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Pediatric Cardiology
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Tricuspid Atresia: What is it?
Tricuspid atresia is a type of heart defect that is present at birth. A child has tricuspid atresia when the tricuspid valve isn’t formed. What the child has instead is a firm tissue found between the chambers. As a result, the blood can’t flow well through the heart and into the lungs to get its needed oxygen. When this happens, the child isn’t provided with its needed oxygen supply and hence, could end up getting tired easily and having cyanosis (blue-tinged skin).
Causes of Tricuspid Atresia
This congenital heart defect occurs while the baby is still developing. The exact cause of the condition is still unknown although there are certain risk factors that can increase one’s risk of getting tricuspid atresia. One of these factors is Down syndrome.
Other factors that may increase the risk of the baby being born with tricuspid atresia include the mother getting German measles or other viral disease while pregnant, drinking alcohol during pregnancy, smoking before or after pregnancy, mother having lupus disease, the use of anti-seizure and acne medications during pregnancy, and a family history of congenital heart defect.
Signs and Symptoms
The signs and symptoms of tricuspid atresia become evident as soon as the child is born. Some of the known clinical manifestations of this heart defect include difficulty in breathing, slow growth, poor weight gain, and cyanosis (blue-tinged skin including the lips).
There are also children with tricuspid atresia who develop these signs and symptoms of heart failure such as edema in the lower extremities, fatigue, shortness of breath, and sudden weight gain (this results from fluid retention).
Diagnosis and Management
After birth, the doctor may suspect of tricuspid atresia if he hears murmurs while auscultating the child’s chest. A heart murmur is an abnormal heart sound characterized by a whooshing sound. This indicates a turbulent blood flow.
In order to confirm the diagnosis, the doctor may have to subject the child to a series of tests including echocardiogram, electrocardiogram, and chest X-ray. In some cases, the doctor may do cardiac catheterization to examine the heart.
Surgery is the standard treatment for tricuspid atresia. A child, may unfortunately, have to undergo a series of procedures including shunting (creating a bypass), Glenn procedure, Fontan procedure, atrial septostomy, and pulmonary band replacement.
Prior to any of these surgical procedures, the doctor may recommend the child to take up prostaglandin in order to dilate the ductus arteriosus.
When tricuspid atresia is left unmanaged, it can lead to serious complications such as formation of blood clots, heart rhythm abnormalities, and complications in the lymphatic system.
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Pediatric Cardiology
OUR FULL RANGE OF PEDIATRIC CARDIOLOGY SERVICES
Our dedicated pediatric cardiology team understands that infants, children, and teens have unique health care needs because their bodies are growing. They know that children and adolescents often experience symptoms differently than adults. In addition, our pediatric experts know it can be difficult for kids to answer questions, tell parents and practitioners what they are experiencing, and sort out emotions they might have as a result of illness. For these reasons, our child cardiology experts are focused on helping children and teens relax, feel comfortable, and work together with their medical team for the best possible results.
The comprehensive children's health care services at Summit Medical Group are recognized for excellence and compassion. We offer the highest quality, comprehensive children’s health care services in a safe, comfortable, and friendly environment designed to ease your child’s medical visits. Our goal is to help your child overcome or better manage chronic or severe heart problems as quickly as possible.
PRENATAL AND POSTNATAL DIAGNOSIS AND CONSULTATION, INCLUDING:
Fetal diagnostic echocardiography
Cardiac consultation for infants, children, and adolescents
Counseling to discuss treatment options
REFERRALS FOR STATE-OF-THE-ART DIAGNOSTICS, INCLUDING:
3-dimensional echocardiography
Cardiac magnetic resonance imaging (MRI)
Cardiac computed tomograph (CT)
Echocardiography
Electrocardiogram and Holter monitoring
Exercise stress tests
Noninvasive exercise stress tests
Nuclear stress tests (treadmill and pharmacologic)
Stress echocardiography
3-dimensional echocardiography
Summit Medical Group offers many cardiac diagnostics for children and adolescents; however, if your child needs a test we do not offer, we will refer you to an outstanding cardiac diagnostic practice that can meet your child's needs.
REFERRALS FOR CARDIAC CATHETERIZATION, INTERVENTIONAL PROCEDURES AND SERVICES, AND PEDIATRIC HEART SURGERY, INCLUDING:
Abnormal blood flow between arteries in the heart (patent ductus arteriosus)
Balloon angioplasty for narrow (stenotic) valves
Balloon angioplasty for stent procedures for a narrowed (coarcted) aorta
Closure of septal heart defects
Coil embolization for abnormal (aberrant) vessels
Invasive eletrophysiology
Pacemaker implantation and services
Radiofrequency ablation therapy
Stent procedures of the pulmonary artery
IN ADDITION TO PEDIATRIC CARDIOLOGY, OUR COMPREHENSIVE CHILDREN’S HEALTH CARE SERVICES INCLUDE:
Allergy and Immunology
Behavioral Health and Cognitive Therapy
Pediatrics and Adolescent Medicine
Pediatrics After Hours
Pediatric Pulmonology
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Children And Youth: Preventing Heart Disease
Lifestyle change is the key towards preventing heart disease starting in childhood. Hence, parents have a vital role to play in leading their kids towards a healthier lifestyle.
Heart disease remains to be one of the leading causes of death not just in the United States but in the whole world. It’s also the highly preventable cause of death.
A common misconception people have when it comes to heart disease is that they think that it starts to develop during adulthood. While it could be true in some cases but in so many cases, it’s not. Heart disease is a lifestyle disease and so one’s lifestyle during childhood, the diet and the physical activity, plays a vital role in its development.
Prevention Starts in Childhood
Controlling as many risk factors as early as possible can help in preventing the development of heart disease later in life.
High Blood Pressure
Although high blood pressure only affects less than 3% of the children in the United States, it’s still considered to be a serious condition in childhood. What’s worse is that it often goes undetected because it usually doesn’t have any symptom.
High blood pressure in children is not considered to be a congenital disease but something to do with one’s family health history. Kids whose parents have high blood pressure are more likely to have it too. This is why these kids should have their blood pressure constantly checked.
If the child is diagnosed to have high blood pressure, then it’s very important for parents to work on necessary lifestyle changes in order to help the child maintain a healthy body weight. This may mean improving their physical activity and their diet.
Cholesterol
A high blood cholesterol is another risk factor in the development of heart disease. Less than 15% of kids have high blood cholesterol. It can be risky as it can progress when they reach adulthood.
Cholesterol is a fat-like substance in all body cells. Outside the body, we get cholesterol from the food that we eat like from meat, dairy, eggs, and other meat products.
Like high blood pressure, high blood cholesterol also run in families (a condition called familial hypercholesterolemia). Kids who have this condition should have their cholesterol checked before the age of 5.
To keep the high blood cholesterol from progressing, parents should do something to motivate their kids to engage in regular physical activity (about 30 to 60 minutes a day, most days of the week). Their diet must also be changed, cutting back on food high in cholesterol and fat. Parents must also be proactive to make sure that their kids are aware of the dangers of cigarette smoking as smoking couple with high blood cholesterol are major risk factors in developing heart disease.
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Understanding The Eisenmenger Syndrome
When left untreated, this syndrome can lead to sudden cardiac arrest, heart failure, stroke, and even problems in the kidneys. This can be a fatal condition when left unmanaged.
Eisenmenger syndrome is a complication of congenital heart disease. When a child is born with a hole or shunt between two heart chambers, it causes abnormal circulation of blood in the heart and lungs. This typically occurs in heart conditions like ventricular septal defect, atrial septal defect, patent ductus arteriosus, and atrioventricular canal defect.
The syndrome develops when there is an increased pressure in the blood going to lungs. As a result, there is a reverse flow of blood in the body. The oxygen-poor blood is being pumped to the body, leading to insufficient oxygen supply to the tissues and organs.
Symptoms
Because the circulation of oxygen-rich blood is affected in this condition, the symptoms of Eisenmenger syndrome reflects the insufficiency of oxygen in the body. These are manifested through the following:
Cyanosis or bluish discoloration of the skin
Clubbing (large and rounded fingernails and toenails)
Shortness of breath
Fatigue
Chest tightness
Palpitations
Fainting
Headache
Abdominal swelling
Tingling sensation felt on the fingernails and toenails
Diagnosis
Aside from physical assessment, the following tests are done to confirm the diagnosis of the syndrome:
Electrocardiogram (ECG)
Through ECG, the electrical activity of the heart is evaluated. This determines the type of defect a child has that causes the syndrome.
Chest X-Ray
Eisenmenger syndrome results from abnormal blood circulation. This results to enlargement of the heart and pulmonary artery which could be seen through chest x-ray.
Echocardiogram
Echocardiogram helps in determining the type of heart defect a child. This test makes use of sound waves to provide a clearer structure of the patient’s heart.
Blood Tests
Patients with Eisenmenger syndrome often have higher than normal blood cell count. Aside from blood cell count, children suspected to have this syndrome are also advised to be tested for liver and kidney function tests.
Cardiac Catheterization
In this procedure, a thin tube called catheter is inserted into the patient’s artery in the groin and guided until it reaches the heart. This measures the blood pressure in the blood vessels or of the heart chambers.
Management
Management for Eisenmenger syndrome aims at managing the symptoms. Part of the management plan for this syndrome includes administration of drugs that control arrhythmia, iron supplements if iron level is too low, blood-thinning medications, drugs that reverse the effect of endothelin (substance that causes narrowing of the blood vessels), hypertension medications, and antibiotics when certain procedures are done.
In some cases, phlebotomy may be recommended especially in cases when there is higher than normal blood cell count. If most treatments do not provide relief, then a child may need heart or lung transplant.
Complications
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Michelle Obama Tackles Kids' Health
Let’s Move! is a program developed by the First Lady of the United States, Michelle Obama. The program aims to address the issue of childhood obesity.
Obesity has doubled in children and quadrupled in adolescents for the past 30 years. About 1 in 3 American kids and adolescents is considered to be overweight or obese. The weight problem is one of the health concerns of parents in the United States, alongside drug abuse and smoking.
Factors Contributing to Obesity
There are several factors that lead to childhood obesity. These include the following:
1. Diet
One of the culprits of childhood obesity is diet. There has been a growing consumption of unhealthy meals consisting of soda, chips, candy, and other highly processed food. The presence of vending snack machines also contribute to this epidemic as it makes junk food highly accessible to kids.
Another major culprit seen that contribute to childhood obesity in the United States is snacking. The caloric intake of kids have increased, going between 168 to 586 calories per day.
2. Sedentary lifestyle
Televisions and digital products like smartphones and tablets have kept kids from exploring the outdoors. These things, though may have helped in developing certain skills, are contributing factors to the growing problem of childhood obesity as they keep kids from getting physically active.
3. Psychological factors
Kids pick certain habits from the adults they’re surrounded with. If you’re a parent and resort to food to deal with your emotional issues, then your kids will more likely grow up picking up that habit.
4. Sleep
Sleep deprivation is another contributing factor to obesity. In a study, it shows that kids who have less than the recommended number of sleeping hours (13 hours) are more likely to become overweight than those who get the right amount of sleep. It’s because fatigue alters the hormones responsible for regulating appetite.
5. Genetics
If a child is born to an overweight family, then he/she is more likely to become one especially if the family has unhealthy lifestyle habits.
Risks of Being Obese
Being overweight is a health risk at it predisposes the child to certain diseases like diabetes, heart disease, asthma, liver problems, problems in reproductive system (i.e. menstrual problems), and gallstones.
Let’s Move! Programs
To address the growing problem of childhood obesity, Let’s Move aims to come up with different programs including the following:
Let’s Move! Cities, Towns, and Counties
The program is designed to provide support to local officials in their goals in improving the health condition of their constituents.
Let’s Move! Child Care
This program is created to empower child care and early education providers towards giving the young population a good start towards healthy living.
Let’s Move! Active Schools
This program is geared towards schools in making sure that kids engage in physical activities.
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Heart doctors outraged Florida dumps hospital standards after big gifts to GOP
The state of Florida is putting thousands of children with heart defects at risk, a group of cardiac doctors say, because of a change in policy that came after Tenet Healthcare contributed $200,000 to Florida Republicans.
In a widely publicized investigation in June, CNN revealed that a program at a Tenet hospital in Florida had failed to live up to state quality standards for children's heart surgery.
Less than two months later, the state decided to get rid of those standards.
That decision came after the giant for-profit hospital chain made contributions to Republican Gov. Rick Scott and his party that dwarfed those the company made to candidates or parties in other states.
"The whole situation is outrageous. It's just outrageous," said Louis St. Petery, a pediatric cardiologist in Tallahassee and former executive vice president of the Florida chapter of the American Academy of Pediatrics.
Doctors from around the state say the decision came right from the governor's office. Representatives for Tenet and Scott deny conversations took place between them about getting rid of the standards.
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