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Areas of expertise

The key feature of paediatric cardiology is the diagnosis and management of congenital heart diseases. Close collaboration with the department of obstetrics/ prenatal diagnosis means that the diagnosis of a structural heart defect is often established in utero, so that the timing and method of delivery, and direct postnatal care can be planned. This is particularly important for patients with duct-dependent lesions, in whom it is vital that postnatal patencs of the duct is ensured.

It is often unavoidable that a heart operation needs to be performed in the neonate. We undertake surgical repair of structural heart defects at all ages, beginning with the neonate (paediatric cardiac surgeon: Prof.dr.Gerardus Bennink). We have built up a large practice of operating on neonates with complex structural heart defects such as hypoplastic left heart syndrome (the Norwood procedure), transposition of the great arteries (the arterial switch) repair of total anomalous pulmonary venous drainage, and aortic arch obstructions or interruption. Operations in later infancy or early childhood that are routinely performed at our center include repair of tetralogy of Fallot, repair of atrioventricular septal defects, ventricular septal defect closure, the bidirectional superior cavopulmonary shunt and Fontan completion. Prof.Dr.Gerardus Bennink is an internationally renowned congenital heart surgeon, and one of the best in his field in Europe.

Therapeutic catheterization

Not all clinically significant structural heart defects require corrective surgery. A wide variety of lesions can be treated with interventional catheterization techniques. These include intracardiac and extracardiac shunts such as atrial septal defects (ASDs), some ventricular septal defects (VSDs), and arterial ducts, for which a wide variety of devices can be deployed using a percutaneous approach to close the defect. The majority of patients can then be discharged from hospital one day after the procedure. The same is true for balloon valvuloplasty of pulmonary or aortic valve stenosis, and for angioplasty or stent implantation for coarctation of the aorta or branch pulmonary artery stenoses. All of thse procedures are routinely performed in our department.

New developments in the field of interventional catheterization at the Heart Center Cologne include transcatheter pulmonary valve implantation (the Melody valve), which avoids the need for surgical replacement of right ventricle to pulmonary artery valved conduits. In selected patients, open heart surgery can be combined with therapeutic catheterization (the so-called hybrid technique), where stent implantation in a vessel or device closure of a septal defect with a device can be part of a complex surgical repair. In selected patients with hypoplastic left heart syndrome, we also employ the Giessen procedure, combining bilateral pulmonary artery banding at surgery with stent implantation in the duct. All such hybrid procedures, involving a combination of open heart surgery with a therapeutic interventional catheterization procedure, are undertaken in a dedicated hybrid operating room which incorporates all modern surgical facilities with a biplane catheter laboratory.

Cardiac arrhythmias in the paediatric population

This is another area of expertise for the department. We routinely perform standard Holter analysis, 12 lead ECG Holter recordings, transoesophageal electrophysiologic procedures and invasive electrophysiologic studies. We also have special expertise in the diagnosis and management of ion channel disorders such as the long QT and Brugada syndromes.

Catheter ablation for tachyarrhythmias

We routinely perform catheter ablation procedures for a variety of tachyarrhythmias in children and young adults. The use of sophisticated mapping systems, such as the LocaLisa navigation system and the CARTO three-dimensional mapping system have improved both the safety and efficacy of catheter ablation procedures for all arrhythmia substrates. For ablation of arrhythmia substrates in the vicinity of the His-bundle, such as para-Hisian accessory pathways, congenital junctional ectopic tachycardia, or for modulation of the slow pathway in patients with atrioventricular nodal re-entrant tachycardia, we routinely use cryomapping and cryoablation. With cryo-mapping, the ablation target is cooled to -300C, to confirm whether this is a safe ablation site. If any disturbance of AV conduction is noted, the catheter tip is allowed to warm up, and no permanent lesion is created at that site. When the ablation target is confirmed to be the correct, and safe, site, the catheter tip is cooled to -800C and a permanent lesion is created.
For complex arrhythmias in the atria or ventricles, such as postoperative incisional atrial tachycardias, focal arrhythmias or re-entrant ventricular tachycardias, we routinely use the three-dimensional electroanatomic mapping system (CARTO), which can be merged with information obtained from other imaging modalities such as MRI images (Carto-Merge) so that the anatomic information can be combined with the electrophysiologic data to better understand a particular arrhythmia circuit.
There are few centers in Europe dedicated to invasive therapy in children with heart rhythm disturbances. Prof.Dr.N.Sreeram is one of the few specialists in the field of paediatric cardiology who is experienced in ablation therapy for infants, children and young adults with various types of tachyarrhythmias. He receives referrals not only from within Germany, but also from the Benelux countries and from North Africa.

Device therapy for cardiac arrhythmias and for heart failure

We routinely undertake implantable device therapy (ICDs) for unstable arrhythmias which are poorly tolerated by the patient. We also perform transvenous or epicardial biventricular pacing in selected patients with heart failure, either as definitive therapy or as a bridge to future cardiac transplantation. In both these areas, we also are currently participating in international collaborative studies aimed at improving patient outcome.

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