171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
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Children's Heart Program of South Carolina
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Services
General Pediatric Cardiology
Every day our clinic provides patient care at MUSC Children's Hospital and in seven outreach locations across South Carolina. Our team provides ongoing evaluations for patients with congenital heart disease, as well as receives new referrals for typical cardiac symptoms such as chest pain, palpitations or syncope. Since August 1998, Girish Shirali, MD, has directed our echocardiography laboratory, further enhancing our clinical services and diagnostic imaging team at MUSC Children's Hospital.
Pediatric Cardiac Surgery
Pediatric cardiac surgery (heart surgery) encompasses all surgical procedures performed on the heart or blood vessels going to and from the heart. Surgical intervention is needed when medical treatment (treatment with drugs or other methods without "cutting") is no longer effective or is not able to treat the heart problem. Your child's cardiologist determines when heart surgery is necessary and discusses the problem in conference with other members of the cardiac team (surgeons, other cardiologists, anesthesiologists and intensivists). The team then agrees that surgery is indeed indicated before proceeding; thus multiple opinions are provided during the discussion. There are a number of ways in which surgeons may correct heart abnormalities. Some procedures are known as "minimally invasive", others are called "closed heart" operations, and others are called "open heart" operations.
Scott Bradley, MD, joined Fred Crawford, MD, at MUSC in July of 1996. After graduating from Harvard Medical School, Dr. Bradley trained at the Massachusetts General Hospital, the University of California, San Francisco, and finished with a pediatric cardiac surgery fellowship with Dr. Ed Bove at the University of Michigan. Dr.Bradley is a devoted pediatric cardiac surgeon who has had spectacular results that are only seen in a handful of centers throughout the states. His and Dr. Crawford's mortality rate in over 3000 procedures, performed from 1995-2005, has been 2.7%, including the most difficult cases in neonates. This success comes from a combination of high technical skill, and the willingness to see these patients through what are often difficult postoperative courses. Further, the perioperative care of these patients is now focused under a dedicated pediatric cardiac intensivist, Dr. Andy Atz, recruited from Children's Hospital in Boston. His staff includes Dr. Tim McQuinn, Dr.Geoffrey Forbus, Dr.Eric Graham and Dr. David Habib.
Interventional Catheterization
Cardiac catheterization is a procedure that involves puncturing an artery and/or vein, usually located in the groin, so that a small, long, flexible tube (catheter) can be guided into the heart and major vessels around the heart. The catheter is moved through the heart with the aid of fluoroscopy (x-ray machine). This is usually performed to help in providing a diagnosis of heart problems. Interventional catheterization is a type of cardiac catheterization where actual treatments can be performed by use of specialized catheters. These specialized catheters include balloon catheters that can open up narrowed valves or arteries and also catheters where devices can be deployed which can close extra vessels or certain "holes" in the heart.
Electrical Impulses Keep Your Heart Pumping
The heart's electrical system controls the rhythmic contractions that keep the blood pumping and circulating throughout your body. These electrical impulses are controlled by the sinus node, a group of specialized cells that act as the heart's natural pacemaker.
Philip Saul, MD, division chief, joined MUSC as cardiology chief and director of the arrhythmia management team in 1997. He began his career in pediatric cardiac electrophysiology in 1987 and was the first to perform a radiofrequency catheter ablation for WPW in a child in 1991. He was part of a five-member electrophysiology team at Children's Hospital in Boston where he was involved in over 700 ablation procedures, and has extensive experience in both adults and children with common and uncommon forms of supraventricular and ventricular tachycardia. In addition, Dr. Saul has a long experience in autonomic physiology research, including research into the causes of common and uncommon forms of syncope.
Adults with Congenital Heart Disease
As of the year 2002, over half of the patients with tetralogy of Fallot were adults. This phenomenon has resulted from the spectacular surgical advances in the treatment of all forms of congenital heart disease, but perhaps earliest for tetralogy patients. Thus, the trend will soon follow for all forms of congenital heart disease, indicating that the care of adults will become increasingly important. Because of the lack of training of most adult cardiologists in congenital heart disease, the field is currently under-served, leading to the institution of a specific effort in the care of adults by MUSC. Dr. David Gregg came to the adult cardiology program in 2006 to co-direct the adult congenital service with Dr.Saul.
Genetics of Congenital Heart Disease
Congenital heart disease affects 8 per 1000 liveborn babies making congenital heart defects the most common group of fetal malformations. It has become increasingly clear that a large portion of congenital heart disease (perhaps 30-50%) has some genetic basis. Part of the reason for the under-recognition in the past has been what is called reduced penetrance, a situation where a patient inherits a gene defect but never develops the actual disease. However, closer examination by a number of investigators has revealed that familial heart disease is indeed quite common. Under the direction of Dr. Saul, the Children's Heart Program at MUSC has begun a program to identify all of the families with familial congenital heart disease in the state of South Carolina, and eventually identify the genes responsible and their cause. This is a coordinated effort with the cardiac developmental biology center, run by Dr. Roger Markwald, chairman of cell Biology and anatomy at MUSC. This program will include genetic screening and genetically directed therapy for patients with congenital long QT syndrome, a disease where a genetic diagnosis is probably now possible in as many as 75-80% of patients. The program will be making an important effort to screen all fetuses in families with heart disease.
Fetal Cardiology
The ability to successfully repair many, if not most, congenital heart defects in the first week of life has made it increasingly important to identify all patients with congenital heart disease as fetuses, optimizing their care in the newborn period, and preventing any hemodynamic decompensation prior to surgery. Once these fetuses are identified, a significant amount of counseling and support is almost always necessary for these families. Dr. Girish Shirali facilitates the fetal cardiology program. In addition, the echocardiography laboratory at MUSC Children's Hospital performs fetal screens on all high-risk patients, including those families with congenital heart disease, diabetes and fetuses with other known abnormalities.
Cardiomyopathy and Cardiac Transplant
Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn't work as well as it should. Cardiomyopathy can be classified as primary or secondary. Primary cardiomyopathy can not be attributed to a specific cause. Secondary cardiomyopathy, on the other hand, is due to specific causes such as high blood pressure, viral infections, heart valve disease, artery diseases or congenital heart defects. Secondary cardiomyopathy is also often associated with diseases involving organs other than the heart. There are three main types of cardiomyopathy -- dilated, hypertrophic and restrictive.
Jeremy Ringewald, MD, heads our cardiomyopathy and transplant service. Dr. Ringewald's expertise in treatment of patients with myocarditis and cardiomyopathy provides for excellent care of these patients as well as those in need of a heart transplant. While the number of transplants so far has been relatively small, 100% hospital discharge survival is testimony to the excellent care the transplant team has provided for these patients.
Cardiac Transplantation/Heart Failure
We continue to offer a dedicated pediatric transplant/heart failure service with a coordinated team of doctors, nurses, nutritionists, and social workers. Along with the entire pediatric cardiology service in support, South Carolina pediatric heart failure patients have received and continue to receive the latest in medical, electrical, cardiac catheter based, and surgical interventions.
The MUSC Children's Heart Transplant Service has joined the Pediatric Heart Transplant Society. This society is a consortium of the vast majority of major pediatric heart transplant centers. Its purpose is to provide extensive data collection and help us learn important lessons to improve the care of pediatric heart transplant recipients. Joining this society will help continue MUSC's dedication to providing state of the art care for South Carolina's pediatric heart transplant recipients.
Echocardiography
The Pediatric Echocardiography Laboratory at MUSC performs over 5500 echocardiograms annually. It is directed by Dr.Girish Shirali, who came to MUSC in 1998. Multiple dedicated physicians, pediatrics-registered cardiac sonographers and sedation nurses provide staffing for the laboratory. In 2004, the laboratory received renewal of accreditation from the Intersocietal Commission for Accreditation of Echocardiography Laboratories in pediatric transthoracic, transesophageal and fetal echocardiography. The laboratory has four 3D-capable echocardiography machines, and has been a pioneer in the area of 3-D echocardiography. All sonographers are 3D-trained, and have participated in workshops at a national level to train over 100 pediatric cardiologists and sonographers in 3D echocardiography. Comprehensive pre-surgical and pre-interventional echocardiography now includes 3D imaging in all cases. 3D echocardiography has also been used to guide right ventricular endomyocardial biopsy as an adjunct to fluoroscopy. Over a dozen clinical studies in 3D echocardiography are under way. Several of these studies interact heavily with ongoing studies from the NIH-funded Pediatric Heart Disease Clinical Network. The echocardiography laboratory serves to coordinate a statewide program for the care of fetuses with congenital heart disease and their families, providing for multi-specialty consultation, family support and planned delivery at MUSC.
Arrhythmias, Electrophysiology and Syncope
This service focuses on the management of patients with heart rhythm abnormalities and fainting (syncope) disorders. The heart's rhythm may be abnormal if it beats too fast, too slow or irregularly. Outpatient evaluations are performed for palpitations (feeling an abnormal heart beat), known rhythm abnormalities, pacemaker or implantable defibrillator management, and syncope. In addition to routine pediatric cardiology testing such as electrocardiograms (ECG) and echocardiograms, non-invasive testing may include Holter monitoring (24 hour ECG monitoring), trans-telephonic event monitoring (episodic ECG monitoring over the phone), stress testing, tilt-testing and pacemaker programming.
Cardiac electrophysiology is the study of the heart's electrical system. Patients with identified or suspected rhythm abnormalities may also require invasive electrophysiological testing or therapy in the cardiac catheterization laboratory. The term electrophysiology study or EP study applies to any procedure that requires the insertion of an electrode catheter into the heart. Electrode catheters are long, flexible wires that transmit electrical currents to and from the heart. Some electrophysiology studies are done to diagnose abnormalities while others are done to access the heart for treatment or correction of certain conditions, using techniques such as Cardiac Catheter Ablation. The physicians at MUSC who specialize in these procedures are highly experienced. In fact, Dr. Saul, the division chief, performed the first such procedure in a child in 1990.
Some patients require permanent implantation of a device (Pacemaker Implantation, ICD Insertion) to either speed up or slow down the heart's rhythm when abnormalities occur. The MUSC team is also highly experienced at placing these devices, even in the smallest children or infants.
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