Centres Of Excellences

Paediatric Cardiology

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The paediatric cardiac program was initiated in 1998  at AIMS having recognized the pressing need for quality care for children with heart disease at an affordable cost. It is perhaps the first and most comprehensive model of a dedicated and cohesive team specifically focused on the care of children with heart disease.

The program is now recognized as one of the leading paediatric heart programs in India and is a preferred destination for patients from all over India, other countries in South Asia, the Middle East and Africa. The program is known for the quality and range of services provided at an affordable cost, its training program and its research initiatives.

The constituent departments of the paediatric cardiac program include the following:

  • Paediatric cardiology
  • Paediatric cardiac surgery
  • Paediatric cardiac intensive care and anaesthesiology

Services Currently Being Provided

Cardiac surgical program: newborn heart surgery, cosmetic congenital heart surgery, surgery for complex heart defects.

Catheter interventions including closure of common heart defects without surgery (ASD, PDA and VSD), newborn interventions, interventions to complement surgery.

Comprehensive imaging and diagnostic services: echocardiography (trans thoracic, 3D echocardiography, trans-esophageal and fetal echocardiography), multi-slice CT scan (64 slice CT), MRI for congenital heart defects (AIMS has the country's first cardiac MRI service), diagnostic cardiac catheterization and angiography.

Fetal cardiac unit: A comprehensive fetal cardiac program (the only one of its kind in the country) is available at AIMS. The services include prenatal diagnosis and counseling of pregnant mothers with suspected heart defect in the fetus and, prenatal treatment for fetuses with cardiac rhythm disorders.

Training programs: AIMS has a well-established structured training program in paediatric cardiology (fellowship of national board FNB): This is a two-year structured training in paediatric cardiology under the auspices of the National Board of Examinations, New Delhi. We have now started a training course in paediatric echocardiography for paediatricians and cardiologists. Additionally there are dedicated training programs in cardiac anesthesiology and intensive care. AIMS offers an ideal opportunity to train paediatric cardiovascular surgeons in their formative years. Four leading paediatric heart surgeons in South India have been trained here and overseas programs in Japan, China and Portugal have sent their surgeons for advanced training at AIMS.

Researchu Unit: this is under the Indian Council of Medical Research (ICMR). Community based research projects in all facets of paediatric heart care in developing countries are being conducted here.

Equipment and Procedures

Equipments

A: Non-invasive

Advanced paediatric and fetal echo lab: launched in 2008, this lab has two Philips IE 33 echo machines exclusively for paediatric cardiac imaging (2D, 3D, TEE) and fetal echocardiography. The lab has a work-station with the advanced Q-lab software for offline processing of 3D images, a digital library for image archiving in DVDs, electronic databases of the echo reports and a dedicated staff consisting of two nursing assistants and a secretary.

Additional echo machines

Philips 5500 echocardiogram machine with three dedicated probes with paediatric and adult multi-plane TEE probes.

Two portable machines for community based activities.

(Siemens Cypress machines).

Exercise machines

CPX machine (exclusively for paediatric work), treadmill.

Arrhythmia and syncope evaluation: head up tilt test, holter.

Additional imaging equipment available through the radiology and nuclear medicine department.

  • Siemens multi-slice 64 slice CT scan.
  • Siemens Sonata: MRI and MR angiography.
  • Gamma camera (Siemens).

B: Invasive

1. Two Siemens Hi-Cor catheterization laboratories (digital flat panel)

2. Comprehensive facility for arrhythmia and pacing

I. Advanced EP laboratory

II. Facilities for implantation and follow up of pacemakers and ICD

3. Electronic databases and digital library of the catheterizatin studies.

C: Dedicated operation rooms with facilities for newborn, infant and complex congenital heart surgery. State-of-the-art monitoring systems including dedicated paediatric trans-esophageal echocardiography are available.

D: Dedicated state-of-the-art paediatric cardiac intensive care facility with supporting monitors and ventilators, inhalational nitric oxide and facilities for LV assist and extra-corporeal support.

The paediatric cardiac intensive care unit has twenty four beds in total, twelve of which are located close to the operation theater.

Procedures

A. Paediatric Heart Operations

A strong dedicated team of three full time paediatric cardiac surgeons performs heart operations with results that match international standards. On an average three to four operations are performed for children with congenital heart disease every day. The open heart procedures include closure of common heart defects, repair of tetralogy of Fallot, repair of total anomalous pulmonary venous connection, arterial switch operation, the Senning operation, the Fontan procedure (including the extra-cardiac Fontan operation), the Glen procedure and, repair of common AV canal defects. The closed heart procedures include BT shunt, coarctation repair and PDA ligation and interruption.

The highlights of the paediatric cardiac surgical program at AIMS are the excellent outcomes with heart operations in newborns and young infants. Complex defects (such as double outlet right ventricle, multiple ventricular septal defects) are routinely corrected here with excellent results.

B: Catheter Interventions

Closure of many heart defects traditionally need operations for their treatment and often this is an open-heart operation. Today newer developments in cardiac catheterization technology allow closure of selected patients with heart defects without an operation. This avoids the trauma of surgery and allows very rapid recovery. The procedures are performed in the cardiac catheterization laboratory and require no more than a needle prick in the groin. AIMS has leadership status in catheter interventions and several regional, national and international workshops are frequently conducted here for a variety of cardiac defects.

Examples of heart defects that can be closed in the catheter laboratory include:

  • Atrial septal defects (ASD): AIMS has one of the largest experience in trans-catheter ASD device closure in India.
  • Patent arterial ducts (PDA): using cost-effective techniques developed at AIMS over two thousand PDA closures have been performed in the catheterization laboratory at AIMS. This is one of the largest experiences in the world.
  • Ventricular septal defects (VSD): the technique has been modified at AIMS to allow closure of some of these defects at a reduced cost to the patient.
  • Other defects: coronary artery fistula, pulmonary arterio-venous malformation.

Additional procedures performed in the catheter laboratory at AIMS include balloon dilation procedures for valve obstruction at all ages, stenting of coarctation, pulmonary artery and PDA. Recently, we have performed hybrid procedures for complex CHDs like hypoplastic left heart where the surgeon and the cardiologist combine together.

C: Pacemaker implantation in children: AIMS has comprehensive facilities for pacemaker therapy in children.

D: Paediatric electrophysiology: a comprehensive EP facility is available at AIMS for children of all ages.

List of Clinics with Schedules

Regular Outpatient Clinics:

Monday to Saturday - 8.30 AM - 5.00 PM, Sunday - (9 AM -12.00 noon). All patients undergo a comprehensive evaluation and every effort is made to complete the evaluation process including all non-invasive tests and most procedures (surgical or catheter interventions) are scheduled before the patient leaves the hospital.

Specialty Clinics:

1. Fetal cardiac services (Monday – Friday 8.30 AM - 5 PM) was initiated in 2008. Provides comprehensive diagnosis and counseling besides inutero treatment for arrhythmias.

2. Paediatric lifestyle  - This clinic was established in February 2007, to address lifestyle related diseases such as childhood obesity and hypertension. The clinic functions on all weekdays.

3. A grown-up congenital heart disease (GUCH) clinic is – to be launched this year to provide follow-up into adult life for children with corrected CHDs as well as evaluation and treatment of adults with CHDs (like atrial septal defects).

4. Our pulmonary hypertension clinic will focus on patients with various forms of pulmonary hypertension- Our department is one of the nodal centres for the international organization, pulmonary vascular research institute (PVRI).

Outreach Clinics:

We have successfully run a bi-annual outreach program in Mumbai providing non-invasive paediatric cardiac services. So far, since 2005, more than five hundred patients have been treated through this initiative. A similar program is being planned in East India this year on a bi-annual basis. We have also been successfully running an outreach clinic in Kalpetta, Wayanad to cater to patients from areas that are difficult to access.

Telemedicine:

Patients from many remote locations can stay in touch with us through our advanced telemedicine communication facility. This medium is also used for webinar transmissions and several distant learning initiatives.

Academics

DM in paediatric cardiology: The paediatric cardiology department is the first center in India that has been recognized by the Medical Council of India for DM in paediatric cardiology. This course will begin in August 2011.

Overseas fellowship: the paediatric cardiology program is now training fellows from overseas. We have committed to train a fellow from Sri Lanka each year for the next five years.

PDCC (post doctoral certification course) in cardiac anesthesiology and intensive care: The department of anesthesiology has an intense training program in cardiac anesthesia and intensive care. This one-year course has prepared many candidates to independently deliver paediatric cardiac anesthesia and take care of the operated children in postoperative ICU.

CME courses: our department has organized a large number of major conferences and CMEs over the past ten years. Some of the major ones include the annual conference of the Paediatric Cardiac Society of India (PCSI) in 2000 and 2008, a symposia in post operative care for CHD (2003, 2006) the first interventional forum for structural and congenital heart diseases (IFISCH 2008), a teaching program in cardiology (2005), fetal echo workshops (2005 and 2006), paediatric echo CME (2002) and a CME on neonatal cardiac care (2008).

Research

Several grant funded research projects of the Indian Council of Medical Research (ICMR) and department of science and technology (DST) have been conducted by the department of paediatric cardiology at AIMS. A dedicated research office has been set up for this purpose.

Publications:

Over sixty original papers and eighteen reviews have been published from the department in peer reviewed journals. (e.g. Paediatrics, Circulation, Annals of Thoracic Surgery, Cardiovascular and interventional Radiology , Catheterization and Cardiovascular Interventions, Journal of thoracic and cardio-vascular surgery, Journal of Paediatrics, Heart, National Medical Journal of India. The department faculty have helped initiate a new journal (Annals of Paediatric cardiology) and edited two books.

International Collaborations

Children's heartlink: the paediatric heart program at AIMS has been a partner site for children's heartlink (www.childrensheartlink.org) for over a decade and we are the first among several international sites to acquire the status of a global training site.

Children's Hospital Boston, Harvard Medical School: collaborations have been initiated between the children's hospital and AIMS. The areas include cardiac MRI, fellowship exchange and clinical research.

International quality improvement collaborative: The paediatric heart program at AIMS is now a member of the IQIC (an initiative of the Boston Children’s Hospital) and a number of quality improvement processes have been initiated and monitored through this process.

Lucille Packard Children's Hospital, Stanford: collaborations have been initiated for intensive care and nursing. This has been in the form of frequent visits by leading nurse practioners and Dr. Steve Roth, chief of paediatric cardiac intensive care at LPCH.

Government of SriLanka (Sri Lankan college of paediatrics): The first three dedicated paediatric cardiologists in Sri Lanka have been trained at AIMS.

Training Overseas Surgeons: The paediatric cardiac surgical program has training facilities for overseas surgeons:

Luis Baccero: Portugal

Kadohama: Japan

Ruan Xin Hua: China

Awards and Distinctions

Dr. Balu Vaidyanathan - Commonwealth fellowship in Fetal Cardiology London, UK; Young Investigator award PCSI 2005.

Dr. K. Mahesh - Travel Award, Asia-Pacific Congress, Korea 2008; Best paper PCSI 2010.

Dr. R. Krishna Kumar - Chairperson PVRI South East Asia, Fellow of American Heart Association, Vocational Service Award, Rotary International for contributions to the Rotary “Gift of Life” Program, Tri-decennial Medical Teacher of Excellence Award by the National Board of Examinations, Sept 2011.

Dr. Rakhi B. - Young investigator award, PCSI 2010.

1. What heart diseases afflict children?

Approximately one in ten or twelve children are born with a congenital heart defect.

Congenital heart defects include a number of conditions. There are hundreds of types and making a precise diagnosis is sometimes quite challenging. The common heart defects include:

Holes or communications in the heart or great vessels: Examples of such holes in the heart include: atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA)

Conditions resulting in the child becoming a blue baby: These conditions are also known as cyanotic heart defects. Common examples include tetralogy of Fallot’s (TOF) and transposition (TGA).

Congenital narrowing of heart valves or vessels: Examples include congenital narrowing of the pulmonary or aortic valve.

Thirty percent of congenital heart defects are potentially life threatening early in life and require attention in infancy. Rheumatic heart disease continues to afflict large numbers of school-going children and young adults in India and other developing countries. This condition seriously damages heart valves and many children eventually require an operation or balloon procedure in the cardiac catheterization laboratory.

2. How does congenital heart diseases develop?

In most cases we do not know what causes congenital heart disease to develop. The parent’s should not feel that it is their fault for having a child with this problem. Rarely, a viral infection in the mother during the first few months of pregnancy may produce a serious heart problem (for example if the mothers gets German Measles during the first three months of pregnancy, the child’s heart may not develop normally)

Heredity sometimes plays a role. More than one child in a family may have a congenital heart defect, but this is rare. Certain conditions that affect multiple organs, such as Down’s syndrome (Mongolism), can also affect the heart. Some drugs can also affect heart development if consumed during early pregnancy. Alcohol consumption can also affect heart development.

3. What are the common symptoms of heart disease in children?

The possible pointers to heart disease in infants (less than one year age) include:

  • Difficulty with feeding
  • Excessive sweating
  • Breathing difficulty
  • Blueness of lips, fingers and toes
  • Poor growth
  • Frequent episodes of chest infection
  • Sometimes heart disease may be first identified during a routine check-up by your pediatrician.

4. What is required for care of children with heart disease?

Care of children with heart disease requires a highly coordinated effort from a team of specially trained personnel. Pediatric cardiologists, pediatric cardiac surgeons, intensive care physicians and intensive care nurses should ideally constitute this team. In addition, a variety of sophisticated and very expensive equipment is required. Establishing an infrastructure for care of children with heart disease involves substantial investments and few institutions in India are able to afford it.

5. Can heart defects be closed without surgery?

Many heart defects need an operation for their treatment and this is often an open-heart operation. Today, newer developments in cardiac catheterization technology allow selected patients with heart defects closure without an operation. This avoids the trauma of surgery and allows very rapid recovery. Examples of these heart defects include the atrial septal defect (ASD), the patent ductus arteriosus (PDA) and selected patients with ventricular septal defects. The procedures are performed in the cardiac catheterization laboratory and require no more than a needle prick in the groin.

6. What resources are available for treating children with heart defects in India?

At present, less than a dozen institutions, including AIMS, support a comprehensive infrastructure for newborn and infant heart surgery in India. All of these institutions have a busy adult cardiac surgery programs and much of the infrastructure is shared by both the adult and pediatric cardiac services. Not more than fifteen hundred neonatal and infant heart operations are performed in all of India every year. This would account for less than 2% of the affected population of newborns and infants in India.

CONTACT US

Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, AIMS Ponekkara P.O.,
Kochi 682041, Kerala, India.
Phone: (0484) 2801234, 2853570
Fax: (0484) 2802020
Email: paediatriccardiology@aims.amrita.edu

Department of Paediatric Cardio-Vascular and Thoracic Surgery, Amrita Institute of Medical Sciences, AIMS Ponekkara P.O.,
Phone: (0484) 2851559
Email: cvtsop@aims.amrita.edu

Paediatric Cardiac Intensive Care Unit, Amrita Institute of Medical Sciences, AIMS Ponekkara P.O.,
Phone: (0484) 2851234
Email: cvtsop@aims.amrita.edu