children’s hospital in the United States. The entire fourth floor houses the Joseph Bruno Pediatric Heart Center. It is connected to UAB by a skywalk that allows physicians to easily move between facilities rather than the patients having to be transported back and forth. 

“The teams working in pediatric cardiology had the opportunity to offer input into the design of the facility, so it was built with the specific needs of children who have cardiovascular problems in mind,” Lau said. “We’ve increased the CVICU beds from seven to 20, we have four dedicated ECMO rooms, and we now have two cath labs, with a hybrid lab where we can do more types of procedures in the same room.”

The CV team includes more than two dozen cardiologists, cardiothoracic surgeons, cardiac intensivists and cardiovascular anesthesiologists.

“Our physicians have many years of experience in a wide range of subspecialties, and we work closely with other specialties. It’s a good environment for collaboration,” Lau said. “Another advantage of caring for our patients at Children’s Hospital is that we have support teams who are trained and experienced in working with children, from nurses, pharmacists and social workers to physical therapists, occupational therapists and speech therapists.”

The program’s ongoing quality improvement efforts are also achieving notable results, including a reduction in the time required for fluoroscopy, the need for less blood, and innovative treatments that have reduced the average length of stay and time on a vent.

Such excellence in care and an exceptionally good track record in outcomes earned Children’s Hospital of Alabama the distinction of being selected as one of only 10 pediatric hospitals in the United States to be named a charter member of The Healthcare Colloquium, a national group of hospitals dedicated to improving heart failure through expert-to-expert collaboration.

Care for young hearts begins even before birth, with advanced imaging in fetal echocardiography. When newborns anywhere in the metro area appear to have heart-related problems, they don’t have to come in for a consultation. The consultation goes to them. A pediatric echo tech is sent to the hospital where the child was born to perform tests. Images and data are relayed to the consulting cardiologist, who reviews the case and contacts the child’s pediatrician to discuss the diagnosis and treatment options.

While surgery may be necessary to correct serious malformations such as a missing chamber or a transposition of the great arteries, a growing list of conditions can be remedied using interventional catheterization.

“A radiofrequency ablation can eliminate errant nerves that are causing an arrhythmia, and catheters can be used to close atrial septal defects or insert a transcatheter Melody valve,” Lau said.

“In cases where a transplant is necessary, pediatric patients need not only a good tissue match, but also a donor heart that is reasonably close in size. As a bridge to help them stay healthy enough for a transplant while they are waiting, we can give them a ventricular support device such as a Berlin heart.”

Advances in care are helping more pediatric heart patients grow into adulthood and build a life beyond the limits of the condition they were born with or acquired in childhood.

New possibilities in treatment are opening up new possibilities in a future they can look forward to living.