Pediatric Cardiology - Children’s Heart Care - Acıbadem
Pediatric Cardiology & Cardiovascular Surgery

Pediatric Cardiology & Cardiovascular Surgery

United for Saving Hearts!

At ACIBADEM Children’s Heart Center, we are committed to making a difference in pediatric heart care. For more than 30 years, we have been treating congenital malformations and acquired heart disorders in children with medical excellence and human touch. As a leading medical facility in Turkey and the region, ACIBADEM provides state-of-the-art diagnosis and treatment options for the entire spectrum of pediatric cardiac conditions, even the most severe or complex cases, with the best possible outcomes. Every aspect of heart disease in children is covered at ACIBADEM, including neonatal heart surgery, complex procedures, and reoperations. The exceptional patient care here is based on knowledge, experience, and the latest technology available worldwide. Advanced medical equipment enables our specialists to diagnose complex medical conditions quickly and accurately, and treat them with success rates exceeding 95%. Children and their families are referred here from all over the world.

It is widely acknowledged that comprehensive services provided by multidisciplinary teams in well-equipped specialized facilities deliver the best outcomes for children with heart disorders. The pediatric heart care teams at our ACIBADEM Bakirkoy and ACIBADEM Atakent hospitals involve experienced physicians in pediatric cardiology, pediatric cardiovascular surgery, anesthesia and intensive care, cardiac imaging and radiology, neonatology and rehabilitation, social work and psychology. Specialized teams are constantly in contact with the other departments throughout our hospitals, ensuring quick access to any specialist that might be needed, under the same roof. We have also specially trained nurses for the operating rooms, intensive care and patient work. Each and every member of our pediatric heart teams has devoted years of efforts to better understand the specific physical and emotional needs of our little heart patients, in order to provide the best care and the best chance at life: United for saving hearts!

Pediatric Heart Conditions We Treat

Cardiac diseases in the pediatric age group are different than those in adults. There are two major types of heart disorders in children: inborn (congenital heart defects) or acquired later in life. Some of the

  • Arrhythmia-Irregular Heart Rhythm
  • Cardiomyopathy
  • Congenital Heart Diseases:
    • Atrial Septal Defect
    • Ventricular Septal Defect
    • Atrioventricular Septal Defect
    • Coarctation of the Aorta
    • Hypoplastic Left Heart Syndrome
    • Pulmonary Atresia
    • Pulmonary Stenosis
    • Tricuspid Atresia
    • Tetralogy of Fallot
    • Total Anomalous Pulmonary Venous Return
    • Transposition of the Great Arteries
    • Truncus Arteriosus
    • Patent Ductus Arteriosus (PDA)
    • Aortic Coarctation (AoCoA)
    • Hypoplastic Left Heart Syndrome (HLHS)

Why Acibadem Children’s Heart Centers?

Fast facts about our centers and team:

  • Cumulative team experience: 15 000 patients in 30 years;
  • More than 600 patients every year, including the most complex congenital heart diseases;
  • Success rate more than 95%;
  • ACIBADEM is a reference center for complex congenital heart diseases and other cardiac conditions in children;
  • World-class physicians, sophisticated technology, and patient-centered approach.

For international patients

At ACIBADEM Children’s Heart Centers, we know that traveling abroad for the treatment of your child can be a stressful and overwhelming experience. That is why we have designed International Patient Services Center as a “one-stop” solution that supports every patient from the first request until the final return to your home country. Medical appointments, travel and accommodation, airport-hotel-hospital transfers are arranged according to your needs and preferences. 24-hour  coverage of interpreting services is provided in native languages. By choosing ACIBADEM Turkey and our comprehensive patient service, international patients can rest assured that their health journey will be perfectly organized, with their comfort in mind.

Symptoms of heart problems in children

In congenital heart diseases, about 30% of all affected children require treatment within the first month of life. Therefore, early diagnosis and timely treatment are essential. It is crucial for parents to recognize the symptoms of heart diseases and consult a doctor without losing time. It is good to know that the risk of developing congenital heart diseases is 2 to 3 times higher for babies with a mother or father who has the same disorder. The early signs of heart problems in children vary depending on the condition, but the most common symptoms are:

  • Bluish (cyanotic) color on the lips, in the mouth and under the nails of babies,
  • Rapid breathing or difficulty breathing,
  • Developing respiratory diseases frequently,
  • Unwillingness to nurse or tiring quickly during breastfeeding,
  • Lack of appetite and difficulty in gaining weight,
  • Tiring quickly.

In some cases, congenital heart diseases that are less serious may not manifest any distinctive symptoms during the first years of life. In older children, signs and symptoms such as heart palpitations, shortness of breath, tiring quickly, chest pain, dizziness or fainting during exercise might be alarming for heart problems.

Pediatric Heart Conditions Diagnosis

Congenital heart diseases can often be diagnosed before birth, as early as the 16th gestational week of pregnancy. Fetal echocardiography is a non-invasive diagnostic method similar to ultrasonography. It allows a detailed examination of the baby’s heart while it is still in the womb. If any problem is identified, the baby is monitored closely and the treatments to be applied after birth are planned in the meantime. Diagnosing congenital heart defects during pregnancy helps to reduce serious complications in infants.

However, heart problems can also be diagnosed later in childhood. If cardiac disease is suspected in your child, the pediatric cardiologist performs a physical examination and various tests using advanced technological diagnostic tools. A comprehensive diagnostic process may include:

Electrocardiogram (ECG): A noninvasive test that examines heart function. It uses a device to measure the electrical activity passing through the heart and records heartbeats onto ECG paper. The procedure helps to assess the heart rate and detect rhythm disorders.

Chest X-ray: It shows if the heart is enlarged or if the lungs have extra fluid. The level of radiation used in chest X-rays is very low and has no side effects.

Echocardiography (cardiac ultrasound): An ultrasound is used to monitor live images of the heart and to evaluate heart muscle function.  How much blood is flowing through the arteries and veins can be measured using sound waves with the Doppler ultrasound of the aorta. These two techniques provide useful information about the structure and function of the heart. 

Transesophageal echocardiography (TEE): In some patients, we may need to obtain better images using a special ultrasound probe through the mouth and down the esophagus.

Stress test: An ECG is performed while the child is walking on a treadmill at a fast pace. It detects problems in heart function provoked by exercise.

Cardiac CT (computed tomography): It is used in specific cases for detailed visualization of a child’s heart and blood vessels. In complex cases, CT scanning is needed for precise anatomical details.

Cardiac MRI scan: Provides clear pictures of the heart and blood vessels in the chest using magnetic technology, without radiation.

Cardiac catheterization and angiography: Advanced examination method using a thin tube (catheter) inserted into a blood vessel, and x-rays (fluoroscopy) to guide it to the heart. It allows direct visualization of anatomical details.

Electrophysiology (EP study):  A test used to diagnose irregular heartbeats or arrhythmia. Similar to the cardiac catheterization method, special catheters are used to look at the heart and help identify the areas of abnormal electrical activity within the heart tissue.

Interventional Pediatric Cardiology

Some heart diseases in children can be treated with cardiac catheterization (or ‘heart cath’ for short) instead of traditional surgery. This is an innovative, non-surgical treatment that involves inserting a thin, flexible tube called a catheter through a blood vessel to the heart, under X-ray guidance. It can be used both for diagnosis and treatment. When the procedure is applied to fix a heart defect, it is called interventional catheterization. It allows experienced physicians to treat certain heart disorders avoiding surgery, using special catheters. Once the catheter has reached the heart defect, tiny tools can be delivered through it to repair the defect. For instance, there are balloon catheters that can open up narrowed valves or vessels, and there are also catheters that can close holes between the chambers of the heart. The therapeutic interventional procedures might include:

  • Balloon angioplasty & Valvuloplasty: A catheter with a balloon at the tip is inserted to open a narrowed heart valve or vessel;
  • Transcatheter aortic valve replacement (TAVR/TAVI): A new artificial valve is inserted using a catheter instead of open-heart surgery;
  • Trascatheter ASD & VSD closure: Septal defects can be repaired by cath techniques;
  • Endovascular  stenting: Can be used to expand narrow vessels;
  • Electrophysiology & Transcatheter  arrhythmia ablation: Used for the treatment of heart rhythm problems through cauterization (destroy by heating) of a small tissue causing the problem with radiofrequency ablation;
  • Hybrid procedures & MAPCAs occlusion: Hybrid cardiac procedures are usually used for complex heart conditions. They may combine surgery and cardiac catheterization.

Cardiac catheterization is performed under anesthesia, but it does not require surgical incisions and allows fast recovery and short hospital stay. There are no age restrictions; it can be used for small children and even babies immediately after birth. At ACIBADEM Children’s Heart Centers, advanced interventional procedures are performed by highly experienced pediatric cardiologists with high success rates. Whenever possible, they choose minimally invasive approaches to reduce pain, recovery period and hospital stay.

Surgery and minimally invasive cardiac surgery

Cardiac surgery in children is very different than in adults. It requires experienced pediatric cardiac surgeons and a team of professionals specially trained to work with children. At ACIBADEM Children’s Heart Center, all types of pediatric cardiac operations are performed successfully, including complex procedures and reoperations. There are 3 main types of heart surgery: 

Open Heart Surgery: The surgeon opens the chest through the breastbone to get access to the heart. These types of surgeries usually require a heart-lung machine to take over the heart and lung functions during the operation.

Closed Heart Surgery: In this case, the chest cavity still needs to be opened, but the heart itself is not stopped. Therefore, the surgery can be performed without a heart-lung bypass machine.

Minimally Invasive Heart Surgery: This is a less invasive surgical approach. The surgeon makes only tiny incisions to insert special tools and a video camera. Minimally invasive techniques have many advantages over conventional methods, including less pain, smaller scars, and shorter recovery period. In children with a well-developed ribcage, certain heart anomalies can be eliminated through robotic surgery as well.

Treatment of rare and common congenital heart diseases (CHD)

Patent Ductus Arteriosus (PDA):

All babies are born with PDA. This is a hole that allows passage between the pulmonary artery and the aorta. It exists because before birth, the blood does not need to pass through the lungs to receive oxygen. Normally, this hole closes a couple of hours after birth. PDA is when this connection remains open. It is most often seen in premature babies.

TREATMENT: Closing the passage by using a special device called an umbrella or coil through a catheter. Additionally, closed heart surgery to re-connect can be performed depending on the patient’s age and extent of PDA.

Atrial Septal Defect (ASD):

An atrial septal defect is a hole in the wall between the two upper chambers of the heart (atria). Small ASD often closes during infancy. Larger defects may cause serious problems, including right-sided heart failure, heart rhythm abnormalities, increased risk of a stroke and shortened life span.

TREATMENT: In some patients, the defect can be closed with catheterization. However, the condition usually requires open-heart surgery. At the end of the treatment, circulation returns to normal, and the child can grow up as a healthy adult.

Ventricular Septal Defect (VSD):

A ventricular septal defect is a hole in the wall between the two ventricles of the heart. In this case, the oxygen-rich blood gets pumped back to the lungs instead of out to the body. As a result, the heart needs to work harder to provide enough oxygen. Without treatment, the complications might include pulmonary hypertension, heart failure due to enlargement, endocarditis, and other heart problems.

TREATMENT: Some defects may close by themselves. That is why your doctor may observe the child’s progress for a while. But usually, the patient needs surgery to repair the defect between the ventricles.

Atrioventricular Septal Defect (AVSD):

This congenital heart condition combines several anomalies. There is a large opening in the middle of the heart. The valves that separate both atriums and ventricles do not develop fully. Both are in the form of a single and large valve. Oxygen-enriched blood in the left side of the heart passes to the right side and is pumped to the lungs again due to the openings.

TREATMENT: Children who develop pulmonary hypertension or have serious symptoms have surgery during infancy. After the operation, the blood flow returns to normal. In some cases, the patients may need a second surgery due to the inadequacy of valves (leaky mitral valve). Success rates exceed 97%.

Aortic Stenosis (AS):

This is a heart valve disorder that narrows or obstructs the aortic valve opening. It causes difficulty for the heart to pump blood to the body. The stenosis limits the flow of blood out of the left ventricle. Early diagnosis is very important for the prevention of irreversible heart damages.

TREATMENT: Children with aortic stenosis who have mild or no symptoms should be monitored closely over time. In cases of moderate to severe symptoms, surgical interventions can be applied: Valvuloplasty (less invasive, balloon placed into the artery); Valvotomy (to ‘free up’ the valve cusps without replacing the valve); Aortic Valve Replacement (AVR).

Aortic Coarctation (AoCoA)

Coarctation of the aorta means that there is a narrowing or constriction of a part of the aorta. It could be anywhere and any degree. The left ventricle has to work harder to move blood through the narrowed part of the aorta. Eventually, the left ventricle is no longer able to handle the extra workload, and it fails to pump blood efficiently. In some cases, it might lead to kidney failure or heart enlargement.

TREATMENT: The narrowed part of the aorta is repaired with balloon angioplasty or stent implantation by cardiac catheterization.

Tetralogy of Fallot (TOF)

This medical condition involves 4 different cardiac anomalies: VSD (a hole between the ventricles of the heart); Pulmonary stenosis (narrowing of the pulmonary valve); Overriding aorta (when aortic valve connects right ventricle as well); Right ventricular hypertrophy (right ventricle is more muscular than normal). Tetralogy of Fallot is the most common heart defect causing cyanosis in little children. Babies with ToF exhibit bluish skin during episodes of crying or feeding.

TREATMENT: It can be applied in two phases, depending on the child’s condition. Phase 1 includes temporary repair using a shunt, stent, or muscle removal. The second phase is the complete repair. It can be performed after the shunt operation or as a first operation in some cases.  After the surgery, circulation returns to normal and cyanosis is completely eliminated.

Pulmonary Stenosis (PS)

This is a very rare condition that can be diagnosed in utero or shortly after birth. It represents a narrowing (stenosis) or blockage of the pulmonary valve. Then the right ventricle needs to work harder. Over time, it causes damages to the heart muscle.

TREATMENT: Balloon valvoplasty applied with a catheter. The survival rate is 99%. In severe cases, open heart surgery might be needed.

Transposition of Great Arteries (TGA)

TGA is one of the most common cyanotic cardiac diseases in children. In this congenital heart defect, the positions of the pulmonary artery and the aorta are reversed and connected to the wrong ventricles. Deoxygenated blood is pumped back to the body. Babies with Transposition of the great arteries are born bluish due to the low levels of oxygen in the blood.

TREATMENT: Surgery is needed immediately after birth or within the first months of life. Drug therapy may be prescribed until the baby is ready for the surgery. There are two main types of surgery for TGA: Arterial switch (the arteries are switched to their usual positions) and Atrial switch (reversal of atriums). The second one is less commonly performed because, in the long run, it may cause rhythm irregularities due to physiological change.

Tricuspid Atresia (TA)

In this congenital heart disorder, the tricuspid valve is not developed. Therefore, there is no blood flow from the right atrium to the right ventricle. As a result, the right ventricle remains small and not fully developed. The blood is mixed and cannot flow correctly.

TREATMENT: Depending on the child’s condition, one or several surgeries may be needed to restore the heart function, including Atrial septostomy (creates or enlarges the opening between the heart’s upper chambers to allow more blood to flow from the right atrium to the left one); Shunting (creates a bypass from a main blood vessel leading out of the heart to the blood vessel leading to the lungs); Pulmonary artery band placement (to reduce blood flow from the heart to the lungs); Glenn operation (when babies outgrow the first shunt, between 3-6 months of age); Fontan procedure (performed when the child is 2-3 years old).

Pulmonary Atresia (PA)

This is an extremely rare form of congenital heart defect. Normally, when the heart squeezes, the right ventricle pushes blood out to the lungs. In patients with pulmonary atresia, the pulmonary valve has not formed properly. It leads to disorders in blood flow to the lungs. Usually, the tricuspid valve is also underdeveloped.

TREATMENT: The treatment plan depends on the severity of each specific case. A shunt can be placed between the pulmonary artery and the aorta using catheterization techniques. Fontan surgery is often used as well.

Truncus Arteriosus

In this condition, one single blood vessel (truncus arteriosus) leads out of the heart instead of the normal two vessels (pulmonary artery and aorta). In addition, ventricular septal defect (VSD) presents. As a result, the blood gets mixed.

TREATMENT: Most infants with truncus arteriosus have surgery within the first weeks of life.

Total Anomalous Pulmonary Venous Drainage (TAPVD)

This is a rare abnormality of the blood flow, where all pulmonary veins are not properly connected to the left atrium. Thus the blood returning from the lungs mixes with the blue blood returning from the body. The baby has a lack of oxygen and turns blue.

TREATMENT: Surgical treatment is a must. Babies with TAPVD need surgery within their first weeks of life.

Hypoplastic Left Heart Syndrome (HLHS)

In this heart disorder, the left part of the heart is underdeveloped, including the aorta, aortic valve, left ventricle, mitral valve.

TREATMENT: Surgical treatment is a must. The treatment plan typically involves 3 stages of operations: Norwood procedure (as soon as possible after birth), Glenn Procedure (6 months later), and Fontan Procedure (18 months – 3 years of age).

Preparing for Your Child’s Stay

If you have a child diagnosed with a congenital heart defect or another cardiac problem, there is no need to panic. Nowadays, children with heart disorders have very good chances for a happy and productive life. Bear in mind that high-volume, experienced medical teams usually achieve better outcomes, especially in complex cases.

If your child needs heart surgery, it is important for the child to be as healthy as possible prior to the operation. Temperature, cough, cold, flu, and other medical concerns must be reported to your doctor in any case.

After the surgery, do not forget that post-op home care is the most important part of the recovery. In most cases, the patient needs to follow a diet and strict medication usage. Parents must follow the doctors’ orders carefully. Patients with congenital heart disease often need to be followed up throughout their life.