When a child requires cardiac catheterization, the procedure necessitates the expertise of highly trained specialists who understand the needs of very young patients. At Nicklaus Children's Hospital's Heart Institute, our compassionate team includes skilled healthcare professionals who not only have vast experience in caring for children but also strive to advance the field of cardiac catheterization.
“Everybody in our cath lab, from the physicians to the nurses to the technicians, is 100 percent patient focused, from the patient experience to the technical aspect of the procedure,” says Lourdes Prieto, MD, Director of the Cardiac Catheterization Lab at Nicklaus Children's. “We are also involved in pioneering the development of the field through trials of interventional devices, and we perform all of the most advanced procedures with excellent results.”
Moving the Needle Forward
Widely recognized as a world leader in pediatric interventional cardiac catheterization, the team at the Heart Institute utilizes the latest devices and procedures. One such device is the Harmony Transcatheter Pulmonary Valve, the first valve approved by the Food and Drug Administration (FDA) for older children and adults who have a dysfunctional native pulmonary valve. The Harmony valve offers an alternative to open-heart surgery.
“Many patients who have pulmonary valve failure, most often a leaky pulmonary valve years after open heart surgery, can now have a replacement done in the cath lab. This was not true 10 years ago,” Dr. Prieto says. “For some, this wasn't even possible two years ago.”
In 2010, the FDA approved a valve called the Melody valve, but this valve did not work for all patients' anatomy. After its approval in March 2021, the Harmony valve increased the number of patients who can have a catheter-based replacement from 25 percent to 85 percent. Made from animal tissue, the self-expanding valve is placed on the end of a catheter and placed directly in the heart.
As of October 2023, 15 patients had received a Harmony valve at Nicklaus Children's, all with excellent results.
“It's very satisfying to be able to do this for our patients,” Dr. Prieto says. “Some patients have had three or more open-heart surgical procedures, and rather than put them through another one, we can now do this in the cath lab.”
Another advanced device offered at Nicklaus Children's is the AMPLATZER Piccolo™ Occluder, which is used to close patent ductus arteriosus (PDA) in premature infants.
“When a baby is born prematurely, often the PDA does not close spontaneously as it should, which causes too much blood flow into the lungs,” Dr. Prieto says. “Many premature infants also have significant lung disease, and having this extra flow into the lungs makes their course much more complicated.”
Until recent years, PDA closure could only be done surgically. In 2019, the FDA approved the Piccolo device, a wire mesh device that can seal the opening in the heart in babies as small as 2 pounds. As many as 98 percent of babies needing PDA closure are candidates for the Piccolo device, which Nicklaus Children's has offered since 2020.
The team has performed 68 Piccolo procedures, with no significant complications.
“When you compare a transcatheter closure to a surgical closure, there are many benefits,” Dr. Prieto says. “Babies get extubated significantly sooner, and their respiratory severity score is significantly lessened.”
Innovating Every Step of the Way
The cardiac team at Nicklaus Children's also participates in research and clinical trials, helping to develop and refine new procedures.
“We're about to embark on a trial for a bio-absorbable atrial septal defect closure device,” Dr. Prieto says. “It's a double disk device to close a hole in the heart, which then becomes absorbed by the body. The only thing that remains is a little frame of the device.”
The Heart Institute team has been involved with developing other procedures, including using radiofrequency energy to treat heart abnormalities, performing hybrid procedures for complex cardiovascular conditions, and replacing leaky or narrow pulmonary valves with the Medtronic Melody valve and Edwards Lifesciences SAPIEN™ valve.
Team-Based Approach
In addition to employing the most advanced treatments available, the multidisciplinary team at the Heart Institute continually collaborates to ensure each patient receives the best possible care. Members of the team, including cardiac surgeons, attending physicians from the Cardiac Intensive Care Unit (CICU), cardiologists, nurse practitioners and those in the fellowship training program, meet two to three times a week to discuss complex cases.
“Everybody has an opportunity to give their expert input on every case,” Dr. Prieto says. “When we make a decision, it's a team consensus.”
The team continues to communicate throughout a patient's treatment, with help available anytime it is needed.
“If the cath lab procedure requires a surgeon, someone is always available,” Dr. Prieto says. “In our dedicated pediatric CICU, patients are monitored around the clock, and rounds are performed daily by surgeons, interventional cardiologists and other pediatric specialists.”
Focus on Families
Physicians, nurses and other members of a patient's team communicate constantly with families, while doing everything possible to make the experience as smooth as possible for everyone.
“When we take patients into the cath lab for a catheterization, we have a nurse assigned to call the parents every hour while the procedure takes place,” Dr. Prieto says. “This happens for every patient, every day. We keep the parents informed to help lessen their anxiety during the procedure.”
Patient comfort is also a top priority.
“We're very careful about minimizing pain and discomfort for children before they go into the cath lab,” Dr. Prieto says. “We give the patient medicine while they are waiting to have the procedure to help them relax. Patient- and family-centered care is our utmost priority.”