Pediatric Cardiology and Cardiovascular surgery - ACIBADEM
Pediatric Cardiology & Cardiovascular Surgery

Pediatric Cardiology & Cardiovascular Surgery

United to save hearts!

At Acıbadem 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 a human touch. As a leading medical facility in Turkey and the surrounding region, we provide state-of-the-art diagnostic and treatment options for the entire spectrum of pediatric cardiac conditions, including the most severe or complex cases, with the best possible outcomes. Every aspect of heart disease in children is covered by our doctors, including neonatal heart surgery, complex procedures, and reoperations. Our exceptional patient care is based on knowledge, experience, and the latest technologies 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 to us from all over the world.

It is well known 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 Acıbadem Bakirkoy and Acıbadem Atakent hospitals include experienced physicians in pediatric cardiology, cardiovascular surgery, anesthesia, intensive care, cardiac imaging, radiology, neonatology, rehabilitation, social work, and psychology. Specialized teams are in constant contact with other departments in our hospitals, ensuring quick access to any specialist who might be needed, all under the same roof. We also have specially trained nurses for operating rooms, intensive care units, and patient work. Every member of our pediatric heart team has devoted years of effort to better understanding the specific physical and emotional needs of our little heart patients to provide the best care and the best chance at life. We are united to save hearts!

Pediatric heart conditions we treat

Cardiac diseases in children are different than those in adults. There are two major types of heart disorders in children: inborn (congenital heart disease [CHD]) and acquired. Some examples are:

Why should you choose Acıbadem children’s heart center?

Fast facts about our center and teams:

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

For international patients

At Acıbadem Children’s Heart Center, we know that traveling abroad for your child’s treatment can be an overwhelming and stressful experience. So, we have designed the International Patient Services Center as a one-stop solution that supports every patient from the day they arrive until they return to their home country. Medical appointments, travel and accommodation, and airport–hotel–hospital transfers are arranged according to your needs and preferences. We provide 24-hour interpreting services in your native language. By choosing Acıbadem Turkey and our comprehensive patient service, international patients can rest assured that their health journey will be organized with their comfort in mind.

Symptoms of heart problems in children

With congenital heart diseases, about 30% of affected children require treatment in the first month of life. Early diagnosis and timely treatment are essential. Parents must recognize the symptoms of heart disease and consult a doctor immediately. The risk of congenital heart disease is two to three times higher in children whose mother or father has the same disorder. Early signs of heart problems in children vary depending on the condition, but the most common symptoms are:

  • Bluish (cyanotic) color on the lips and mouth and under the nails
  • Rapid breathing or difficulty breathing
  • Frequent  respiratory illness
  • Unwillingness to nurse or tiring quickly during breastfeeding
  • Lack of appetite and difficulty gaining weight
  • Tiring quickly

Less serious congenital heart diseases may not manifest any distinctive symptoms in the first years of life. In older children, symptoms such as heart palpitations, shortness of breath, tiring quickly, chest pain, dizziness, or fainting during exercise might be signs of heart problems.

Diagnosis of pediatric heart conditions

Congenital heart diseases can often be diagnosed prenatally, 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 in-utero. If a problem is identified, the baby can be monitored closely and treatment is planned for after the birth. Diagnosing congenital heart defects during pregnancy helps reduce serious complications in infants.

Heart problems can also be diagnosed later in childhood. If you suspect your child has cardiac disease, a pediatric cardiologist can perform a physical examination and conduct various tests using advanced technological diagnostic tools. A comprehensive diagnostic process may include:

  • Electrocardiogram (ECG): An ECG is a noninvasive test that examines heart function. It uses a device to measure the electrical activity passing through the heart and records heartbeats on ECG paper. The procedure helps to assess heart rate and detect rhythm disorders.
  • Chest x-ray: This shows if the heart is enlarged or if there is extra fluid in the lungs. The level of radiation in a chest x-ray is very low and has no side effects.
  • Echocardiography (cardiac ultrasound): This is an ultrasound that shows live images of the heart to evaluate heart muscle function. A Doppler ultrasound of the aorta uses sound waves to measure blood flow through the arteries and veins. These two techniques provide useful information about the structure and function of the heart. 
  • Transesophageal echocardiography: For some patients, better images are obtained using a special ultrasound probe through the mouth and down the esophagus.
  • Stress test: In a stress test, an ECG is performed while the child is walking on a treadmill at a fast pace. This can help to detect problems in heart function triggered by exercise.
  • Cardiac computed tomography: This provides a detailed visualization of a child’s heart and blood vessels. In complex cases, computed tomography scanning is needed to visualize precise anatomical details.
  • Cardiac magnetic resonance imaging: This provides clear pictures of the heart and blood vessels in the chest using magnetic technology without radiation.
  • Cardiac catheterization and angiography: This is an advanced examination method in which a thin tube (catheter) is inserted into a blood vessel using an x-ray (fluoroscopy) to guide it to the heart. This allows for direct visualization of anatomical details.
  • Electrophysiology study: This is a test used to diagnose irregular heartbeats or arrhythmias. As in the cardiac catheterization method, special catheters are used to examine the heart and identify areas of abnormal electrical activity in the heart tissue.

Interventional pediatric cardiology

Some heart diseases in children can be treated with cardiac catheterization 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 for both diagnosis and treatment. When used to fix a heart defect, the procedure is called interventional catheterization. This procedure allows experienced physicians to treat certain heart disorders without surgery. Once the catheter has reached the heart defect, tiny tools can be delivered through it to repair the defect. For example, balloon catheters can be used to open narrowed valves or vessels, and some catheters can close holes between the chambers of the heart. Therapeutic interventional procedures include:

  • Balloon angioplasty and valvuloplasty: A catheter with a balloon at the tip is inserted to open a narrowed heart valve or vessel.
  • Transcatheter aortic valve replacement: An artificial valve is inserted using a catheter instead of via open-heart surgery.
  • Transcatheter ASD and VSD closure: Septal defects can be repaired using catheterization techniques.
  • Endovascular stenting can be used to expand narrow vessels.
  • Electrophysiology and transcatheter arrhythmia ablation can be used for the treatment of heart rhythm problems through cauterization (destruction by heating) of a small tissue using radiofrequency ablation.
  • Hybrid procedures and 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 a surgical incision and allows for fast recovery and a short hospital stay. There are no age restrictions; it can be used for small children and infants immediately after birth. At Acıbadem Children’s Heart Center, our highly experienced pediatric cardiologists perform advanced interventional procedures with high success rates. Whenever possible, they choose minimally invasive approaches to reduce pain, the recovery period, and the length of the 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 Acıbadem Children’s Heart Center, we perform all types of pediatric cardiac operations successfully, including complex procedures and reoperations. There are three main types of heart surgery: 

  • Open heart surgery: The surgeon opens the chest through the breastbone to get access to the heart. This type of surgery usually requires a heart–lung machine to take over heart and lung functions during the operation.
  • Closed heart surgery: The chest cavity is opened, but the heart is not stopped. Therefore, the surgery can be performed without a heart–lung machine.
  • Minimally invasive heart surgery: This is a less invasive surgical approach than the two mentioned above. The surgeon makes tiny incisions to insert special tools and a video camera. Minimally invasive techniques have many advantages over conventional methods, including reduced pain, smaller scars, and shorter recovery periods. In children with well-developed ribcages, certain heart anomalies can be eliminated through robotic surgery.

Treatment of rare and common congenital heart diseases (CHD)

Patent ductus arteriosus

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

TREATMENT: The passage is closed using a special device called an umbrella or coil delivered through a catheter. Additionally, closed heart surgery to reconnect may be performed, depending on the patient’s age and the extent of the PDA.

Atrial septal defect

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

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

Ventricular septal defect

A VSD is a hole in the wall between the two ventricles of the heart. In this case, 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, complications may include pulmonary hypertension, heart failure due to enlargement, and endocarditis.

TREATMENT: Because some defects may close by themselves, the doctor may observe the child’s progress for a while. However, the patient usually needs surgery to repair a VSD.

Atrioventricular septal defect

This congenital heart condition is a combination of anomalies—there is a large opening in the middle of the heart, and both the valve that separates the atria and the valve that separates the ventricles do not develop fully. Both are in the form of a single and large valve. The atrioventricular septal defect causes oxygen-enriched blood in the left side of the heart to pass to the right side, and it is pumped back to the lungs.

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

Aortic stenosis

This is a heart valve disorder that narrows or obstructs the aortic valve opening. It makes it difficult 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 to prevent irreversible damage to the heart.

TREATMENT: Children with aortic stenosis who have mild or no symptoms should be monitored closely. In cases of moderate to severe symptoms, surgical interventions may be required, such as valvuloplasty, which is minimally invasive (a balloon is placed into the artery), valvotomy (to free the valve cusps without replacing the valve), or aortic valve replacement.

Aortic coarctation

Coarctation of the aorta is a narrowing or constriction of part of the aorta. This could be anywhere and to any degree. It makes the left ventricle 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 fails to pump blood efficiently. In some cases, this can lead to kidney failure or heart enlargement.

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

Tetralogy of Fallot

This medical condition involves four different cardiac anomalies: VSD (a hole between the ventricles of the heart), PS (a narrowing of the pulmonary valve), overriding aorta (the aortic valve connects to the right ventricle), and right ventricular hypertrophy (the right ventricle is more muscular than normal). ToF is the most common heart defect that causes cyanosis in small children. Babies with ToF exhibit bluish skin while crying or feeding.

TREATMENT: There are two phases, depending on the child’s condition. The first phase involves temporary repair using a shunt, stent, or muscle removal. The second phase is the complete repair. This may be performed before or after the shunt operation. After these surgeries, circulation returns to normal, and cyanosis is eliminated.

Pulmonary stenosis

This is a very rare condition that can be diagnosed in utero or shortly after birth. PS is a narrowing (stenosis) or blockage of the pulmonary valve, which causes the right ventricle to work harder. Over time, this causes damage 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 the great arteries

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 they are connected to the wrong ventricles. Deoxygenated blood is pumped back into the body. Babies with TGA are born bluish due to the low levels of oxygen in their blood.

TREATMENT: Surgery is needed immediately after birth or within the first few months of life. Drug therapy may be prescribed until the baby is ready for 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 atria). The second is less common because it may cause rhythm irregularities due to physiological changes.

Tricuspid atresia

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 underdeveloped. The blood is mixed and cannot flow correctly.

TREATMENT: Depending on the child’s condition, one or more surgeries may be needed to restore 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 to the left atrium), shunting (creates a bypass from the 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), the Glenn procedure (when babies outgrow the first shunt at 3–6 months of age), and the Fontan procedure (performed when the child is 2–3 years old).

Pulmonary atresia

This is an extremely rare congenital heart defect. Normally, when the heart contracts, the right ventricle pushes blood to the lungs. In patients with pulmonary atresia, the pulmonary valve is underdeveloped, which disrupts blood flow to the lungs. Frequently, the tricuspid valve is also underdeveloped.

TREATMENT: Treatment depends on the severity of the case. A shunt may be placed between the pulmonary artery and the aorta using catheterization techniques. The Fontan procedure is often used as well.

Truncus arteriosus

In this condition, a single blood vessel leads out of the heart instead of the normal two vessels (pulmonary artery and aorta). In addition, VSD is present. As a result, the blood gets mixed.

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

Total anomalous pulmonary venous drainage

This is a rare abnormality of the blood flow, where none of the pulmonary veins are properly connected to the left atrium. This causes the blood returning from the lungs to mix with the deoxygenated blood returning from the body. The baby lacks oxygen and turns blue.

TREATMENT: Surgical treatment is imperative. Babies with total anomalous pulmonary venous drainage need surgery in the first weeks of life.

Hypoplastic left heart syndrome

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

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

Preparing for your child’s stay

If a child is diagnosed with a congenital heart defect or other cardiac problem, there is no need to panic. Nowadays, a child with a heart disorder has a very good chance of leading a happy and productive life. Bear in mind that high-volume, experienced medical teams usually achieve the best outcomes, especially in complex cases.

If a child needs heart surgery, they must be as healthy as possible before the operation. A temperature, cough, cold, flu, or other medical concern must be reported to their doctor.

After surgery, postoperative home care is the most important part of recovery. In most cases, the patient needs to follow a diet and strict medication regimen. Parents must follow the doctors’ orders carefully. Patients with congenital heart disease often need follow-up treatment throughout their life.