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Treatments
Cardiac catheterization and interventional treatments
A Riley cardiologist performed a balloon valvuoplasty on the smallest patient to successfully undergo the procedure. The baby weighed just one and three-fourths pounds. Riley cardiologists were among a small group of experts nationwide to design the study protocols and manage the enrollment of the Food and Drug Administration trials of the Amplatzer Septal Occluders, which treat atrial septal defects (ASD) and Amplatzer Duct Occluders, which treat patent ductus arteriosus (PDA). The devices have received FDA approval, and Riley is one of first hospitals in the country to use them on a large scale. A team model of care shapes the treatment in the catheterization laboratory and recovery within the Riley Heart Center. Pediatric interventional cardiologists, anesthesiologists, nurse practitioners and other intensivists are involved at every step. A partial list of procedures include:
All told, over 500 cardiac catheterizations (diagnostic, interven-tional, biopsy, and electrophysiologic) take place each year at Riley Hospital. No other facility in Indiana and few in the region perform this many pediatric catheterization procedures. Treating arrhythmias with technology and experienceThe Riley Heart Center provides the complete range of state-of-the-art services for the diagnosis and treatment of cardiac rhythm disorders. The level of experience is unparalleled in the region, as each year Riley cardiologists perform and interpret over 6000 electrocardiograms (ECGs), 200 24-hour continuous ECG monitors and approximately 200 event recorders. Sixty radio frequency catheter ablations are performed annually, with the Riley Heart Center pioneering the imple-mentation of new ablation techniques in collaboration with adult cardiology researchers at Indiana University School of Medicine's Krannert Institute of Cardiology. A busy and active pacemaker service follows approximately 200 patients with various types of pacemakers and defibrillator devices. With the guidance of a pediatric cardiologist specially trained and experienced in pediatric electrophysiology, these services ensure that Riley Heart Center patients receive the best and most current care for heart rhythm problems. Exercise stress testingOver 200 cardiac exercise stress tests are performed at the Riley Heart Center each year in a laboratory dedicated solely to the evaluation of pediatric cardiology patients. The reasons why a stress test is ordered vary widely, including evaluation of exercise-induced chest pain, assessment of specific patients prior to participation in athletics, evaluation after cardiac surgery or heart transplantation, cardiomyopathy and evaluation of cardiac arrhythmias. State-of-the-art equipment in the pediatric cardiac exercise stress laboratory includes exercise treadmills and bicycles with computer controlled workload adjustment. The lab also features computerized monitoring equipment for the digital analysis and storage of continuous 12-lead electrocardiogram and blood pressures and an updated metabolic cart that allows for optimal and more accurate measurement of respiratory and metabolic parameters. Pediatric cardiac surgeryLike the children born with them, congenital abnormalities of the heart have distinctly individual characteristics. Their hearts are remarkably different in their anatomy, physiology and timing. The interdisciplinary surgical teams of Riley Hospital have the experience to repair all of them. Cardiovascular surgeons at Riley perform an average of 650 cardiac surgical cases per year. Over the past decade, the volume of pediatric cardiac surgeries performed has increased by seven percent per year. With this steady increase in case volume, Riley cardiac surgeons are also expanding the range of treatable patients. Cases that were once surgically untreatable are now routine. Risks and outcomes vary with different procedures, but when all pediatric cardiac surgeries performed at Riley are considered, including the most complex cases, overall mortality is among the best in the country. The cardiothoracic surgery staff at Riley has earned an international reputation for its pioneering skills and excellence in this technically difficult subspecialty. Because technology and technique are constantly changing, surgeons at Riley are continually evaluating emerging new methods. One of the most promising is the limited incision-limited sternotomy, which decreases pain, scarring, hospital stay and enhances overall recovery. Now, most closed and open heart procedures on infants and young children can be done through a one to three-inch incision. In every surgical case, the least invasive procedure that does not compromise outcome is the first option. The aim is to minimize surgical trauma while accelerating recovery.
[Keywords: heart, Cardiac catheterization, cardiac defects, cardiologists, Amplatzer Septal Occluders, atrial septal defects, ASD, Amplatzer Duct Occluders, patent ductus arteriosus, PDA, balloon angioplasty, stent placement, balloon valvuloplasty, Balloon blade atrial septostomy, Coil closure, CardioSeal implantation, fontan fenestration closures, electrocardiograms, ECGs, catheter ablation, cardiac exercise stress test, congenital abnormalities] |
Rapidly advancing catheterization technology is allowing for the diagnosis and repair of the most complex cardiac defects. Some defects that only a few years ago would require surgery can now be treated with catheter-based techniques. The interventional pediatric cardiologists of Riley Hospital have been at the forefront of those advancements.
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