Cardiology

Montefiore Medical Center and its physicians have long been leaders in Pediatric Cardiology and the management of the child with congenital or acquired heart disease. One of the first Cardiac Catheterization Laboratories for children was established at Montefiore by Dr. Doris Escher and Dr. Dennison Young, and Dr. Seymour Furman was one of the first surgeons to implant pacemakers in children.

Our philosophy of family-centered care provides education about a child's current heart problems, and education to prevent heart problems later.

Hybrid procedures

In a hybrid procedure, skills from both pediatric cardiac surgeons  and pediatric interventional cardiologists (heart catheterization expert) are used to treat the child during one procedure.  Through physician teamwork  the child enjoys the latest techniques of both specialities to reduce both the impact of cardiac procedures and their length of stay in the hospital.  An interventional cardiologist usually places special devices in children to close holes in the heart, or to keep certain vessels open, or even to close other vessels.  Hybrid procedures can utilize the skills of the surgeon, to allow the implanation of these devices in small hearts or small patients that previously required open heart surgery. 

With this minimally invasive surgery, advantages include removing the need for arresting the circulation, the heart, or even the use of cardiopulmonary bypass (heart lung machine)  Although the procedures are not new themselves, the fact that they are combined is new and allows them to be available to a wider patient population.

This procedure is available to even the tiniest patients – those who may benefit the most from this innovation.  In some cases, hybrid surgery is the preferred method for treating newborns.

How might hybrid procedures help your child?  A hybrid approach allows babies once considered too small for device closure of a hole (avoiding open heart surgery) to still have this minimally invasive approach through a small incision.  For a baby with hypoplastic left heart syndrome whose heart is mixing blue and red blood, hybrid procedures allows the medical team to do the initial surgery to correct the pumping action of the right ventricle without using the heart-lung bypass machine.

The Fetal Cardiology Center offers expertise in the diagnosis and management of heart disease in the unborn child.

All women at risk of having a baby with heart disease should have a fetal echocardiogram. These include mothers with gestational diabetes, collagen vascular disease such as Lupus, exposure to certain drugs, toxins or infections, and/or a history of congenital heart disease in herself, the father, or close family members.

A fetal echocardiogram is used to assess the structure, function and rhythm of the heart. Antenatal counseling is given concerning the severity and prognosis of the disease and available options and treatments.

The Pediatric Dysrhythmia Center performs all invasive and non-invasive electrophysiology studies in children.

Electrode catheters can be introduced into the heart through blood vessels to map out where an abnormal rhythm is coming from and destroy the abnormal tissue using radiofrequency energy. Pacemakers can be implanted using a vein to treat dangerously slow or fast heart rhythms. Some pacemakers can even shock the heart into a normal rhythm.

Exercise testing, Holter (ambulatory) monitoring, and transtelephonic monitoring are used to diagnose the type of abnormal rhythm. Recordings of the electrocardiogram (ECG) made by a child during a symptom such as palpitations can be transmitted over the telephone 24 hours a day and sent to the cardiologist. Tilt table testing is useful in finding the cause of fainting. Abnormal heart rhythms in the fetus can be detected by means of echocardiography and treated by giving medicine to the mother.

Meghan D. Kelly, MS, CCLS