Pediatric Cardiology

What Is Pediatric Cardiology?

Pediatric cardiology deals with congenital and acquired heart diseases in newborns, children and adolescents, with congenital heart diseases foremost among them. Congenital diseases include conditions such as tetralogy of Fallot, atrial septal defect and ventricular septal defect. Acquired cardiac diseases include rheumatic heart disease, cardiomyopathy and pericardial diseases. The diagnosis and treatment of these diseases are handled by pediatric cardiologists. In children, cardiac diseases may present with symptoms such as heart murmurs, chest pain and cyanosis (bluish discoloration). Early diagnosis and treatment of these diseases are important to prevent the disease from progressing as pediatric patients reach adulthood. Treatment methods vary: in some patients, congenital anomalies may resolve as the child grows, while in others surgery may be required. Surgical correction of structural heart anomalies and procedures such as cardiac catheterization and angiography in pediatric patients, whose anatomical structures differ from those of adults, are performed by pediatric cardiology.

What Are Pediatric Cardiology Diseases?

Pediatric cardiology provides the diagnosis, treatment and follow-up of patients from the newborn period up to the age of 18, as well as of fetuses found to have a congenital heart disease in the womb by fetal echocardiography. These diseases are usually congenital or develop during childhood. Some of the diseases commonly encountered in pediatric cardiology are:

Congenital Heart Diseases

Congenital heart diseases cover abnormalities in the structure of the heart and blood vessels that babies have from birth. Congenital heart diseases are generally divided into two groups: acyanotic and cyanotic. Acyanotic congenital heart diseases are conditions that cause no bluish discoloration of the body and may produce no symptoms for many years. Cyanotic congenital heart disease, on the other hand, presents with bluish discoloration of the extremities (fingertips, toes) or the lips. While some congenital heart diseases may be small structural anomalies without noticeable symptoms, others can lead to serious health problems and even life-threatening conditions:

• Ventricular septal defect (VSD): A ventricular septal defect is a hole in the wall between the two lower chambers of the heart (the ventricles). This hole allows oxygen-rich blood to pass from the left ventricle to the right ventricle, making the heart and lungs work harder. Symptoms may vary depending on the size of the VSD. Small holes usually cause no symptoms, while large holes can lead to problems such as shortness of breath, growth retardation and frequent infections.

• Atrial septal defect (ASD): An atrial septal defect is a hole in the wall between the two upper chambers of the heart (the atria). This hole allows oxygen-rich blood to pass from the left atrium to the right atrium, which places an extra load on the lungs and the right side of the heart.

• Patent ductus arteriosus (PDA): Patent ductus arteriosus is a condition in which a blood vessel called the ductus arteriosus, which should close after birth, remains open. This open channel causes abnormal blood flow between the aorta and the pulmonary artery, making the heart and lungs work harder.

• Tetralogy of Fallot: Tetralogy of Fallot is a combination of four separate heart defects: ventricular septal defect, pulmonary stenosis (narrowing of the pulmonary valve), right ventricular hypertrophy and an abnormal position of the aorta. This condition causes oxygen-poor blood to be pumped to the body.

• Coarctation of the aorta (CoA): Coarctation of the aorta is characterized by a narrowing of the aorta, which makes it harder for the heart to pump blood to the body. This narrowing is usually located in the upper part of the aorta, just below the left subclavian artery.

Acquired Heart Diseases

Acquired heart diseases include diseases of the heart and blood vessels that develop after birth for various reasons. These diseases usually arise as a result of external factors such as infections, autoimmune diseases or environmental factors. Acquired heart diseases seen in children can cause serious health problems if not treated at the right time and in the right way:

• Kawasaki disease: Kawasaki disease is a condition that is common in children under five years of age and causes inflammation of the blood vessels. It can particularly affect the coronary arteries and, if left untreated, there may be a risk of aneurysm development.

• Rheumatic heart disease: Rheumatic heart disease is a complication of rheumatic fever, which usually develops after a streptococcal infection. It can cause damage and scar tissue formation in the heart valves.

• Myocarditis: Myocarditis is inflammation of the heart muscle and is usually caused by viral infections. This condition can lead to weakening of the heart muscle and heart failure.

• Pericarditis: Pericarditis is inflammation of the membrane surrounding the heart (the pericardium). It is usually caused by viral infections, injuries or autoimmune diseases. Symptoms include sharp chest pain, fever, fatigue and cough. The pain usually worsens when lying down or breathing deeply.

• Cardiomyopathy: Cardiomyopathy is a disorder that affects the child's heart muscle. The heart muscle may be stiff, too large or too thick. In this disorder, the child's heart cannot pump blood as effectively as it should and has difficulty delivering enough blood to the body.

• Hypertension: In hypertension, the force of the blood flowing through the child's arteries is too high. This condition may occur throughout the body (systemic hypertension) or in specific areas such as the lungs ( pulmonary hypertension ). (2,3,4,8).

What Are the Symptoms of Pediatric Heart Diseases?

The symptoms of pediatric heart diseases may vary depending on the type and severity of the disease and the age of the child. Some of the symptoms may include:

• Shortness of breath

• Feeding and growth problems

• Bluish discoloration (cyanosis)

• Chest pain and palpitations

• Fatigue and fainting.

How Are Pediatric Heart Diseases Diagnosed?

In diagnosing pediatric heart diseases, the specialist first examines whether there is a family history of heart disease, the child's birth history, growth and development, and symptoms such as shortness of breath, cyanosis, chest pain and palpitations. During the physical examination, the doctor listens to the heart sounds to detect murmurs, irregular rhythm or other abnormalities. Tests may be requested to help establish a definitive diagnosis. Some of the tests used in the diagnosis of pediatric heart diseases are:

• Electrocardiogram (ECG): An ECG is a test that records the electrical activity of the heart. It evaluates the heart's rhythm, rate and electrical conduction pathways. ECG plays an important role particularly in the diagnosis of conditions such as rhythm disorders and heart muscle diseases. Echocardiography: Echocardiography is a test that allows the heart to be imaged with ultrasound. It enables detailed examination of the heart's structures and is widely used in the diagnosis of congenital heart diseases.

• Chest X-ray: A chest X-ray provides an overall view of the heart and lungs. It helps evaluate the size and shape of the heart and the blood circulation in the lungs.

• Holter monitor: A Holter monitor is a portable device that continuously records the child's heart rhythm for 24 hours or longer. This test is used to diagnose rhythm disorders that cannot be detected with a short ECG.

• Cardiac MRI and CT: Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) scans provide detailed three-dimensional images of the heart and blood vessels. These advanced imaging techniques are used in the diagnosis of complex congenital heart diseases and in planning surgical interventions.

• Cardiac catheterization: Cardiac catheterization is an invasive test performed to measure pressures and oxygen levels inside the heart. Catheterization can also be used to image the heart's blood vessels (angiography) and to treat certain congenital heart diseases.

How Are Pediatric Heart Diseases Treated?

The treatment of pediatric heart diseases is planned by specialist doctors according to the specific type and severity of the heart problem. Some of the treatment methods are:

Medication

Medication is a treatment method used in the management of many heart diseases. It may be prescribed by doctors to relieve symptoms, improve heart function and prevent complications. Medications include diuretics, beta blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs), antiarrhythmic drugs and antibiotics.

Surgery and Other Treatments

Some congenital heart diseases and serious heart problems in children may require surgical intervention. Operations are performed to correct structural abnormalities of the heart or to improve heart function:

• Open-heart surgery: Used to correct structural problems such as holes in the heart (VSD, ASD) or abnormal heart valves. These operations are aimed at directly repairing the structure of the heart and usually require large surgical incisions.

• Heart valve repair or replacement: Procedures to repair damaged heart valves or replace them with artificial valves. They are performed to ensure that the valves function properly.

• Repositioning of blood vessels: Performed in conditions such as transposition of the great arteries to bring the vessels into their correct anatomical positions. This surgical procedure aims to ensure the correct flow of oxygen-rich and oxygen-poor blood.

• Repair of congenital heart defects: Involves the surgical correction of complex congenital heart defects such as tetralogy of Fallot. These operations aim to correct several structural problems at the same time.

• Heart transplantation: If a serious heart defect cannot be repaired, a heart transplant may be necessary.

• Cardiac catheterization: Some congenital heart disorders can be repaired using thin, flexible tubes (catheters) without the need for open-heart surgery.

15% of infant deaths in the first 30 days of the newborn period are caused by congenital heart diseases. More than half of babies born with heart disease definitely require surgical treatment. At least 6,000 new patients need heart surgery every year. Thanks to advances in surgery, anesthesia, technology and intensive care techniques in recent years, more than 90% of children born with congenital heart diseases can achieve a normal or near-normal quality of life and chance of survival through surgery and interventions. In conditions such as simple holes in the heart, like atrial septal defect (ASD) and ventricular septal defect (VSD), and narrowing of the heart valves, like pulmonary stenosis, if surgical treatment is needed, the vast majority of these children can go on to live with a completely normal heart after surgery and do the same activities as their healthy peers. With the knowledge, experience and modern technological facilities of the Pediatric Heart Diseases and Surgery Advanced Diagnosis and Treatment Center at Hisar Hospital Intercontinental, heart and vascular diseases that once seemed hopeless can now be treated.

The Pediatric Cardiology department provides the diagnosis, treatment and follow-up of heart diseases in fetuses, babies, children and adolescents, starting from the heart of the unborn baby in the womb up to the end of age 18. These diseases mainly include congenital heart diseases (holes, narrowings), heart diseases that develop later (rheumatic valve diseases, infectious diseases) and heart rhythm disorders. Our patients frequently come to our outpatient clinic with complaints such as a heart murmur, cyanosis, getting tired quickly, chest pain, palpitations, dizziness, fainting (syncope) or high blood pressure. In most of our patients, a diagnosis can be made with methods such as electrocardiography (ECG), telecardiography and echocardiography (ECHO). The heart of the unborn baby is evaluated with fetal ECHO. When necessary, exercise testing, Holter monitoring, cardiac catheterization, angiography and other methods are used. For detailed information, please see the headings below.

Why the Pediatric Heart Diseases and Surgery Advanced Diagnosis and Treatment Center?

Hisar Hospital Intercontinental, with its modern architecture, its academic and specialist physicians using advanced medical technologies, and its trained nurses who combine knowledge and skill, provides services in the diagnosis and treatment of pediatric heart diseases with a multidisciplinary council approach.

1. Operating Rooms

Of the 7 operating rooms in our hospital, 2 have been specially designed for pediatric heart surgery. Our operating rooms are equipped with spacious rooms, sterile and semi-sterile corridors that make it easier to maintain sterility, the PYXIS safe medication management system and anesthesia machines whose safety is continuously monitored. All operating rooms have a sterile airflow system that provides positive-pressure airflow from the inside out, preventing germs and foreign substances from entering the room. In the operating rooms, anesthesia machines, all systems and instruments are suspended from the ceiling by special systems (pendants), making them suitable for sterility and ergonomic use.

2. Intensive Care Services

The care following these major interventions that must be performed on tiny hearts is one of the main treatment steps and significantly affects the course of recovery. The Neonatal Intensive Care and Pediatric Intensive Care Units of Hisar Hospital Intercontinental have been specially designed for this delicate and compassionate care. The most up-to-date practice accepted worldwide, in which each patient has a separate room within the unit, is meticulously implemented in our hospital. In the Pediatric Intensive Care Unit, patient monitoring is carried out under ideal conditions thanks to dedicated nurse stations at the entrance of each room, and in a special section within the unit, patients can be given a full-body wash without being lifted from their beds. Beds and incubators are designed to allow immediate intervention in emergencies. With monitors displaying vital functions, electronic syringe and infusion pumps that control the rate of intravenous medications, suction, mechanical ventilation, devices that assess heart function and other equipment, the units enable the most effective treatment and care.

3. Experience, Knowledge and Expertise

With our multidisciplinary treatment approach, our hospital can provide every kind of healthcare service that may be needed at any stage of life. Services are provided by a distinguished team of physicians who graduated from Turkey's respected medical schools, trained at major healthcare centers around the world, specialize in specific treatments and continuously contribute to the international medical literature with their publications. Reliable diagnostic and treatment methods based on objective data and proven by scientific studies are applied by the academic and specialist physicians of Hisar Hospital Intercontinental. The success that our Hisar Hospital Intercontinental Pediatric Cardiology and Cardiac Surgery team has achieved over many years with surgical and medical treatments in their fields shows that they have turned experience into success.

4. High Investment in the Use of Advanced Technology

As with other diseases, diagnosis and treatment are of great importance for successful treatment in pediatric heart diseases as well. At Hisar Hospital Intercontinental, we have equipped our hospital with modern equipment featuring today's advanced technologies, which requires high investment costs, so that our physicians can act with greater confidence in diagnosing and treating diseases of tiny hearts. Our hospital uses an advanced medical service infrastructure including the PACS system, which allows all test results to be viewed and archived digitally, and PYXIS, the computerized medication preparation system that prevents medication errors. Our hospital serves with an advanced diagnosis and treatment team able to perform all kinds of diagnostic and treatment procedures as well as emergency surgery 24 hours a day, 7 days a week. Our mission in the use of medical technology is: “To believe that the correct diagnosis is reached by carefully selecting and applying the lowest-risk, fastest and most appropriate method for each patient.”

Our Advanced Technology That Provides Speed and Excellence in Diagnosis

Echocardiography

A diagnostic method that does not harm the child in any way and allows the structure and function of the heart of children of all ages to be evaluated using ultrasound.

Fetal Echocardiography

An advanced-technology ultrasound device that, from the 16th week of pregnancy, allows the structure of the unborn baby's heart and the vessels leaving the heart to be examined and detects findings indicating the presence of heart disease.

Transesophageal Echocardiography

A device that enables echocardiography to be performed through the esophagus with the transesophageal echocardiography method in cases where the commonly used surface (transthoracic) echocardiography method is insufficient or the patient's chest structure does not allow echocardiographic images of sufficient quality to be obtained due to reasons such as lung disease or deformity.

1. Exercise Test: A method that investigates the effort and exercise capacity of the child's heart. With this method, both the effort capacity of children with heart disease and the condition of healthy children who have complaints during exertion (getting tired quickly, chest pain, fainting, etc.) can be evaluated. It also allows a risk assessment of healthy children who will engage in intensive sports activities.

2. Rhythm Holter: This is the evaluation of the heart rhythm over 24 hours, using a small, harmless device attached to the child, in children with rhythm disorders, in healthy children complaining of palpitations or in certain other medical conditions.

3. Angiography (Cardiac Catheterization – Angiocardiography)Anomalies of the heart and blood vessels can be detected with the help of a thin catheter inserted into the arteries or veins from the groin area and advanced up to the heart.

What Does the Pediatric Cardiology Department Treat?

The pediatric cardiology department provides the diagnosis, treatment and follow-up of congenital and acquired heart diseases in children. This department evaluates and treats problems related to the heart and circulatory system in all age groups, from babies to young adults.

Which Department Should I Go to for My Child's Heart?

For the treatment of heart-related problems in children, you can consult pediatric cardiologists. Pediatric cardiologists are doctors who specialize in the diagnosis and treatment of congenital or acquired heart diseases.

Do Pediatric Cardiologists Perform Surgery?

Pediatric cardiologists may perform interventional procedures in some cases. Surgical operations, however, may be necessary especially for children with congenital heart diseases or other serious heart problems.

What Are the Symptoms of Heart Pain in Children?

Although heart pain in children is not as common as in adults, it may be a sign of various heart diseases or other medical conditions. Symptoms may include a feeling of tightness, pressure or pain in the chest, shortness of breath, rapid or irregular heartbeat, dizziness or fainting.

How Is a Rhythm Disorder Recognized in Children?

Rhythm disorders in children usually present with certain symptoms. Complaints such as irregular or rapid heartbeat, occasional fainting or dizziness, shortness of breath or chest pain may be seen. The doctor performs a physical examination to evaluate these symptoms and, if necessary, can make a diagnosis by examining the heart rhythm with tests such as an ECG.

What Causes Heart Palpitations in Children?

Heart palpitations in children can have various causes. They often occur due to temporary factors such as stress, physical activity or consuming drinks containing caffeine or sugar. In some cases, however, underlying health problems such as congenital heart diseases, thyroid problems or infections can also cause palpitations.

Don't Postpone Your Child's Heart Health

Pediatric Cardiology is a medical field specializing in the diagnosis and treatment of congenital and acquired heart diseases. In heart diseases, early diagnosis is of great importance for the success of the treatment process. If you notice symptoms in your child that may indicate heart disease, it is recommended that you consult a specialist pediatric cardiologist without delay.

Book an appointment at our Pediatric Cardiology Outpatient Clinic right away to safeguard your child's heart health.