PEDIATRIC CARDIOLOGY DEPARTMENT
The 16-bed pediatric cardiology ward has been operating since November 2003 to monitor patients requiring hospitalization. Approximately 3000 echocardiographic examinations are performed annually in the echocardiography outpatient clinic. Furthermore, routine and emergency echocardiographic examinations after surgery in the intensive care unit bring this figure to 4500 per year. Pediatric cardiac catheterization and angiography are performed twice a week in the angiography unit. The average annual number of pediatric angiograms is around 1000. Approximately one-third of these are interventional (therapeutic) in nature.
GENERAL INFORMATION ABOUT HEART DISEASES IN CHILDREN
We categorize the heart diseases we see in childhood into two main groups: Congenital (present at birth) and Acquired (developed later in life). Unlike in adults, congenital heart disease accounts for the majority of heart diseases seen in childhood. Children with congenital heart disease are born with structural abnormalities in the heart.
These structural abnormalities result from the disruption of the heart's normal development in the very early stages of pregnancy, often before the mother is even aware of her pregnancy. While the exact cause of this disruption is often unknown, some viral diseases (measles, rubella, mumps, certain microbes that cause the common cold, etc.) have been shown to play a role.
Furthermore, heredity (through genes) and chromosomal abnormalities (children with Down syndrome have a 50% risk of heart disease) are also considered factors that increase the risk of congenital heart disease. It has also been reported that certain medications used during pregnancy, especially in the first three months (some medications used to treat epilepsy and neurological disorders) and alcohol can cause abnormalities in heart development.
The severity of these structural abnormalities in the heart can range from a simple problem like a small "hole" between the chambers to much more complex and serious diseases such as the absence of one or more chambers or valves of the heart. The probability of a mother giving birth to a child with congenital heart disease is 8 out of 1000 births. Accordingly, approximately 10,000 to 15,000 children are born with congenital heart disease in our country every year.
Approximately half of this number consists of significant diseases requiring surgical intervention before the age of one. If parents have a child with congenital heart disease, the risk of it occurring in subsequent children is high.
The risk increases to approximately twice the normal level (16/1000). If a parent has congenital heart disease, the risk for the child can vary between 2% and 16%, depending on the disease and whether it is present in the parent.
Today, with the "Fetal Echocardiography" method, performed by specialists trained in this field, it is possible to examine the baby's heart and identify major heart anomalies between the 16th and 20th weeks of pregnancy in high-risk pregnancies. However, there is currently no treatment available in the womb. How and when do heart diseases appear in children? Children with significant congenital heart disease usually show symptoms within the first few months after birth. Rarely, it may present as an emergency shortly after birth due to severe low blood pressure and impaired blood circulation. In some babies, cyanosis (bluish discoloration of the lips, tongue, and nail beds) is the first sign. In another group of heart diseases, rapid breathing, difficulty breathing, poor feeding, failure to gain weight or weight loss, and excessive sweating may be the first signs.
In some less serious conditions, the child often has no complaints. These types of conditions are usually discovered during routine checkups when a heart murmur is detected. A murmur is an extra sound heard between heartbeats. After examination and tests by a cardiologist, it will be determined whether the murmur is indicative of any disease.
More than half of the murmurs heard in children are called "normal" or "innocent murmurs," meaning the heart is completely normal and this murmur does not increase the child's risk of developing heart disease later in life. However, some of these may be indicative of a silent heart condition that does not show any outward symptoms. An experienced pediatric cardiologist can most likely determine which group the murmur falls into after an examination, but for a definitive diagnosis, echocardiographic examination is recommended, especially in children under 2 years of age.
Treatment of Congenital Heart Diseases
Except for small heart defects that do not hinder the patient's growth and development and/or have the potential to close spontaneously, mild and non-progressive vascular narrowings, or some problems with the heart valves, most significant congenital heart diseases are treated surgically. The treatment of congenital heart diseases requires highly specific and meticulous care.
For successful and intensive treatment of pediatric heart patients, the collaboration of an experienced team of doctors specializing in pediatric cardiology, pediatric cardiac surgery, and pediatric anesthesia is of paramount importance. Not so long ago, approximately 50 years ago, it was not possible to perform any corrective surgery on children born with significant heart problems. However, thanks to the research and advancements in this field, especially in the last 30 years, many significant heart diseases can now be treated early.
It is possible for patients to lead a normal or near-normal life. Contrary to popular belief, in our modern congenital heart surgery centers, many congenital heart defects can be successfully and completely treated surgically.
The risk to life in these surgeries ranges from 1% to 10%. After surgical treatment, almost all children with relatively simple congenital heart defects and some of those with complex cases reach adulthood. However, in patients with multiple and more complex problems where one or more chambers of the heart, or the main arteries and/or valves exiting the heart, have not developed, complete correction is not always possible. Nevertheless, a large majority of these patients undergo supportive surgeries that allow them to live better lives. Naturally, the risk to life is higher in these patients both before and after surgery. While current research in organ transplantation and genetic engineering offers a glimmer of hope for these patients, it has not yet reached the desired level.
TREATMENT WITH INTERVENTIONAL CARDIOLOGICAL METHODS
Today, the role of interventional cardiology methods in the treatment of congenital heart diseases is rapidly increasing. For example, many valve or vessel stenoses can now be opened in the angiography laboratory without the need for surgery. Furthermore, some vascular defects and holes in the heart can be closed without surgery. Treatment with interventional cardiology methods provides patients with advantages such as avoiding the risks associated with surgery, reducing hospital stays, and leaving no incision scars.
Of course, it should not be forgotten that these procedures also carry a small risk of life-threatening complications. It is our natural right to receive detailed information about the treatment planned for your child, its alternatives, and its benefits and risks when speaking with your doctor. Dr. Siyami Ersek Hospital, with its experienced pediatric cardiology, cardiac surgery, and anesthesia doctors, and using the latest technology and facilities, is one of the leading centers providing high-quality service in the diagnosis and treatment of congenital heart diseases.