Specialized Cardiovascular Services and Treatment at the Children's Hospital of Michigan include:
Cardiac Intensive Care Unit
The Pediatric Cardiac Intensive Care Unit (CICU) at Children’s Hospital of Michigan provides up to 16 designated beds with 24 hour attending-level staff dedicated to comprehensive, multidisciplinary cardiac care for patients with congenital and acquired heart disease —including all forms of cardiomyopathy — from birth through early adulthood.
Services include:
- Comprehensive care for fetal cardiac diagnosis and in some cases fetal cardiac treatment.
- A dedicated team of cardiac intensivists, cardiac surgeons, cardiologists, cardiac nurse practitioners, anesthesiologists and physician assistants.
- An Extracorporeal Membrane Oxygenation (ECMO) program
- Cardiac imaging including CT and MRI
- Temporary and permanent ventricular assist device services
- Electrophysiology
- Pre-operative and postoperative management
Catheterization Procedures
The catheterization labs at Children’s Hospital of Michigan feature equipment for diagnostic and interventional catheterization procedures. Pediatric cardiologists perform a wide range of procedures – including balloon valvuloplasty, percutaneous valve placements, stent angioplasty, coiling of collaterals and closure of atrial and ventricular septal defects.
Echocardiography Lab
Physicians at 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 ultrasound to diagnose heart defects before the child is born to plan and develop the best possible timely treatment after birth.
Electrophysiology and Rhythm Disorders
Children’s Hospital of Michigan pediatric electrophysiology experts provide innovative diagnostic services and therapies to children with cardiac 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 Children’s Hospital of Michigan offers outpatient clinics and daily inpatient services for management of patients awaiting transplants and those who have already received transplants. An Advanced Heart Failure Program is available to evaluate and optimize medical therapy for those patients who require a transplant. When necessary, ventricular assist devices are used as a lifesaving treatment in patients that can’t wait for a donor heart to become available. Other mechanical support devices include Extracorporeal Membrane Oxygenation (ECMO), which functions as a temporary replacement for the child’s heart and lungs. Two dedicated Nurse Practitioners serve as full-time Pediatric Cardiac Tansplant Coordinators.
Michigan Adult Congenital Heart Center
The physicians on staff at the Detroit Medical Center’s (DMC) Michigan Adult Congenital Heart Center (MACH), work together to provide multi-disciplinary care for adults with congenital heart disease. MACH physicians combine the expertise of congenital heart disease in adults with cardiovascular surgeons who also specialize in the health needs of adults with congenital heart disease.
Pulmonary Hypertension Program
The Pulmonary Hypertension (PH) Program operates within the Division of Cardiology at 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), echocardiography and cardiac MRI, 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 for the severest forms of the condition.
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 creates a communication between the right and left atria and relieves pressure on the right side of the heart or Potts shunt surgery to relieve the pressure off of the right pumping chamber to make it function better.
Preventive Cardiology/Lipid Management
Children’s Hospital of Michigan pediatric lipid management program is a preventive care program for children with lipid disorders featuring specialized pediatric testing, innovative lipid management therapies, and dietary counseling. Patients are seen by a pediatric lipid specialist (cardiologist or nurse practitioner), a dietitian and an exercise specialist.
Patients are evaluated for presence of risk factors associated with the development of premature cardiovascular disease (CVD). Additional testing may be offered for secondary causes of hyperlipidemia, early indicators of heart disease. Found risk factors are then managed via pharmacologic and non-pharmacologic treatment, and referral to appropriate specialty service. Specialists and families discuss risk factor prevention including educating both the child and family about 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. After initial consultation specialists follow patients at least annually (more often in higher risk patients) and provide complete reports detailing findings and a plan of care to the referring physician following each clinic visit.
Telemedicine
Established at Children’s Hospital of Michigan in 1999, telemedicine allows timely evaluation for infants and children with suspected congenital heart disease. This technology prevents the unnecessary transfer of patients for further cardiac evaluation and allows immediate conferencing and consultation between the referring physician and the cardiologist.
Cardiovascular Surgery
The Department of Cardiovascular Surgery offers surgical repair of congenital heart defects in children, with special expertise in the primary repair of heart disease in newborns and infants. On average approximately 200 surgical procedures are performed by cardiovascular surgeons at the Children's Hospital of Michigan every year.
Advanced treatment and technology
Cardiovascular surgeons and interventional cardiologists on staff at Children’s Hospital of Michigan are experts in the use of hybrid approaches to repair certain forms of complex congenital heart disease.
ECMO
Pediatric 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, is available at Children’s Hospital of Michigan and is one of only a few hospitals in Michigan to provide this level of advanced care to children.
Ventricular Assist Devices
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 Children’s Hospital of Michigan are leaders in the use of this advanced technology and testified to the FDA about its life-saving benefits. In larger patients, it is sometime possible to use the HeartWare ventricular assist device. The pump and connecting tubes for this centrifugal flow device are contained with the patient’s chest with only a small driveline exiting the body. And connecting to the portable controller and battery packs. Under the right circumstances, it is possible for patients to go home with this portable device to await their heart transplant.
Multidisciplinary Care
Surgery patients are treated by a comprehensive multidisciplinary team that specializes in the care of pediatric cardiac surgical patients. Members of this team include pediatric cardiac surgeons, pediatric cardiologists, specialists in pediatric cardiac critical care, pediatric cardiac anesthesiologists, pediatric cardiac surgical nurse clinicians, pediatric cardiac surgical advanced practice providers, 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.
Diagnosing and treating children’s heart disease requires specialized knowledge and a dedicated team-approach to care. Children’s Hospital of Michigan is equipped with the experience children need when going through this difficult time.
Surgical Outcomes
Children’s Hospital of Michigan participates in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database, which provides data on Operative and Adjusted Operative Mortality. Further information can be found at https://www.sts.org/registries-research-center/sts-national-database/congenital-heart-surgery-database.
