Cardiothoracic Surgery

The Children's Hospital at Montefiore: A fresh approach to pediatric care
 

At CHAM we have a team of the most experienced pediatric heart specialists. Here, doctors collaborate across disciplines to provide the most efficient care for all patients with congenital cardiac defects-from neonates to adults.

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 implantation 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.

Caring for the family

CHAM understands how frightening it can be to manage the fear and sadness stirred up by navigating the healthcare needs of children with pediatric heart conditions. We offer an array of compassionate educational options. Resources include our child life specialists who are there to assist you and your child before and after surgery, to alleviate any anxiety your child is experiencing, and the Family Learning Place, an on-site health research center where families can learn about their diagnosis.
 
CHAM also accommodates parents who remain by their children's side with attentive staff to ensure that parents and the child have everything they need, including lodging, financial assistance for travel expenses, and food.

A snapshot of CHAM's expertise

The following is a partial list of the more than twenty-five diagnoses treated by the pediatric heart team at CHAM:

• ventricular septal defects
• valve disease
• atrial septal defects 
• Marfan syndrome
• Tetralogy of Fallot
• Patent Ductus Arteriosus
• Atrioventricular canal 
• single ventricles 
• hypoplastic left heart syndrome 
• lung or airway disease
• tracheal disease
• any hole or obstruction in the heart

CHAM treats a full range of pediatric heart defects, offering each patient a team approach that ensures your child will receive care from a panel of highly qualified cardiac specialists.

Beyond Pediatric Cardiology

The Pediatric Airway Team at the Children's Hospital at Montefiore (CHAM) is comprised of a team of specialists devoted to the medical and surgical management of complex pediatric airway disorders.  This group of nationally renowned physicians provide their expertise and innovation to the care of children with tracheal obstruction or masses; feeding disorders; sleep abnormalities including apneas; and "blue spells." The team treats patients, ranging from newborns to age 21, with conditions including:

• laryngo- and tracheomalacia
• tracheal and sub-glottic stenosis
• sub-glottal webs
• complete tracheal rings
• laryngeal papillomatosis
• congenital and acquired airway diseases due to accident or intubation.

The Airway Team at CHAM includes Sanjay R. Parikh, MD, Chief of Pediatric Otolaryngology, Alfin G. Vicencio, MD, assistant professor of Pediatrics, Section of Respiratory and Sleep Medicine, and Samuel Weinstein, MD, director of Pediatric Cardiothoracic Surgery. A multidisciplinary evaluation of the patient is followed by a conference which may incorporate additional pediatric airway specialists including anesthesiologists, pediatric critical care specialists, pediatric radiologists, as well as highly skilled nursing staff, with all participants drawing on their particular capabilities to devise the best treatment plan possible.

CHAM's Airway Team uses highly sophisticated technology to assess patients' pulmonary function including non-invasive techniques such as virtual bronchoscopy, a state-of-the-art sleep study and a specialized procedure to test infants' breathing capabilities. Some conditions, such as certain apneas, may be managed using Continuous Positive Airway Pressure (CPAP), Bi-level Positive Airway Pressure (BPAP) or other techniques. When surgery, such as tracheal resection, is indicated, the team's pediatric cardiothoracic surgeon supports these complex procedures, including those that require heart/lung bypass.

CHAM physicians also specialize in chest wall reconstructions for patients suffering from pectus excavatum and and pectus carinatum. Pectus excavatum, or funnel chest, is marked by a deep depression in the patient's sternum. If severe enough, this dip can restrict full motion of the heart and lungs. In pectus carinatum, or pigeon breast, the cartilage in the sternum protrudes. In severe cases, patients are unable to fully contract their chests while exhaling.

Because young children and adolescents with chest wall deformitites can suffer severe self consciousness, CHAM's team of surgeons, social workers, nurses, and psychologists evaluate patients to determine how their defects affect them physically and emotionally.

Click here to learn more about the Airway team at CHAM.

Tania Shiminski-Maher, MS, CPNP