Services and Innovations
Specialized Cardiovascular Services and Treatment at the Children's Hospital of Michigan include:
Adult Congenital Services
All Congenital Heart Patients Need a Lifetime of Care
In 2010, it was reported by the CDC there are now more adult patients over the age of 18 with congenital heart disease, than there are pediatric congenital heart disease patients under 18.
Adult congenital heart patients include individuals 18 years and older who were successfully diagnosed and treated as children, as well as those adults who are diagnosed with heart defects for the first time. As children with heart disease grow older, they are at risk for re-intervention for variety of reasons such as valve problems, heart failure, heart infection, stroke, arrhythmia, and heart block, so they require ongoing monitoring and highly specialized care throughout their lives.
The physicians on staff at the DMC’s Michigan Adult Congenital Heart Center (MACH), work together to provide multi-disciplinary care for adults with congenital heart disease. MACH physician combines the expertise of congenital heart disease in adults and cardiovascular surgeons who specialize in the health needs of adults with congenital heart disease.
The catheterization labs at the Children’s Hospital of Michigan feature the latest pediatric equipment for diagnostic and interventional catheterization procedures. Highly-trained physicians perform a wide range of catheter-based procedures – including balloon valvuloplasty, percutaneous valve placements, stent angioplasty, coiling of collaterals and closure of atrial and ventricular septal defects.
Physicians at the Children’s Hospital of Michigan use specialized digital echocardiogram equipment to create video images of the beating heart. This noninvasive test can be performed in an inpatient or outpatient setting with either transesophageal or 3-D echocardiography technology. Physicians and technicians also specialize in fetal echocardiography – an advanced imaging procedure to detect heart defects before the child is born. Fetal echocardiography is routinely offered to the fetuses of parents who have congenital heart disease and for several other maternal indications.
Electrophysiology and Rhythm Disorders
When it comes to diagnosing and treating pediatric patients with cardiac rhythm disorders, the electrophysiology lab at the Children’s Hospital of Michigan is known as a leader in research and care. Electrophysiology experts provide innovative diagnostic services and therapies to children with rhythm disorders – including invasive treatments such as pacemaker implantation. Exercise stress testing is often used to study exercise related problems in children and in patients who have undergone prior repair of congenital heart defects. Tilt table testing is used to evaluate the causes of fainting.
Heart Transplantation/Advanced Failure
Heart transplant recipients require a lifetime of medical care. The Pediatric Heart Transplant Program at the Children’s Hospital of Michigan offers outpatient clinics and daily inpatient rounds for management of patients awaiting transplants and those who have already received transplants. An Advanced Heart Failure Program was developed to evaluate and optimize medical therapy for those patients who may one day require transplant services.
When necessary, ventricular assist devices are used as a lifesaving treatment in patients for whom a donor heart may not be readily available. Few surgeons in the United States have as much experience with pediatric-sized ventricular assist devices as the cardiovascular surgeons of the Children’s Hospital of Michigan. Other mechanical support devices include Extracorporeal Membrane Oxygenation (ECMO), which functions as a temporary replacement for the child’s heart and lungs.
Pulmonary Hypertension Program
The Pulmonary Hypertension (PH) Program operates within the Division of Cardiology at the Children's Hospital of Michigan. The program is the only one of its kind in metropolitan Detroit. Specialists on staff treat children with a wide range of conditions that can cause elevated pressure within the lung arteries. The clinic sees patients in a wide range of ages, including adult patients with congenital heart disease.
Screening for PH includes a thorough history and physical examination along with diagnostic testing including an electrocardiogram (EKG) and echocardiography, as well as a six-minute walk test for older children. Some will require a heart catheterization for direct measurements of pulmonary hemodynamics and for guidance in mediation selection and dosage.
Depending upon the patient's underlying cause of PH and the severity of illness, the goals of the Pulmonary Hypertension Program range from reversing the PH to making children feel better and experience improved quality of life, to palliative care the severest forms of the condition.
Traditionally, pulmonary hypertension carries a very poor prognosis. Over the last five or 10 years, there have been many advances in newer therapies and medications that have improved both survival and quality of life.
Treatment options can include oxygen therapy and medications to help the heart pump better or relax the muscles in the walls of the blood vessels. Other beneficial treatments may include oral or inhaled medicines and infusion therapy to deliver appropriate medicine continuously through their vein. Children may also require surgery such as a lung transplant or atrial septostomy, a surgical procedure that is designed to improve communication between the right and left atria and to relieve pressure on the right side of the heart.
Preventive Cardiology/Lipid Management
The Children’s Hospital of Michigan pediatric lipid management program is a preventive care program for children with lipid disorders features specialized pediatric testing, innovative lipid management therapies, and dietary counseling. Patients are evaluated by a pediatric lipid specialist (cardiologist or nurse practitioner), a dietitian and an exercise specialist.
Patients are evaluated for the presence of risk factors associated with the development of premature cardiovascular disease (CVD). Thereafter, the patient may undergo and participate in additional appropriate testing (secondary causes of hyperlipidemia, early indicators of heart disease), management of identified risk factors (pharmacologic and non-pharmacologic treatment, referral to appropriate specialty service) and discussion in the prevention of risk factor development. Education may be provided to the child and family on the pathophysiology of premature CVD, risk factor prevention through lifestyle modification, and the role of diet, nutrition and physical activity in both the development and treatment of premature CVD. Once the initial consultation is complete, patients may be followed at least annually (more often in higher risk patients), and reports of findings and plans of care may be forwarded, as appropriate, to the referring provider following each clinic visit which detail findings and plan of care.
The Department of Cardiovascular Surgery is a leader in the surgical repair of congenital heart defects in children, with special expertise in the primary repair of heart disease in newborns and infants.
Cardiovascular surgeons and interventional cardiologists on the medical staff at the Children’s Hospital of Michigan are experts in the use of hybrid approaches to repair certain forms of complex congenital heart disease.
The Children’s Hospital of Michigan is one of the nation’s leaders in the use of Extracorporeal Membrane Oxygenation (ECMO) — an advanced technology that functions as a temporary replacement for a child’s heart and lungs before and after cardiovascular surgery.
The U.S. Food and Drug Administration (FDA) approved use of the Berlin Heart, the first ventricular assist device made specifically for pediatric patients. Ventricular assist devices are used when a patient needs a heart transplant, but can’t wait for a donor heart to become available. The Berlin Heart assists the failing heart until an appropriate donor heart can be found. Surgeons on staff at the Children’s Hospital of Michigan are leaders in the use of this advanced technology and testified to the FDA about its life-saving benefits.
Surgery patients are treated by an illustrious world-class multidisciplinary team that specializes in the care of pediatric cardiac surgical patients. Members of this team include pediatric cardiac surgeons, pediatric cardiologists, pediatric intensivists, pediatric cardiac anesthesiologists, pediatric cardiac surgical nurse clinicians, pediatric cardiac surgical house physicians, physician’s assistants, nurse practitioners, as well as pediatric cardiac perfusionists, circulating nurses and surgical technicians.
In preparation for surgery, patients and their families are given an opportunity to visit the intensive care unit prior to their procedure and to see patients that have recently undergone cardiac surgery.
Diagnosing and treating children’s heart disease requires specialized knowledge and a dedicated team-approach to care. The Children’s Hospital of Michigan is equipped with the experience your child needs when going through this difficult time.
Established at Children’s Hospital of Michigan in 1999, telemedicine allows timely evaluation for infants and children with suspected congenital heart disease. This technology helps prevent the unnecessary transfer of patients for further cardiac evaluation and allow immediate conferencing and consultation between the referring physician and the cardiologist.