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Information for Patients
Outpatient Services and Inpatient Units: (302) 651-6660
After 5 p.m. and Weekends:
Cardiac Intensive Care Unit: (302) 651-6644
General Inpatient Unit, 2B: (302) 651-6690
+1 (302) 651-4993
Treatment & Testing Services
A Full Spectrum of Specialized Testing & Treatment
At the Nemours Cardiac Center, based at the Nemours/Alfred I. duPont Hospital for Children, we offer high-quality heart center care with a very clear, family-centered mission. Our expansive, comprehensive program provides thorough treatment for children with all kinds of heart conditions, from the simple to the complex.
Our integrated model of care combines all of the critical cardiac disciplines any child would need in one centralized place.
With heart surgery, heart transplants and cardiac catheterization at the core of our services, we also provide outpatient cardiology, advanced diagnostic testing, and programs and clinics tailored to each patient's very specific needs. At the Nemours Cardiac Center, we deliver specialized, coordinated heart care at every age and stage.
- Arrhythmia Treatment
- Cardiac Imaging & Diagnostics
- Outpatient Cardiology
- Specialized Programs & Clinics
Electrophysiology & Arrhythmia Program
In our leading-edge cardiac catheterization and electrophysiology suite, the Nemours Cardiac Center team is able to use advanced techniques to determine the exact details of an abnormal heart rhythm and in many cases perform a procedure to eliminate it at the same time.
Cardiac electrophysiology (or “EP”) is the study, diagnosis and treatment of the electrical activities of the heart which produce normal and abnormal rhythms (called “arrhythmias”). Pediatric cardiology doctors who specialize in heart rhythm diagnosis and treatment are called “electrophysiologists” (or “EP doctors”). At the Nemours Cardiac Center, our electrophysiologist has all the tools available to diagnose and treat arrhythmias starting with a basic EKG to electrophysiology studies to insertion of pacemakers or defibrillators when needed.
At the Nemours Cardiac Center, our specialized Arrhythmia Program is dedicated to evaluating fetuses, infants, children and teens with signs and symptoms suggesting an arrhythmia (also called dysrhythmia). We see patients for arrhythmia diagnosis and management at our main location within our outpatient services office at duPont Hospital for Children, as well as our satellite locations.
Through specialized clinics, we offer general arrhythmia diagnosis and management, as well as specific diagnosis and care for patients with:
Premature atrial contraction (PAC) and premature ventricular contraction (PVC). These are usually considered minor arrhythmias, in which the person may feel a fluttering or pounding in the chest caused by an early or extra beat. When it feels like your heart “skips” a beat — that’s a PAC or PVC. But it doesn't actually skip a beat — an extra beat just comes sooner than usual. Occasional premature beats are common and considered normal, but in some cases they can indicate an underlying medical problem or heart condition.
Tachycardias. These arrhythmias, which involve an abnormally rapid heartbeat, fall into two major categories:
- supraventricular tachycardia (SVT), the most common significant arrhythmia, characterized by bursts of fast heartbeats that originate in the upper chambers of the heart. The bursts can happen suddenly, and episodes can last anywhere from a few seconds to several days. Specific treatment is usually recommended if incidents of SVT are long-lasting or happen often.
- ventricular tachycardia, a possibly serious, but relatively uncommon condition that originates in the lower chambers of the heart.
Bradycardias. These arrhythmias are characterized by an abnormally slow heartbeat, and include:
- sinus node dysfunction, in which the heart’s normal rhythm generator, the sinus node, isn’t working correctly, most commonly following surgery to correct a congenital heart defect. An abnormally slow heartbeat is typically seen in this condition; however, episodes of rapid heartbeat due to supraventricular tachycardia also can occur.
- heart block, which is often caused by a congenital heart defect, but also can be the result of disease or injury. Heart block happens when electrical impulses can't make their way from the upper to lower chambers of the heart. When this happens, another site in the lower chambers takes over and acts as the heart's pacemaker. Although it sends out electrical impulses to keep the heart beating, the transmission of the signals is much slower, leading to a slower heart rate.
Postural orthostatic tachycardia syndrome (or POTS) can cause something called “orthostatic intolerance” (or OI) — in which far too little blood returns to the heart when a person stands up after lying down. The OI can cause lightheadedness or fainting, as well a rapid increase in heartbeat. With POTS, the faintness or lightheadedness often goes away when the person lies down again.
Inherited arrhythmias are arrhythmias that are passed down from generation to generation. The Nemours Cardiac Center can work with your family to diagnose and treat inherited arrhythmias. For many of the inherited arrhythmias, the genetic cause is able to be determined through genetic testing on a blood or saliva sample. This can be beneficial not only for the patient, but for the immediate and extended family as well. Other family members who may have the same disease or are at risk of having the disease can be identified, screened and treated appropriately. Our genetic counselor:
- analyzes your family history
- orders testing for various inherited arrhythmias at laboratories that are leaders in cardiac genetics
- counsels you about inheritance (the likelihood of the same condition occurring again), as well as the impact of a positive or negative genetic test result for your child and the entire family
The heart has its own conduction system, or electrical system, that sends electrical signals around the heart, telling it when to contract and pump blood throughout the body. The electrical signals originate from a group of cells in the right atrium (called the “sinus node”).
The sinus node functions as the heart's pacemaker and makes sure the heart is beating at a regular and appropriate rate. The sinus node normally increases the heart rate in response to factors like exercise, emotions and stress, and slows the heart rate during sleep. But sometimes, the electrical signals flowing through the heart don’t “communicate” properly with the heart muscle, and the heart can start beating in an abnormal pattern or rate — this is an arrhythmia.
Because arrhythmias can cause the heart to beat less effectively, blood flow to the brain and to the rest of the body can be interrupted. If the heart is beating too fast, its chambers can't fill with the proper amount of blood. If it's beating too slowly or irregularly, the proper amount of blood can't be pumped out to the body.
Abnormal heart rhythms can lead to a variety of symptoms, including:
- palpitations (a feeling of fluttering or pounding in the chest)
- shortness of breath
- chest pain
- fainting (also called “syncope”)
Sometimes arrhythmias cause no detectable symptoms at all. In these cases, the arrhythmia may be discovered during a physical examination or heart function test.
Arrhythmias also can be:
- constant, or come and go at random
- temporary or permanent
- caused by problems with the heart or other medical problems several things, but also can occur for no apparent reason
- congenital (meaning kids are born with it), sometimes due to a birth defect of the heart but can sometimes happen even when the heart has formed normally
Arrhythmias are often caused by microscopic defects in the heart muscle. If an arrhythmia is suspected, our Nemours Cardiac Center experts usually start with a resting electrocardiogram (an “EKG”) to measures the heart’s electrical activity. There’s nothing painful about an EKG — a series of electrodes (small tabs) are fixed to the skin with sticky papers, then information about the electrical activity of the heart is transferred to a computer, where it's interpreted and drawn as a graph.
Your child’s cardiologist might recommend the following types of special EKG tests:
Exercise EKG (also called a “stress test”). This measures heart rate and rhythm while exercising, such as riding a stationary bicycle or walking on a treadmill.
Signal-average EKG. This measures heart rate much like a resting EKG. The only difference is the signal-average EKG monitors the heartbeat over a longer time period (around 15–20 minutes).
Holter monitor. This is an EKG done over a long period of time, usually 24 hours or more. The electrodes are connected to the chest, and the wires are attached to a portable EKG recorder. Kids are encouraged to continue normal daily activities, but they have to be careful to not get the electrodes wet (for example, no swimming, showering or activities that cause a lot of sweating). The two kinds of Holter monitoring are:
- “continuous recording,” which means the EKG is on throughout the entire monitoring period
- “event monitoring,” which means data is recorded only when the child feels symptoms and then turns the Holter monitor on
When there’s high suspicion that a child has an abnormal cardiac rhythm, your child’s cardiologist may recommend a cardiac electrophysiology study (also called an “EPS”). An electrophysiology study is used to map out the area of the heart that’s causing the problem and determine the best treatment.
During an EPS, a Nemours Cardiac Center electrophysiologist inserts several specialized electrode catheters (thin tubes) into blood vessels that lead to the heart. Using these catheters and a sophisticated computer, a map is made of the electrical activity in a child’s heart to pinpoint the abnormal rhythm location. In children, this procedure is performed with deep sedation or anesthesia to eliminate pain and anxiety. Our pediatric cardiac anesthesiologists work exclusively with our heart center patients who need sedation and anesthesia, making them as comfortable as possible during and after the procedure.
In some cases, particularly in small babies, electrophysiology testing is performed by passing a small electrode catheter through the mouth into the esophagus (the tube that moves food from the throat to the stomach), which lies behind the heart, and recording its electrical activity from there. Babies receive sedation or anesthesia to prevent any discomfort associated with this test.
Some arrhythmias don’t require treatment; however, others can pose a health problem and need to be evaluated and treated by a cardiologist.
Depending on the type and severity of the arrhythmia, our Nemours Cardiac Center cardiologists may recommend one of these options:
Medications. Many types of prescription anti-arrhythmic medications are available to treat arrhythmias. Your child’s cardiologist will determine which is best by considering the type of arrhythmia, possible underlying medical causes, possible side effects, other medical conditions and any other medications your child is taking.
Catheter ablation. “Ablation” literally means “removal or elimination.” Second to medication, ablation is the most common method for treating arrhythmias in children and teens and offers a high possibility of a permanent cure. To perform an ablation, we guide a catheter (a long, thin tube) through a vein in the leg to the heart at the end of a cardiac electrophysiology study (see above). Once we’ve pinpointed the problem area of the heart, the catheter heats or freezes the muscle cells and destroys them.
Pacemakers. A pacemaker is a small, battery-operated device implanted in the body (usually near the collarbone) through a surgical procedure. Connected to the heart by a wire, pacemakers can help treat bradycardia (an arrhythmia characterized by an abnormally slow heartbeat). Through a sensing device, a pacemaker can detect if the heart rate is too slow and sends electrical signals to the heart to speed up the heartbeat.
Defibrillators. Like a pacemaker, a defibrillator can detect and deliver electrical impulses to and from the heart. A small battery-operated implantable cardioverter defibrillator (an “ICD”) can be implanted near the left collarbone through a surgical procedure. Wires run from the defibrillator to the heart. It senses if the heart has developed a dangerously fast or irregular rhythm and delivers an electrical shock to restore a normal heartbeat.
Ablation surgery. Surgery is usually recommended only if all other options to control a serious arrhythmia have failed. It’s also sometimes performed when a child is having heart surgery to correct another problem. A surgical ablation procedure (often called a “Maze procedure”) is an open-heart procedure using cardiopulmonary bypass (when a surgeon makes a series of incisions or freezes the heart tissue to prevent passage of the abnormal rhythm currents through the heart).
Although many arrhythmias are minor and don’t represent a significant health threat, some can indicate a more serious problem. If your child has been having symptoms of an arrhythmia, call your doctor.
Get Detailed Information About Electrophysiology & Arrhythmia
Check out these articles from Nemours’ experts at KidsHealth.org to learn more about:
What to Expect: Prepare Your Child for a Procedure »
Noninvasive Cardiac Imaging & Other Diagnostic Testing
Your child may be referred to a Nemours pediatric cardiologist for a suspected or known heart problem. The Nemours Cardiac Center offers a complete range of cardiac testing — many are available at our outpatient offices throughout the Delaware Valley and all are provided at our main location, Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.
Like you, we want to get to the bottom of your child’s heart problem as soon as possible so we can start figuring out the best way to manage it. In order to make the best treatment decisions, our doctors need an accurate understanding of what’s going on inside your child’s heart. Often using a combination of diagnostic tests, the Nemours Cardiac Center strives to provide the most accurate diagnosis and early repair so that your child can have the healthiest future possible. Backed by our skilled and experienced team, advanced pediatric cardiac diagnostic tests can help us pinpoint and address pediatric heart conditions in kids of all ages — accurately and quickly.
“Cardiac Imaging” includes the many different methods that may be used to create an “image” or picture of your child’s heart. Each of these tests provides slightly different information, so it’s not unusual for a child to have more than one test. Our Nemours Cardiac Center physicians sometimes team up with pediatric imaging doctors to decide which test is best and to interpret the results together.
Our Cardiac Center physicians always choose the test that has the least risk and discomfort for your child but can still provide the needed information. Noninvasive testing refers to techniques that don’t require inserting any equipment into the body.
Echocardiography (or “echo,” for short) is our most frequently used pediatric heart imaging method. Echo is a completely safe and painless test that uses ultrasound (sound waves) to build a picture of your child’s heart which is called an “echocardiogram.”
Echos can be done:
- in our Nemours Cardiac Center Echocardiography Lab (or “Echo Lab”) at the hospital
- any of our satellite outpatient locations
- anywhere within the hospital — often right at your child’s bedside to make the experience as stress-free and comfortable as possible
And when your child gets an echo here, know that you’re in good hands. Our Echocardiography Lab received a three-year accreditation for pediatric transthoracic (chest) echocardiography by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), which is the country’s highest level of achievement in the specialty.
Types of Echos
The Nemours Cardiac Center offers four types of echocardiography:
- Transthoracic echocardiography — The most common method of echocardiography, this produces images of your child’s heart when a small wand is moved on the surface of the chest and upper abdomen. Transthoracic echocardiography can be used to diagnose a heart problem and monitor changes in the heart as your child grows. These studies can be performed with ease in both the inpatient and outpatient settings. We also offer 3-D echocardiography, which allows us to visualize heart valves and other heart structures in even greater detail. Often, these images are so precise that no other testing is needed.
- Transesophageal echocardiography — Also called a “TEE,” this test is performed by inserting a small ultrasound probe through the mouth and into the esophagus (the food pipe that connects the throat with the stomach and lies directly behind the heart). This is often used for older, larger children and gives the best close-up view of some otherwise hidden regions of the heart. It’s extremely useful for obtaining images during surgery and cardiac catheterization. This test is performed only with anesthesia or sedation.
- Fetal echocardiography — This is an in-depth ultrasound study used to view the structure, function and rhythm of a baby’s heart while in utero (still in the mother’s womb) — as early as the 18th week of pregnancy. Our fetal cardiologists and sonographers (trained technicians with specialized ultrasound training) travel to many satellite locations, and fetal studies are also performed at duPont Hospital for Children. For registration and information, call (800) 416-4441 or the Echocardiograpy Lab at (302) 651-5099.
For a cardiovascular computed tomography, or "CT scan," a small amount of contrast agent (or dye) is injected into your child’s bloodstream while a very rapid X-ray is taken. This test allows your child’s cardiologist to get an accurate image of the important blood vessels attached to the heart and to better understand some abnormalities of the heart and other chest structures such as the lungs and airways. Our up-to-date scanner works very rapidly, with most studies being completed in a few minutes.
Due to the need for specialized methods and coordination with a pediatric imaging specialist, all cardiovascular CT scans are performed at duPont Hospital for Children. Although reactions are rare, you’ll be asked whether your child has ever had a problem with X-ray contrast.
Magnetic resonance imaging (or “MRI”) is an extremely helpful and safe tool that uses a strong magnetic field to produce strikingly clear, complete pictures of your child’s heart and the blood vessels that connect to it. A cardiac MRI allows doctors to analyze the structure and function of the heart, as well as the area surrounding the heart (that are less visible with other diagnostic tools) — specifically the lungs, airways and the esophagus.
Because kids must be completely still for MRI, sedation or anesthesia may be required, although older children and teenagers are often able to have an MRI without medications. Because the MRI scanner is a very large and complicated machine, all cardiac MRIs are performed at duPont Hospital for Children.
All of the technicians who assist the Cardiac Center doctors in performing cardiac testing are experienced, enjoy working with children, and are skilled in putting children at ease. Because kids need to be still during the tests (so we can get the most accurate results), it’s helpful to bring a favorite video or handheld game to play.
Babies and younger children may need a sedative medication or anesthesia to enable us to obtain the best pictures of their heart. Nemours Cardiac Center anesthesiologists and nurses who understand your child’s heart problem are experts in providing safe and effective anesthesia or sedation for these tests when needed. With any imaging test, your child’s safety is our main concern. Although most cardiac testing will not expose your child to X-ray radiation, when it’s needed we will inform you and use the lowest dose necessary to get an accurate image.
We know you’re worried and want answers as soon as possible. In many cases, our doctors can give you the results of testing during the same visit.
If not, we deliver test results within one or two business days so that you can know what’s happening.
Other Cardiac Testing
Whether you have an infant, growing child or teen, our team of pediatric cardiac experts provides a variety of ways to understand what’s going on with your child’s heart and blood vessels. We offer a full range of diagnostic tests which, depending on your child’s age and condition, may be ordered or performed during your initial visit, follow-up visits, before and/or after a procedure, and during hospitalization. Some tests are available at out outpatient satellite offices.
In some cases, it’s important to measure a child’s blood pressure when participating in normal activities (in school, on the field, playing with friends, etc.) over a span of 24 hours. This monitor uses a small digital blood pressure machine that’s attached to a belt around your child’s body and is connected to a cuff around the upper arm. It’s small enough that kids can go about their normal daily lives and even sleep with it on.
An electrocardiogram (also called an “EKG” or “ECG”) is a completely painless test that measures and records the heart’s electrical activity. A series of 12 electrodes (small sticky tabs) are attached to your child’s skin and connected to the EKG machine, which records the information and transfers it to a computer for viewing and storage.
If an abnormal rhythm of the heart (also called “dysrhythmia” or “arrhythmia”) is suspected, your child’s cardiologist may order different types of EKGs:
- Holter monitor, which is an EKG device that can be worn at home to record information over a period of time, usually 24 hours or more.
- signal-average EKG, which measures the heart rate and rhythm much like a resting EKG, but over a longer time period (around 15-20 minutes).
- loop recorder, a small device that’s inserted under the skin for long-term EKG monitoring and recording of heart rhythm.
Our Nemours Cardiac Center care team can do basic EKGs in all of our satellite office locations, our hospital cardiac outpatient locations, as well as at your child’s bedside during hospitalization.
During a cardiopulmonary exercise assessment (also called an “exercise test” or a “stress test”), your child’s heart rate and rhythm are recorded by an EKG while he or she is exercising — for example, riding a stationary bicycle or using a treadmill under supervision. If your child has, or might have, a heart problem or has undergone heart surgery, this test may help determine which kinds of physical activities are OK and which ones aren’t. It can also pick up abnormalities in the heart’s rhythm that aren’t obvious during rest. Exercise tests are performed in the Exercise Lab, located in the cardiac outpatient services area at duPont Hospital for Children, by exercise physiologists and interpreted by pediatric cardiologists.
Myocardial Perfusion Imaging Scan
Myocardial perfusion imaging scan, a special form of exercise test, is used to look at blood flow to the heart muscle during rest and stress. Performed only for certain cardiac diagnoses, this test uses a short-lived, safe, radioactive material which, along with computer imaging, will help highlight any blood vessels that may be causing decreased blood flow to a child’s heart. Because the test is done at rest and repeated with exercise, it can take a while — plan to be here for up to 5 to 6 hours for the appointment to ensure the best technical quality of the test.
Lung perfusion scans are used in certain patients to measure the percentage of blood going from the heart to each lung. The test involves injecting a small amount of safe, short-lived, radioactive material into an IV and using a special camera and computer to calculate the amount of blood that travels to the right and left lung. The scan takes about 30 minutes and most infants and children are able to stay still enough without sedation.
This test is most often used to look for a cause of fainting. We’ll monitor blood pressure and the heart’s electrical activity with an EKG as your child is lying securely on a table that moves from horizontal to vertical. This test is done within the Exercise Lab at the Nemours Cardiac Center’s outpatient services office.
Fetal (Unborn Baby) Cardiac Testing
About two-thirds of children with critical heart disease are diagnosed while still developing in the womb (before birth) or soon after. Thanks to our highly skilled team and advanced technology, most children — even newborns only hours old — who are born with a heart condition (called “congenital heart disease” or a “congenital heart defect”) can be treated right away.
If you’re pregnant and your obstetrician and/or perinatologist (a doctor who specializes in high-risk pregnancies) suspect your baby may have a heart condition, our experienced sonographers and fetal cardiologists will work with your doctors to see what’s going on inside your baby’s heart.
In cooperation with the Nemours Partners for Perinatal Management Program, we’ll:
- help you understand your baby’s condition
- coordinate consultation with a pediatric cardiothoracic surgeon and other specialists if necessary
- plan for treatment at or soon after the birth
As early as the 18th week of the pregnancy, we can perform fetal echocardiography (fetal “echo”) — an in-depth cardiac ultrasound study that allows us to view the structure, function and rhythm of a baby’s heart while still in the womb.
Our heart center teams can do these special fetal ultrasounds:
- here at the Nemours Cardiac Center at duPont Hospital for Children
- at Nemours duPont Pediatrics locations in Pennsylvania (Bryn Mawr, Collegeville and Lancaster), New Jersey (Vineland and Voorhees) and Delaware (Seaford, Dover and Middletown)
- in consultation with maternal-fetal medicine specialists at two of our collaborating health care facilities, Thomas Jefferson University Hospital (in Center City Philadelphia), Lankenau Medical Center (in Wynnewood, Pa.) and Inspira Medical Center Woodbury (in Woodbury, N.J.)
Many cardiac conditions are caused, at least in part, by changes in genes that are important for the heart to develop and function normally. Nemours Cardiac Center’s certified genetic counselor offers counseling to our patients and families when the cause of a cardiac condition may have a genetic component. Providing further insight into the genetic cause of a condition frequently benefits the immediate and extended family as well as the patient — so that you and your whole family will know if the heart condition could possibly affect siblings and generations of your family in the future.
At your request, our genetic counselor:
- analyzes your family history
- tests for various cardiac conditions at laboratories that are leaders in cardiac genetics
- counsels you related to inheritance and the implications of a positive genetic test result for your child and the entire family
Cardiac Diagnostic Testing in Your Community
Pediatric cardiologists and other personnel from the Nemours Cardiac Center travel to sites throughout the Delaware Valley so that you can receive our top-quality pediatric cardiac care at a location that’s convenient for you.
We see families at our Nemours duPont Pediatrics (primary and specialty care) offices in Delaware, Pennsylvania and New Jersey. At these satellite offices, we offer echocardiography, fetal echocardiography, EKGs, Holter monitors and ambulatory blood pressure monitors.
The Nemours Cardiac Center’s experienced, board-certified pediatric cardiologists offer outpatient cardiology care at our Nemours Cardiac Center, located within Nemours/Alfred I. duPont Hospital for Children, as well as our satellite Nemours duPont Pediatrics locations throughout the Delaware Valley.
Our kid-friendly Nemours Cardiac Center outpatient services offices will serve as your home base for your child’s heart care needs. We see infants, kids and teens, as well as expectant parents (of unborn babies who may have a congenital heart defect) for:
- preoperative (before surgery) appointments
- postoperative (after surgery) follow-ups
- preventive cardiology diagnosis and care (screening and ongoing care for high blood pressure, high cholesterol, obesity, etc.)
- congenital (present at birth) and acquired (developed after birth) heart disease/defect diagnosis, care and follow-ups
- cardiac diagnostic testing (e.g., echocardiography, EKGs, Holter monitors, ambulatory blood pressure monitors)
- fetal echocardiography (echos) testing for expectant parents (to diagnose congenital heart defects during pregnancy)
- follow-ups and care coordination for expectant parents with a congenital heart disease diagnosis for their unborn baby
During your outpatient clinic visit to the Nemours Cardiac Center and any of our satellite locations, you can expect to:
- have your child’s “vitals” checked by a cardiac center medical assistant or nurse (e.g., blood pressure, heart rate, temperature, weight, height)
- have your child examined by a cardiologist
- have your child receive recommended diagnostic tests (during your visit or at your convenience)
- learn about your child’s condition
- find out what to expect from treatment
- meet other Nemours Cardiac Center team members if needed
- receive or arrange a tour if your child needs a procedure or to be hospitalized
- kid-friendly waiting areas with activities and computers to help keep your child occupied.
Our pediatric cardiologists are experts in diagnosing and treating heart conditions in infants, children and teens. Kids are commonly referred to our Nemours duPont Pediatrics outpatient offices for the evaluation of:
- heart murmurs (sounds that occur as blood flows through the heart; sometimes a heart murmur may signify a heart problem but often, they may be normal sounds — our heart center experts can tell the difference)
- chest pain
- shortness of breath
- fast heartbeat
- palpitations (awareness of your heartbeat)
- arrhythmias (skipping beats, irregular beats)
- cyanosis (blue coloration)
- fainting (also called, “syncope”)
Most (about two-thirds of) children with heart disease have “congenital” heart disease (often called a “congenital heart defect”) — when a baby is born with a heart problem because the heart didn’t develop normally or completely in the early weeks of pregnancy. Other children may have something called an “acquired” heart condition, when a heart problem develops later and may need evaluation or treatment.
At the Nemours Cardiac Center, we have a team of cardiologists working in the area of preventive cardiology services. In fact, we’re internationally recognized for investigations into preventive cardiology, and we maintain a leadership role in national efforts to prevent heart disease.
Our team of pediatric heart center specialists is committed to keeping your children healthy and helping them live long, disease-free lives. That’s why we focus on the prevention of heart problems that can occur in adults as a result of being overweight or obese, such as high blood pressure, increased cholesterol level, diabetes and coronary artery disease (narrowing of the blood vessels of the heart).
Obesity, Hyperlipidemia (High Cholesterol) & Hypertension (High Blood Pressure)
We measure height, weight and blood pressure at every office visit to screen for obesity and hypertension. Your pediatric cardiologist knows the guidelines regarding when to look for elevated cholesterol and may order blood tests at your child’s visit. Sometimes, these problems are inherited, so we’ll explore your child’s family history to understand your child’s risk and develop an individualized treatment plan for your child’s long-term health.
Specific conditions we treat include:
- hypercholesterolemia (increased cholesterol in the blood)
- elevated LDL (“bad cholesterol”)
- elevated triglycerides (fats in the blood that store energy until the body needs it — too many can clog blood vessels and cause health problems)
- familial hypercholesterolemia (or “FH,” a genetic condition that may run in families and can cause heart attacks at a young age)
- high blood pressure (also called, “hypertension”)
Our preventive cardiologists at the Nemours Cardiac Center will formulate diet counseling and an appropriate exercise plan for your child’s situation, and devise a treatment plan that’s individualized for optimum success for your child. We have specialists available to help parents put these recommendations into practice. Nemours’ dedicated weight management program’s pediatricians, cardiologists, diet and nutrition experts, and physical therapists are all committed to improving and maintaining your child’s health and preventing future problems.
Our board-certified pediatric cardiologists from the Nemours Cardiac Center also travel to sites throughout the Delaware Valley and surrounding areas, so you can get our top-quality pediatric cardiology care at a location that’s convenient for you. We provide evaluations, follow-ups and certain diagnostic cardiology tests at our Nemours duPont Pediatrics offices in Delaware, Pennsylvania and New Jersey.
If your child needs further testing, hospitalization or surgery, we may have you come see us at the Nemours Cardiac Center (located within Nemours/Alfred I. duPont Hospital for Children) or other local hospitals we work with, so that your child can get the best, most comprehensive care.
Specialized Programs & Clinics
At the Nemours Cardiac Center, located within the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., we offer specialized programs and clinics that meet the needs of the wide range of our cardiac patients, from babies who've yet to be born to adolescents with heart disease. Our expansive team's vast expertise enables us to give each and every one of our patients the comprehensive cardiac care they need — all in one place.
Our Aortic Disease Program at the Nemours Cardiac Center combines the expertise of heart surgeons, cardiologists, a cardiovascular geneticist, a genetic counselor, ultrasound technicians (sonographers) and radiologists to evaluate, diagnose and treat children and teenagers with aortic disease. The aorta is the major artery (blood vessel) that carries oxygen-rich blood away from the heart to the body.
Problems with the aorta can include a:
- dilated (enlarged) aorta (called “aortic aneurysm”)
- separation of the layers of the blood vessels (called “aortic dissection”)
- narrowing of the aorta directly above (“supravalvar”) or below (“subvalvar”) the aortic valve
- narrowing or constriction of the aorta (called “coarctation of the aorta”)
Problems with the aorta can occur in children:
- with no other abnormalities
- who had previous heart surgery
- with genetic disorders that affect the body’s connective tissues including: Marfan syndrome and Loeys-Dietz syndrome
Aortic Disease Diagnosis
Aortic disease may be suspected when a child’s doctor hears a heart murmur while listening with a stethoscope. But it’s often identified incidentally (that is, when a child is being evaluated for other concerns). Nemours cardiologists can confirm and better understand the diagnosis using echocardiography (or "echo," an ultrasound that takes pictures of the heart structures and large blood vessels including the aorta), a CT scan of the chest or a cardiac MRI. All of these tests can be performed at the Nemours Cardiac Center at duPont Hospital for Children and will be interpreted by the doctors in our aortic disease program.
Many aortic diseases in children are inherited in families. In our multi-disciplinary Aortic Disease Clinic, a consultation includes an evaluation by one of our Cardiac Center cardiologists, with an echocardiogram and a coordinated genetics evaluation with our cardiovascular geneticist and Cardiac Center genetic counselor all on the same day. The genetics evaluation will include:
- a review of the family and medical history
- a detailed physical examination to look for other clues of a genetic diagnosis
- genetic testing when indicated
In many cases, there may be other family members who should be evaluated for similar problems. We can assist with determining who should be evaluated and making appropriate referrals for your family members.
Aortic Disease Treatment
Whether or not we need to repair a problem with the aorta varies, and is determined by the size of the enlargement or constriction of the aorta. Some kids may need surgery soon after diagnosis. For others, it could be decades. And some may never need surgery at all — in some children the enlargement never gets to the point where it requires an operation. For children with Marfan or Loeys-Dietz syndrome, surgery is common — they eventually need an operation as young adults or later in adulthood.
At the Nemours Cardiac Center, we have experience with complex surgical repair of the aorta, including:
- valve-sparing aortic root replacement (preserving the child’s own aortic valve rather than substituting an artificial one)
- replacement of the aorta in children with a history of congenital heart disease (such as single ventricle physiology, tetralogy of Fallot or transposition of the great arteries)
If a child doesn’t need surgery, our Cardiac Center experts usually recommend blood pressure control and other medicines that may decrease the growth rate of the blood vessel enlargement over time.
Ongoing Follow-Up Care
Children with aortic disease need close observation over time. We often see children in the Aortic Disease Program every six months so we can monitor the rate at which the abnormality progresses. We want to make sure that if surgery is necessary, it’s done at the best time for each child. Throughout the whole process, we do our best to give families a complete understanding of what’s happening with their child and what to expect.
Many cardiac conditions are caused, at least in part, by changes in genes that are important for the heart to develop and function normally. At the Nemours Cardiac Center, we have a medical geneticist who specializes in cardiovascular genetics to assist in the evaluation of your child’s cardiac condition. Learn More About Dr. Nina Powell-Hamilton.
Additionally, the Cardiac Center’s certified genetic counselor, Kristi Fitzgerald, offers counseling to our patients and families when the cause of a cardiac condition may have a genetic component. Providing further insight into the genetic cause of a condition frequently benefits the child by providing clues to suggest other evaluations that may be helpful for your child and possibly for other family members as well. Finding a genetic cause of the heart condition also helps your family know if the heart condition could possibly affect siblings as well as previous and future generations of your family.
Our genetic counselor:
- analyzes your family history
- facilitates testing for various cardiac conditions at laboratories that are leaders in cardiac genetics
- counsels you related to inheritance (the likelihood of the same condition occurring again) and the implications of a positive genetic test result for your child and the entire family
- works with your family to figure out the financial end of genetic testing in the event that testing isn’t covered by your insurance
For more information about a cardiovascular genetics evaluation or genetic counseling at the Nemours Cardiac Center, contact:
At duPont Hospital for Children, our active mechanical circulatory support program provides a variety of heart and lung assist devices for newborns, older infants, children and teens who require “artificial” support while waiting for a heart transplant or for their own serious heart problems to improve. Our Extracorporeal Life Support (ECLS) program is led by a pediatric cardiothoracic surgeon and our experienced extracorporeal membrane oxygenation (“ECMO”) coordinator, who is responsible for organizing the equipment and training the people required to perform this sophisticated support. Our team includes pediatric heart surgeons, anesthesiologists, intensive care unit (ICU) doctors, nurses and ECMO specialists who monitor the function of the ECMO machine.
Our ECLS program earned the Award for Excellence in Life Support from the international Extracorporeal Life Support Organization (ELSO) in 2013. This award recognizes a hospital’s commitment to exceptional patient care and highest-quality standards, equipment and protocols, as well as advanced education of all staff members. (Our ECMO Program is nationally and internationally recognized for simulation training in mechanical circulatory support, available 24 hours a day, seven days a week.)
What Is ECMO?
Extracorporeal membrane oxygenation (ECMO) is a system which temporarily acts as a patient’s heart and lungs. ECMO is a treatment for serious problems of the heart or lungs (or both). It’s used when the heart or lungs are too sick to work like they should and all other treatments to help them work better have been tried. ECMO can give the lungs and heart time to rest and heal. “Extracorporeal” means support that takes place outside the body. “Membrane” means a type of artificial lung. “Oxygenation” means supplying oxygen to the blood.
A pump inside the ECMO machine moves blood from a child to the machine and back to the child through sterile plastic tubes. The ECMO “lung” adds oxygen to the blood and removes carbon dioxide, the waste product of breathing. Because it has a big job to do, the ECMO machine is large. You may hear people call it “the circuit.” This is because it pumps blood to and from the patient and the machine in a circle.
A child’s condition may call for one of two different ECMO treatment options:
- venovenous (or “VV”) ECMO, used when the heart is working but the lungs need time to rest and heal
- venoarterial (or “VA”) ECMO, used when both the heart and the lungs need time to rest and heal
In most cases, children are sedated (asleep) while on ECMO. Those who are awake are protected from pain or discomfort with pain medication given through an IV (a small tube inserted in a vein) or directly into the ECMO machine. We can give extra doses of pain medication if your child seems uncomfortable.
ECMO Referral & Transport
Nemours/Alfred I. duPont Hospital for Children is the only hospital in the region with an Extracorporeal Membrane Oxygenation (ECMO) transport program. We provide extracorporeal life support services for critically ill newborns, babies, kids and teens. In a unique arrangement, Nemours physicians can see children for ECMO evaluation on-site at the referring hospital — a helpful option when the patient is unstable and may be at high risk for complications during transport. Pending evaluation, the Nemours ECMO transport team can place an unstable patient on ECMO at the referring hospital and then transport the child to duPont Hospital for Children in a stabilized condition for as long as needed.
For more information or to ask for an ECMO Referral: call (800) 962-0023
ECMO Transplant at Nemours
Meet Benjamin, whose heart rate surged and he turned blue at just 10 days old. Thanks to the region's only Extracorporeal Membrane Oxygenation (ECMO) transport program, we were able to stabilize little Benjamin's heart and lungs and helicopter him from a hospital three hours away to Nemours/Alfred I. duPont Hospital for Children, where he got the expert pediatric cardiac care he needed.
The Cardiac ECMO Team
Ryan Davies, MD (Director of Mechanical Circulatory Support Program)
Caroline Boyd, MD
Christian Pizarro, MD
Marc Priest, RN
Chris Beatty, RN
The Nemours Cardiac Center is committed to giving every child with heart disease the best chance for a healthy life. Many infants with critical heart disease can be diagnosed before birth (during pregnancy). Fetal cardiologists on-staff at the Nemours Cardiac Center are skilled at making an accurate early diagnosis while a baby is still in the womb. They perform in-depth cardiac ultrasounds (fetal echocardiography or “fetal echo"), which allow them to view the structure, function and rhythm of a baby’s heart as early as the 18th week of pregnancy.
Coordinating Your Baby's Care
If we detect a heart defect, we’ll explain the problem to you and help you decide about the best care after the birth to give your baby the best chance at a healthy start in life. Our fetal cardiologists will work together with your obstetrician or maternal-fetal specialist (also called a “perinatologist,” a board-certified obstetrician with special training in high-risk pregnancies) on the timing and place for your delivery. Our fetal cardiologists will give advice to the neonatal care team at the delivery hospital about your baby’s initial care after birth and arrange for transfer to the Nemours Cardiac Center if that’s your plan.
As part of the broader Nemours Partners for Perinatal Management Program, which helps expectant parents of unborn babies with any kind of diagnosed defect, a perinatal coordinator will:
- arrange a visit to the Nemours Cardiac Center for expectant parents who want to tour the center and meet the staff
- educate you about your baby’s condition
- help you seek out the best medical options for your baby
- prepare you for the care your baby may need after birth
If you decide to bring your baby to the Nemours Cardiac Center after your delivery, know that your little one will be in excellent hands. We specialize in treating newborns and infants with heart disease — in fact, 2 out of 3 of our patients are less than a year old.
When Your Baby Is Born
Most women can give birth in their community hospital, close to family and friends. The Nemours Kids Transport team and Cardiac Intensive Care Unit (CICU) team will be ready to transport and care for the baby if needed after delivery. Our mobile intensive care units provide 24/7 air or ground transportation with an onboard team of pediatric critical care transport specialists who consult with cardiac specialists before and during transport.
In selected cases, the mother will deliver at duPont Hospital for Children so that the Cardiac Center team can care for her baby immediately after birth.
Find Out More About the Nemours Perinatal Management Program
Email the Perinatal Coordinator or call (302) 651-6812.
Children with muscular dystrophy (or “MD,” a genetic disorder that gradually weakens the body's muscles) may develop heart problems (cardiomyopathy) as part of their disease. Heart issues are especially common in children with certain types of muscular dystrophy, particularly Duchenne muscular dystrophy and Becker muscular dystrophy. In Duchenne MD, children may not have any heart symptoms until their teens. In Becker MD, signs of heart trouble may not appear until a patient’s 30s.
The Nemours Cardiac Center’s pediatric cardiologists and genetic counselor work with our muscular dystrophy specialists in neurology at duPont Hospital for Children to diagnose cardiomyopathy and begin early treatment if necessary.
Cardiomyopathy is a disease in which the heart muscle (called the “myocardium”) becomes weak, making it difficult for the heart to pump enough blood to the body. There’s no cure for muscular dystrophy-related cardiomyopathy, but it can be treated. Medications can make a difference and, in rare cases, surgically implanted devices help manage symptoms.
What We Do
The purpose of our Muscular Dystrophy Cardiomyopathy Program is to try to identify myocardial problems early — to figure out which patients with muscular dystrophy are likely and which are unlikely to develop heart issues down the road. Nemours cardiologists follow patients with MD with routine visits, often on the same day as another clinic visit. Physical exams and echocardiograms (painless ultrasound tests) are done to monitor the function of the heart muscle over time. The goal is to detect when a problem starts, begin early treatment, and prevent symptoms.
At duPont Hospital for Children, we have a long tradition of taking care of children with muscular dystrophy. Approved by the Muscular Dystrophy Association (MDA), the Muscular Dystrophy Program here is the only one of its kind in Delaware. Within the Nemours Cardiac Center, we combine that tradition and expertise in muscular dystrophies, with our experience in the treatment of heart failure to provide cutting-edge care. We were the first hospital in the world to insert a Heartware ventricular assist device (“HVAD,” an implantable artificial blood pump) into a child with muscular dystrophy. This enables children with severe heart failure requiring admission to an intensive care unit to improve and be discharged to home where they can return to school and to their life.
If your child needs to be transported from another hospital to the Nemours Cardiac Center, the Nemours Kids Transport program will get your child here quickly and safely. Our mobile intensive care units provide 24/7 air or ground transportation with an onboard team of pediatric critical care transport specialists who consult with cardiac specialists before and during transport.
We offer comprehensive neonatal and pediatric critical care transport by ground ambulance, helicopter or fixed-wing aircraft. Our fleet of three Nemours-owned ambulances provides door-to-door service for patients who come to duPont Hospital for Children from referring hospitals and other facilities throughout the Delaware Valley.
Our doctors on-site are available for consultative care as soon as we receive a request for our services. Health care personnel from our hospital will work together with the contacting hospital or health care facility to plan your child’s care.
Children with congenital (present at birth) heart defects who’ve had heart surgery early in life (particularly in infancy) sometimes develop physical, language and social skills at a slower pace than those without heart problems. As part of routine follow-up care, the Nemours Cardiac Center offers evaluation of early developmental milestones and consultation about child development, emotions and behavior through the Cardiac Learning & Early Development Program (also known as the “Cardiac LEAD Program”).
During the hospitalization for heart surgery, our Nemours Cardiac Center care team provides medical care that’s sensitive to the infant’s developmental needs. Many babies receive developmental/rehabilitative therapies during extended hospitalizations and while recovering from heart surgery. Before leaving the hospital, infants get a brief neurologic examination so that potential problems can be identified and addressed as early as possible.
Keeping Tabs on Early Development
Because the first few years of life are a period of incredible growth and development, we encourage children with congenital heart defects and their families to participate in yearly developmental evaluations (consisting of a variety of play activities) in the Nemours Cardiac Center. At the end of each evaluation, we give parents information about their child’s progress. Developmental therapists provide recommendations for working with the child at home and suggestions for follow-up if needed.
We constantly strive to provide the highest level of care for our patients and believe that the services provided through this program are an integral part of that mission. We’re optimistic that this proactive approach to development following heart surgery will result in improved quality of life for children with congenital heart defects. For questions about the Cardiac LEAD Program, please contact Dr. Erica Sood, pediatric psychologist, at (302) 651-6304.
When babies are born prematurely, they often have an “extra” blood vessel that’s no longer necessary after birth and should close but doesn’t — this blood vessel is called a “patent ductus arteriosus” (or “PDA”). When premature infants need surgery to have the PDA closed, they may not be well-enough to be transferred to the Nemours Cardiac Center. So we go to the infant.
A Nemours Cardiac Center team (including the anesthesiologist, operating room nurses and a pediatric cardiac surgeon) travels to outlying hospitals with all of the operating equipment necessary to safely and rapidly treat infants in a neonatal intensive care unit (NICU) close to home with a procedure called a “PDA ligation.” Among the hospitals where we currently provide off-site PDA ligation are:
- Thomas Jefferson University Hospital (Philadelphia)
- Christiana Hospital (Newark)
- Main Line Health (Pennsylvania)
- Cooper University Hospital (New Jersey)
Pulmonary hypertension (also called “PHTN”) refers to abnormally high blood pressure in the blood vessels which lead to the lungs). When this happens, the right side of the heart has to work harder to pump blood against the high pressure. Pulmonary hypertension may have an unknown cause (called “primary pulmonary hypertension”) or there may be many causes, including:
- lung disease associated with premature birth
- abnormal development of the lungs during pregnancy
- blood clotting abnormalities
- lung damage from infection
- lung damage from severe gastroesophageal reflux
- lung damage from autoimmune diseases (conditions when the body “attacks” its own tissues)
Treatment for Pulmonary Hypertension
Our specialists diagnose and help patients manage pulmonary hypertension, which can often be treated with medications that help improve blood flow in the pulmonary arteries and relieve the stress on the right side of the heart. In some cases, a connection between the right and left side of the heart (called an “atrial septal defect”) may be needed and can be created using a catheter technique rather than open-heart surgery.
Our pulmonary hypertension clinic is led by a pediatric cardiologist with extensive knowledge and experience in diagnosing and treating infants, children and teens with pulmonary hypertension. This physician is assisted by an experienced pediatric nurse practitioner and backed up by other Nemours experts who provide the many services needed by patients with this relatively unusual problem. Our cardiologists perform cardiac catheterizations to test treatment options, measure pulmonary pressures and create atrial septal defects (ASDs) if needed. Our pulmonologists (lung specialists), imaging specialists and rheumatologists (immune experts) help evaluate children for unusual lung diseases that can cause pulmonary hypertension. And our Cardiac Center pharmacists assist with the preparation and home administration of specialized IV medications to treat PHTN.
To help minimize symptoms, we provide advice and counseling about lifestyle changes such as:
- maintaining a healthy weight
- not smoking
- avoiding high altitudes
- staying active
- getting plenty of rest
Children with heart abnormalities are, after all, regular kids who may need regular kid procedures such as ear tubes and tonsillectomies, hernia repairs, eye surgery, treatment for broken bones, MRI tests, etc. The Nemours Cardiac Center anesthesiologists are available to provide anesthesia or sedation for these procedures, using their knowledge and experience to provide the special care that children with heart conditions need. Our “surgical home” program allows the child’s parent, surgeon or other specialist doctor to contact our cardiac anesthesia scheduler who will take it from there, coordinating:
- the day and time of surgery
- preprocedure testing
- admission for the day of the procedure
- a plan for recovery and discharge
All of the before- and after-procedure care takes place within the Nemours Cardiac Center by the cardiac center nurses, therapists, nurse practitioners and physician assistants who are experts with cardiac patients and, in many cases, are familiar faces to the child and family.