Pediatric Cardiology

Pediatric cardiology is a subspecialty that undertakes the diagnosis, treatment, and follow-up of cardiovascular diseases in the age group from the fetal period to the end of adolescence. The pediatric heart shows significant anatomical and physiological differences from the adult heart; therefore, cardiological evaluation in children must be performed by specialists who have received specific training. The Pediatric Cardiology Department of Koru Hospital serves its patients with an experienced expert staff in the diagnosis and treatment of congenital and acquired heart diseases.

What Does Pediatric Cardiology Deal With?

Pediatric cardiologists deal with the evaluation and management of congenital heart anomalies, heart rhythm disorders, heart muscle diseases, heart valve diseases, and acquired heart problems. This specialty enables the early diagnosis of heart diseases starting from the prenatal period. The evaluation of the heart structure and functions of the baby in the womb, namely fetal echocardiography, is one of the important application areas of pediatric cardiology.

Congenital heart diseases are among the most common congenital anomalies and are seen in approximately one out of every hundred live births. While some of these diseases resolve spontaneously, others require surgical or interventional treatment. With early diagnosis and appropriate treatment, the vast majority of these children can lead a healthy life.

Congenital Heart Diseases (Congenital Cardiopathies)

Congenital heart diseases are disorders that are present at birth in the structure of the heart and major vessels, and they constitute the widest field of study in pediatric cardiology.

Acyanotic (Non-Cyanotic) Heart Diseases

• Ventricular septal defect (VSD): The presence of a hole in the wall between the two lower chambers of the heart. It is the most common congenital heart disease. While small holes can close spontaneously, large ones may require surgical intervention.
• Atrial septal defect (ASD): The presence of a hole in the wall between the two upper chambers of the heart. It may not show symptoms for a long time, but it can lead to heart failure if left untreated.
• Patent ductus arteriosus (PDA): The persistence of the vascular connection that is open in the womb and should close after birth. It is seen frequently, especially in premature babies.
• Coarctation of the aorta: The narrowing of a section of the main artery (aorta) that carries blood to the body. It can be diagnosed with high blood pressure in the upper extremities.
• Pulmonary stenosis: Narrowing of the pulmonary artery valve. While mild forms are followed up with observation, severe stenosis requires interventional treatment.

Cyanotic Heart Diseases

• Tetralogy of Fallot: The most common cyanotic congenital heart disease where four different heart anomalies coexist. Cyanosis (bluish discoloration), shortness of breath, and clubbing of fingers may be observed.
• Transposition of the great arteries: The swapping of the positions of the aorta and the pulmonary artery. It is an emergency condition that requires intervention immediately after birth.
• Tricuspid atresia: The congenital absence or closure of the tricuspid valve in the heart.
• Total anomalous pulmonary venous return: A condition where oxygenated blood coming from the lungs returns to the wrong side of the heart.
• Single ventricle physiology: A condition where there is functionally only one chamber instead of the two lower chambers of the heart. It requires staged surgical treatment.

Acquired Heart Diseases

Heart diseases that develop after birth due to various reasons also fall within the scope of pediatric cardiology:

• Acute rheumatic fever: An inflammatory disease that can develop as a result of untreated streptococcal throat infection and can permanently damage heart valves. It continues to be a significant health problem in our country.
• Kawasaki disease: A febrile vasculitis disease that can affect coronary arteries in children. Early diagnosis and treatment are critical in preventing the development of coronary artery aneurysms.
• Myocarditis: Inflammation of the heart muscle. It usually develops due to viral infections and can lead to heart failure.
• Pericarditis: Inflammation of the membrane surrounding the heart. It may present with chest pain and fever.
• Endocarditis: Infection of the inner lining of the heart and its valves. The risk is higher in children with congenital heart disease.
• Cardiomyopathies: Diseases that impair the structure and function of the heart muscle. There are different types, including dilated, hypertrophic, and restrictive.

Heart Rhythm Disorders (Arrhythmias)

• Supraventricular tachycardia (SVT): The most common rhythm disorder of childhood. It is characterized by a sudden increase in heart rate.
• Wolff-Parkinson-White (WPW) syndrome: A condition where there is an extra conduction pathway in the heart, which can cause tachycardia attacks.
• Long QT syndrome: A genetic disorder that affects the electrical activity of the heart. It carries the risk of fainting spells and sudden cardiac death.
• Complete heart block: A condition where the electrical conduction system in the heart is completely interrupted. In some cases, a pacemaker may need to be implanted.

Diagnostic Methods

The Pediatric Cardiology Department of Koru Hospital is equipped with advanced diagnostic technologies:

• Echocardiography: The most fundamental and frequently used diagnostic method in pediatric cardiology that evaluates the structure and function of the heart with ultrasound waves. Its greatest advantage is that it is painless and radiation-free.
• Fetal echocardiography: Allows for the evaluation of the heart structure and functions of the baby in the womb. It is used in the prenatal diagnosis of congenital heart diseases.
• Electrocardiography (ECG): The recording of the electrical activity of the heart. It is a basic test in the diagnosis of rhythm disorders and structural heart diseases.
• Holter monitoring: Provides 24-hour continuous ECG recording, allowing for the detection of intermittent rhythm disorders.
• Exercise stress test: Evaluation of heart performance during exercise. It is used to determine exercise capacity, rhythm disorders, and suitability for sports participation.
• Cardiac MRI: An advanced imaging method that evaluates the structure and function of the heart in three dimensions.
• Cardiac catheterization: An invasive diagnostic method that allows for the direct measurement of intracardiac pressures and oxygen levels. It can also be used for therapeutic purposes.

Treatment Approaches

In the field of pediatric cardiology, treatment is planned according to the type and severity of the disease and the child's condition:

• Medical treatment: Drug therapies such as heart failure treatment, antiarrhythmic drugs, anticoagulant therapy, and infective endocarditis prophylaxis are applied.
• Catheter interventions: Interventional procedures such as balloon angioplasty, stent placement, closure of septal defects, and PDA closure can be performed without surgery.
• Surgical treatment: Open-heart surgeries, correction of congenital heart anomalies, and valve repairs are performed by pediatric cardiac surgeons.
• Electrophysiological study and ablation: Used to determine the source of rhythm disorders and to treat them.
• Pacemaker and ICD implantation: Device therapy may be required in severe rhythm disorders.

When Should You Take Your Child to Pediatric Cardiology?

Your child should be evaluated by a pediatric cardiologist in the following situations:

• If sweating, cyanosis, or rapid fatigue is observed during breastfeeding in an infant
• If a heart murmur is heard during a doctor's examination
• If the child experiences chest pain, palpitations, or fainting spells
• If there is more shortness of breath or fatigue than normal during exercise
• If cyanosis is noticed on the lips or nail beds
• If there is a family history of congenital heart disease or sudden cardiac death
• If a suspected heart anomaly in the fetus is detected during pregnancy
• If a cardiological evaluation is required for a child's sports license examination
• If joint pain or skin rash develops after a streptococcal infection
• If cardiological follow-up is required for a prematurely born baby

Sports Cardiology

Pre-participation cardiological evaluation in children and adolescents has gained increasing importance in recent years. To reduce the risk of sudden cardiac death, it is recommended that children, especially those who will participate in competitive sports, undergo cardiological screening. This screening is performed with a detailed history, physical examination, ECG, and echocardiography when necessary. Early detection of silent but risky conditions such as hypertrophic cardiomyopathy, long QT syndrome, and coronary artery anomalies is life-saving.

Nutrition and Development in Congenital Heart Diseases

Nutritional problems and growth retardation are frequently encountered issues in children with congenital heart disease. Especially in infants with hemodynamically significant heart defects, difficulty in sucking, sweating, rapid fatigue, and insufficient weight gain may be observed. It is necessary to specifically organize the nutrition plans of these children, support them with high-calorie formula or supplements when necessary, and closely monitor growth parameters. At Koru Hospital, the nutritional management of children with heart disease is coordinated by the pediatric cardiology team with the support of a dietitian.

Long-Term Follow-up and Transition Period

The vast majority of children treated for congenital heart diseases require lifelong cardiological follow-up. During the transition period from childhood to adulthood, it is important to plan a coordinated transition between pediatric cardiology and adult cardiology. In this process, the patient's cardiological status, medications used, surgical history, and future risks are evaluated in detail.

Why Koru Hospital Pediatric Cardiology?

• Expert staff: Specialists who have received specific training and have extensive experience in the field of pediatric cardiology are on duty.
• Advanced diagnostic technology: All diagnostic methods such as echocardiography, fetal echo, Holter, exercise stress test, and cardiac MRI are available.
• Prenatal diagnosis: Birth planning is carried out through the early detection of heart anomalies in the womb.
• Interventional treatment: Non-surgical treatment opportunities are offered through catheter interventions.
• Multidisciplinary approach: Coordinated work is carried out with pediatric cardiac surgery, neonatal intensive care, and other branches.
• Continuous follow-up: Long-term follow-up of children with congenital heart diseases is performed regularly.
• Sports cardiology: Sports participation evaluation and sports license examinations are performed.

In the Pediatric Cardiology department of Koru Hospital, our specialist physicians protect children's heart health by applying the most advanced medical approaches in the diagnosis and treatment of congenital and acquired heart diseases. You can safely apply to our pediatric cardiology outpatient clinic whenever you have any concerns or complaints about your child's heart.