When you think about people who need cardiac care, you probably think about adults who have heart problems. Echocardiograms, cardiac catheterizations, pacemakers, stents, open-heart surgery — these are not things children need, are they? Yes, in many cases they are, and in South Texas thousands of babies, children, and adolescents have received these and other types of cardiac services through The Heart Center at Driscoll Children’s Hospital.
The Heart Center at Driscoll provides a full spectrum of pediatric cardiology and cardiothoracic surgery services for heart disease, always with the goal of getting patients back to their families and local physicians as soon as possible. The hospital has even been a pioneer in pediatric cardiac care. Dr. James Duff performed the first successful neonatal arterial switch operation in 1984 at Driscoll Children’s Hospital on a two-week-old newborn, who would not have been able to live long without the surgery.
During his 18 years at Driscoll, Muhammad Khan, MD, FAAP, FACC, FSCA, has seen The Heart Center grow into a premier department with a large staff of high-caliber pediatric specialists and facilities.
“Such high quality, sophisticated care is rare outside of the largest children’s hospitals in major metropolitan areas,” said Dr. Khan, Chief of Cardiology and Director of the Cardiac Catheterization (cath) Lab.
Highly specialized care for complex conditions
“Being a freestanding pediatric hospital allows Driscoll to focus all of its staff and resources on caring for children,” said The Heart Center medical director Ross Ungerleider, MD, MBA. “Our advantages over hospitals with both adult and child services are critical, especially when it comes to having the very specialized equipment and medical staff needed to treat complex pediatric heart problems.”
Dr. Khan echoed that thought. “It is a blessing for the children and families of South Texas to have such an excellent pediatric hospital in this region,” he said. “The administrative leadership is highly supportive and makes sure we have what we need to give the best care.” Many of Dr. Khan’s cardiology colleagues around the country envy the timely investments in technology that Driscoll has made to provide the most advanced pediatric heart treatment.
The Heart Center includes surgical suites, intensive care units, diagnostic testing, and the cath lab. In addition to full-time, onsite cardiologists and cardiothoracic surgeons, numerous other specialists and subspecialists contribute to The Heart Center team.
Two members of the team, pediatric cardiologists Alberto Mendoza Paredes, MD, FAAP, and Ngozi C. Agu, MD, live and work full-time in the Rio Grande Valley. In addition to the Pediatric Cardiology Clinic in McAllen, Driscoll Children’s Specialty Centers in Brownsville, Harlingen, and McAllen provide services from many other Driscoll specialists. “It is our passion to provide local pediatric cardiac care to the communities in the Rio Grande Valley. We value our partnerships with other local providers and continue to develop our services so families can avoid traveling unless absolutely necessary,” said Dr. Mendoza Paredes.
Driscoll’s four pediatric cardiovascular anesthesiologists are involved with a majority of Heart Center procedures, from diagnostics to surgery. “Our job is to keep our patients safe, comfortable, and pain-free before, during, and after surgery and other procedures,” said Euleche Alanmanou, MD, FAAP, chief of cardiovascular anesthesia. That may sound simple, but it can be immensely complex and sometimes requires two anesthesiologists working together. The tiny size of some patients treated in The Heart Center — such as extremely premature babies weighing as little as 500 grams — is just one of the complexities of pediatric anesthesiology.
“During a procedure, we monitor the patient constantly to protect and manage the function of vital organs,” explained Dr. Alanmanou. “Our equipment is state-of-the-art, and we have everything we need to get our patients through what can be the roughest time of their lives.”
“It is our passion to provide local pediatric cardiac care to the communities in the Rio Grande Valley. We value our partnerships with other local providers and continue to develop our services so families can avoid traveling unless absolutely necessary.”
ALBERTO MENDOZA PAREDES, MD, FAAP
Vital role of the Neonatal Intensive Care Unit
As the only Level IV NICU in South Texas, The Driscoll Neonatal Intensive Care Unit (NICU) is central to The Heart Center’s care for babies born with heart conditions. The main medical problem for about one-third of the patients in the NICU is a complex heart defect. Many defects involve multiple organs, which increases the types of specialists involved in intensive care.
“We provide medical management in the NICU until a newborn becomes stable enough to have surgery or gets to the point that surgery can be avoided,” said NICU medical director Miguel DeLeon, MD. “With today’s prenatal imaging techniques, many babies are diagnosed with heart defects before birth and receive medical management before they ever arrive at the NICU,” Dr. DeLeon said. “Our prenatal care sometimes makes it possible for a newborn to avoid being in the NICU at all.”
When the medical team knows in advance that a baby will need surgery immediately following birth, the NICU and cardiac specialists work together to ensure everything and everyone is in place to begin treatment when the newborn arrives.
“We plan and prepare for neonatal care in collaboration with Driscoll’s fetal cardiologists and maternal fetal medicine doctors, and the expectant mother’s local physician,” said Dr. DeLeon. Expectant moms who live in the Valley receive maternal fetal medicine care at Driscoll’s local specialty centers, and they are scheduled to deliver at their local hospital, or if necessary, a facility close to Driscoll.
Dr. DeLeon described a recent case that illustrates how prenatal diagnosis and planning enable a newborn to get immediate cardiac care at Driscoll. Fetal echocardiography found that baby Sam (not his real name) had transposition of the great arteries, in which the two large vessels that carry blood from the heart to the lungs and rest of the body were connected to the wrong right and left ventricles. This defect causes the blood to lack proper oxygen, a life-threatening condition. It is one of the causes of “blue baby syndrome.”
“As a result of the prenatal diagnosis, Sam’s mother was scheduled to travel from the Valley to Corpus for delivery by C-section,” said Dr. DeLeon. “Once at Driscoll, Sam underwent catheterization to improve his oxygen level. Cardiothoracic surgeons then performed an arterial switch to flip the arteries to the correct ventricles. Sam made a good recovery, and he went home like any other normal newborn.”
Pre- and post-surgical care in the Pediatric Intensive Care Unit
The Pediatric Intensive Care Unit (PICU) is another essential part of the Heart Center. After heart surgery, patients receive post-operative care in the PICU until they are feeding, growing, and thriving well enough to go home. The PICU is located next to the cardiac surgery suite to allow for immediate post-op care, and for a rapid return to surgery if needed.
Sometimes a baby born with a heart defect has no symptoms until several months later. When brought to Driscoll in serious condition, the child can be stabilized in the PICU before receiving treatment. Intensive care staff work in concert with cardiac specialists to diagnose the problem and plan treatment.
Ramon Rivera, MD, is a critical care specialist, or intensivist, in the PICU. In describing The Heart Center at Driscoll to South Texas parents whose children need cardiac care, Dr. Rivera said, “It is the place you want your child to be. Our heart team can address all of your child’s needs, from making the proper diagnosis and providing the most complex treatment to monitoring your child’s condition all the way into adulthood.
“Children living with congenital heart disease are more vulnerable to illnesses and infections even when not related to a cardiac problem,” said Dr. Rivera. “Anytime one of these children has a significant illness, the PICU is involved with the child’s care.”
Making treatment and recovery easier
Dr. Khan’s work in Driscoll’s cath lab includes diagnosis and treatment of heart conditions. Catheterization involves using a long, thin flexible tube (catheter) that is inserted into a child’s vein or artery and threaded to the heart. Dr. Khan guides the catheter to the right place using special X-ray and ultrasound equipment.
Several sophisticated procedures, such as closing holes in the heart and opening up narrowed valves, are done in the cath lab. “Very often this treatment allows a child to avoid surgery and recover faster,” said Dr. Khan. “The child leaves the cath lab with a bandage and can usually go home the next day.”
“I believe the care provided by The Heart Center at Driscoll Children’s Hospital matches that of any leading pediatric hospital in the U.S.”
Muhammad Khan, MD, FAAP, FACC, FSCA
Dr. Khan recounted the case of a 16-month-old child with a ventricular septal defect — a hole between the right and left ventricles. The condition was diagnosed and treated through catheterization. “The hole was large, which made closing it challenging,” said Dr. Khan. “Even so, we were able to perform the necessary treatment in the cath lab and avoid open-heart surgery.”
For many babies with highly complicated heart problems, Dr. Khan and Driscoll’s cardiothoracic surgeons collaborate on “hybrid” procedures that combine catheterization and surgery at the same time. “Doing these together can reduce the length and number of surgeries and lower the risk of complications,” Dr. Khan said. “We have a special surgical suite that has space for portable cath equipment for hybrid treatments. Having this kind of facility is one of the big advantages Driscoll offers.”
Working in tandem with compassion
Anesthesiologist Dr. Alanmanou is involved in multiple cardiac procedures, including magnetic resonance imaging (MRI) and echocardiography as well as surgery and catheterization. He is also responsible for pre-operative patient assessment and post-operative monitoring and pain management. He works in tandem with many other specialists.
“Cardiovascular anesthesia depends on excellent teamwork,” Dr. Alanmanou emphasized. That is also true of every specialty service at Driscoll in Corpus and in the hospital’s Valley locations.
The Heart Center has a large team of highly trained medical professionals that also includes highly skilled nurses, echocardiographers, pharmacists, nutritionists, and an electrophysiologist. The team expands according to patient needs and may include a respiratory therapist, kidney specialist, pulmonologist, and numerous other pediatric specialists.
“We all do what it takes to provide the best, most compassionate care for patients and support for their families,” said Dr. Alanmanou. That care includes a team of specialists devoted to the specific needs of each child and family.
This comprehensive and responsive team, along with the most advanced technology and equipment, are what make The Heart Center at Driscoll Children’s Hospital the foremost children’s health facility in South Texas.
To learn more about The Heart Center at Driscoll Children’s Hospital, call 956-688-1300 or visit Driscoll Children’s Medical Plaza – McAllen at 1120 E. Ridge Road, Suite 210.