Pediatric cardiologists and information about pediatric cardiology

Pediatric cardiology: specialty for diseases of the child's heart

The most common congenital malformation in children occurs in the heart. Around every 100th child has a heart defect.

Heart diseases in children differ considerably from the heart diseases that are usually acquired in adults. Children therefore need special medical care from trained pediatric cardiologists. They work closely with pediatric cardiac surgeons . Fortunately, the treatment options today are very good.

Cardiology and pediatric cardiology: different areas of expertise

A doctor can only call himself a cardiologist after successfully completing further training. He or she not only treats heart disease, but also explains how it can be prevented. In the case of congenital heart defects and childhood heart disease, however, prevention naturally plays no or only a subordinate role.

Paediatric cardiologists are responsible for heart disease in children and usually work in heart centers that specialize in the needs of young patients. They do everything they can to ensure that children with heart defects receive the best possible care. Pediatric cardiologists in private practice also offer good outpatient care for affected children.

What is a pediatric cardiologist?

Paediatric cardiologists have specialized in paediatric cardiology. This training follows on from the five-year training to become a specialist in pediatric and adolescent medicine and takes a further three years.

The training focuses on diagnosis and treatment methods for cardiac arrhythmias, congenital heart defects and other diseases of the child's heart.

The most common diseases that a pediatric cardiologist treats are congenital heart defects such as

• Ventricular septal defect (ventricular septal defect): Hole between the two chambers of the heart
• Atrial septaldefect (atrial septal defect): Hole between the two atria
• Pulmonary stenosis (narrowing of the heart valve): Narrowing of the right heart valve
• Open ductus arteriosus(persistent ductus botalli): unclosed connection between the pulmonary artery and the aorta
• Interchanged large heart artery
• Underdevelopment of the left or right ventricle
• Inflammation of the heart muscle(myocarditis)
• Cardiac arrhythmia

The ventricular septal defect is by far the most common heart defect: around 50 percent of congenital heart and vascular abnormalities are caused by this type of heart defect, i.e. around 5 out of 1000 newborns are born with this type of heart defect.

This is how an examination by a pediatric cardiologist works

The entire examination is painless. In a detailed discussion with parents and child, the doctor answers all questions about the diagnosis and the further therapeutic procedure.

During the patient interview (anamnesis), the doctor asks the child or parents questions about the symptoms and signs of illness, the course of the pregnancy and previous findings.

During the physical examination, the pediatric cardiologist looks for general indications of a heart defect as well as other physical abnormalities. These include

• Blue coloration of the skin (cyanosis)
• failure to thrive,
• increased sweating,
• difficulty drinking,
• greatly accelerated breathing or other respiratory abnormalities as a sign of heart failure (cardiac insufficiency)
• Protrusion of the abdomen or chest
• Changes in the veins

Listening to the child's heartbeat is very important. Palpating the pulse, measuring the blood pressure and determining the oxygen saturation of the blood can also provide indications of heart disease. The ECG is standard in every pediatric cardiology examination.

As part of the physical stress test (ergometry), physical performance can also be assessed under stress and certain complaints may be triggered or objectified.

The heart, blood vessels and blood flow can be assessed very well using an ultrasound examination of the heart. In most cases, the examination can be carried out from the outside through the chest. This examination is easy to perform and takes between 10 and 15 minutes. As the child has to be very still during the examination, babies are given a bottle to drink. Many doctors also offer films as a distraction. In some cases, however, the ultrasound probe must be inserted into the esophagus under sedation (sedation) or anesthesia.

Depending on the suspected diagnosis, further examinations may be necessary, such as an electrophysiological examination if cardiac arrhythmia is suspected. If a cardiac catheter examination is required for an infant with a congenital heart defect, this is carried out under surgical conditions and usually under sedation. Therapeutic interventions can also be carried out with the help of a cardiac catheter.

Other imaging examination procedures that are used for certain issues are X-rays, magnetic resonance imaging (MRI) and computer tomography (CT).

Treatment in pediatric cardiology

A pediatric cardiology clinic offers state-of-the-art diagnostics and treatment options.

Treatment depends on the diagnosis. Congenital malformations are treated differently to acquired heart disease or cardiac arrhythmia. The spectrum is so diverse that it is not possible to list everything here. For example, a child may require a pacemaker that is implanted directly under the skin.

Major heart operations are also routine today. The attending physician informs affected families on a case-by-case basis which specialist clinic is suitable for them.

Major advances in pediatric heart surgery

In the field of surgical heart therapy, medicine has made rapid progress in just a few decades. The beginning of heart surgery is usually dated back to 1896, when a stab wound to the heart of a 22-year-old patient was treated with a suture. However, in the 1930s it was hardly possible to adequately treat a diagnosed heart defect. Gradually, the first surgical methods in pediatric heart surgery were developed.

The Blalock-Taussig anastomosis (named after the American heart surgeon Blalock and the cardiologist Helen Brooke Taussig) was first performed in 1944 and was a sensation at the time. An artificial vascular connection improved blood flow to the lungs, and the so-called Blue Babies had a chance of survival for the first time. This method is still used today in a modernized form for certain heart defects.

A heart defect in a child puts a strain on the whole family

Children and their parents experience the diagnosis of a heart defect as a shock and often feel as if the rug has been pulled out from under their feet. The affected families are also very tense before and after a necessary heart operation and need psychological support. For this reason, most pediatric cardiology clinics employ psychologists who are available to families as contact persons - even long after the operation.