Cardiovascular Services

The Pediatric Cardiac Intensive Care Unit (CICU) at Children’s Hospital of Michigan provides up to 16 designated beds with 24 hour attending-level staff dedicated to comprehensive, multidisciplinary cardiac care for patients with congenital and acquired heart disease —including all forms of cardiomyopathy — from birth through early adulthood.

Services include:

• Comprehensive care for fetal cardiac diagnosis and in some cases fetal cardiac treatment.
• A dedicated team of cardiac intensivists, cardiac surgeons, cardiologists, cardiac nurse practitioners, anesthesiologists and physician assistants.
• An Extracorporeal Membrane Oxygenation (ECMO) program
• Cardiac imaging including CT and MRI
• Temporary and permanent ventricular assist device services
• Electrophysiology
• Pre-operative and postoperative management

The Department of Cardiovascular Surgery offers surgical repair of congenital heart defects in children, with special expertise in the primary repair of heart disease in newborns and infants. On average approximately 200 surgical procedures are performed by cardiovascular surgeons at the Children's Hospital of Michigan every year.

Surgery patients are treated by a comprehensive multidisciplinary team that specializes in the care of pediatric cardiac surgical patients. Members of this team include pediatric cardiac surgeons, pediatric cardiologists, specialists in pediatric cardiac critical care, pediatric cardiac anesthesiologists, pediatric cardiac surgical nurse clinicians, pediatric cardiac surgical advanced practice providers, as well as pediatric cardiac perfusionists, circulating nurses and surgical technicians. In preparation for surgery, patients and their families are given an opportunity to visit the intensive care unit prior to their procedure.

Our team provides a full spectrum of surgical techniques, including Fontan procedures, tetralogy of Fallot repair, atrial/ventricular defect repair, coarctation repair, ventricular assist device implantation and removal, and pediatric heart transplant.

Diagnosing and treating children’s heart disease requires specialized knowledge and a dedicated team-approach to care. Children’s Hospital of Michigan is equipped with the experience children need when going through this difficult time.

Children’s Hospital of Michigan participates in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database, which provides data on Operative and Adjusted Operative Mortality. Further information can be found at  https://www.sts.org/registries-research-center/sts-national-database/congenital-heart-surgery-database 

The catheterization labs at Children’s Hospital of Michigan feature equipment for diagnostic and interventional catheterization procedures. Pediatric cardiologists perform a wide range of procedures – including balloon valvuloplasty, percutaneous valve placements, stent angioplasty, coiling of collaterals and closure of atrial and ventricular septal defects.

Children’s Hospital of Michigan provides babies, children, and adults with compassionate medical care for known or suspected congenital heart defects.

The Fetal Care Center at Children’s Hospital of Michigan provides a comprehensive fetal care program for prenatal diagnosis of congenital anomalies to prepare for timely and successful postnatal treatment. Our pediatric specialists in Michigan and other healthcare providers offer patients a complete range of prenatal testing and fetal interventions in one place for the mother and child before and after birth.

Diagnostics include fetal echo and fetal MRI, performed by pediatric technologists and studies interpreted by pediatric cardiologists and pediatric radiologists, respectively

Conditions treated included: hypoplastic heart, atrial septal defect, atrioventricular septal defect, coarctation of the aorta, double outlet right ventricle, d-transposition of the great arteries, and interrupted aortic arch.

Cardiovascular surgeons and interventional cardiologists on staff at Children’s Hospital of Michigan are experts in the use of hybrid approaches to repair certain forms of complex congenital heart disease.

• Ultrasound is a non-invasive diagnostic tool that does not require sedation or radiation. Pediatric patients come in all shapes and sizes. From the tiniest premature neonate to adult congenital patients, EpiQ Philips machines offer a depth of imaging capability combined with streamlined cardiac workflow to reduce the steps and time needed for challenging exams.
• No other premium ultrasound systems can run the complete suite of the world’s most innovative ultrasound transducers. With the touch of a button, xMATRIX offers all modes in a single transducer: 2D, M-mode, color Doppler, Doppler, iRotate, Live xPlane, Live 3D, Live 3D Zoom and Live 3D Full Volume.
• Philips unique, patented Purewave crystal transducer technology provides the best image resolution for diagnostic exam confidence from the smallest neonate to morbidly obese adults.
• Visualize extraordinary levels of detail with the industry’s only PureWave S9-2 transducer that simplify pediatric cardiac exams by displaying high levels of detail and contrast resolution and providing tissue information at greater depths, enhancing coronary artery visualization.
• Leader in 3D Technology for transthoracic (TTE) and transesophageal (TEE) imaging. Philips introduced a 3D TEE in 2007 (x7-2t TEE) and an ergonomic 3D TTE (x5-1) transducer in 2010. Philips is on the 2nd generation of TEE (x8-2t TEE) and 3rd generation of 3D TTE transducer (x3-1, x5-1, x5-1c)
• The only vendor with a 3D transthoracic transducer (x7-2) for pediatrics. Philips also offers the S8-3t micro and s7-3t mini TEE transducers to image even very small infants during critical cardiac catheterization and surgical procedures.
• For advanced fetal echo with exceptional image resolution, Philips offers two PureWave curved array transducers, the C5-1 and C9-2, and 3D imaging with the V9-2 transducer.
• Philips was the first to introduce fully automated analysis of 3D datasets using AI Technology - Dynamic HeartModel for LV and LA and 3D AutoRV for RV. Quantification takes less than 20 seconds. Together, Dynamic HeartModel and 3D Auto RV allow for full-cycle cardiac quantification using artificial intelligence to provide fully automated quantification of the LV, LA and RV. All of our clinic echo machines have the above capability. 
• The EPIQ also automates routine echo measurements and Strain analysis, providing more accurate and reproducible quantification.
• The EPIQ system has a sleep mode with a boot-up time of < 20 seconds, and instant boot-down, saving time when doing exams in the NICU, PICU, and Cath lab. 

Pediatric Extracorporeal Membrane Oxygenation (ECMO) – an advanced technology that functions as a temporary replacement for a child’s heart and lungs before and after cardiovascular surgery, is available at Children’s Hospital of Michigan and is one of only a few hospitals in Michigan to provide this level of advanced care to children. 

ECMO is a form of external life support where artificial circulation is established by cannulas and tubing carrying venous blood from the patient through a gas exchange device (oxygenator) and then pumped into the patient. The oxygenated blood is returned to the patient via the venous side (veno-venous ECMO) to provide lung support when the patient is in severe respiratory failure when no major cardiac dysfunction exists. Blood is returned to the arterial side (veno-arterial ECMO) to provide both heart and lung support. This configuration is used when the patient has severe cardiac failure and usually associated with respiratory failure. 

Patients who are hypoxemic and/or hypercarbic despite maximal conventional ventilator support or who are in reversible cardiogenic shock may be considered for ECMO support. 

Indications for Ecmo 

V-V ECMO 

• Severe viral or bacterial pneumonia
• Pediatric Acute Respiratory Distress Syndrome (PARDS)
• Pulmonary contusions after major trauma

Rarer indications: Alveolar proteinosis, smoke inhalation, status asthmaticus, airway obstruction, aspiration syndromes.

V-A ECMO

• Cardiogenic shock after acute myocardial infarction
• Cardiogenic shock after open heart surgery
• Drug overdose with cardiac failure
• Acute Viral Myocarditis

Rarer indications: Acute pulmonary embolism, Cardiac or major blood vessel trauma, massive hemoptysis, pulmonary trauma, acute anaphylaxis, post-partum cardiomyopathy, sepsis, profound hypothermia.

What is a Fontan Clinic?

A Fontan clinic is a dedicated, multidisciplinary clinic that provides care to children, adolescents and adults who have undergone Fontan palliation for repair of their congenital heart disease. The Fontan clinic is geared to not only provide ongoing care to the patient but to also anticipate and screen for potential complications that can lead to poor survival and limited quality of life. We follow the guidelines put forth by the American Heart Association with the aim to improve long-term care of these patients.

What complications can develop in a Fontan patient?

• Heart failure due to systolic or diastolic dysfunction of the single ventricle
• Fontan circulation failure manifesting as
  • Protein-losing enteropathy
  • Plastic bronchitis
  • Cyanosis
  • Thromboembolism
  • Atrial arrhythmias
  • Fontan-Associated Liver Disease (FALD)

What services do we provide in the Fontan clinic?

Under one roof, we provide:

• Evaluation by dedicated pediatric cardiologists who specialize in the long-term care of Fontan patients, including management of Fontan circulation failure.
• A multidisciplinary approach with evaluation by a nutritionist and social worker.
• Ability to obtain cardiac studies beyond EKG and echocardiogram to include exercise stress test, cardiac MRI and cardiac catheterization services under one roof as needed.
• A dedicated nurse navigator to guide patients through the appointment, tests and follow-up recommendations.
• Identified subspecialists (nephrology, hepatology, pulmonology) with experience in the long-term care of Fontan patients.
• Referral to cardiac rehabilitation program as applicable.
• Expertise in identifying patients that need advanced therapies and evaluation for heart transplant.

Why Choose Children’s Hospital of Michigan for Fontan Care?

Many children thrive and do well after heart surgery. They'll need to see a cardiologist regularly, get EKGs, echocardiograms, lab tests and occasional cardiac catheterizations. A cardiac catheterization is a procedure that lets cardiologists check how the heart is working and perform some types of treatments. Centralized, comprehensive care after surgery is essential to reaching successful surgery outcomes. 

Our dedicated team of pediatric cardiologists, subspecialists, advanced practice providers, nutritionist, social worker and ancillary staff is here to provide individualized care for your patients. Our team will also work with the referring cardiologist to ensure continuum of care for the patient.

Patients are not required to have had their Fontan surgery at Children’s Hospital of Michigan to attend the clinic. We welcome all Fontan patients from across the state and region, as well as second opinions.

To schedule an appointment, please call 313-745-5481.

Children’s Hospital of Michigan pediatric lipid management program is a preventive care program for children with lipid disorders featuring specialized pediatric testing, innovative lipid management therapies, and dietary counseling. Patients are seen by a pediatric lipid specialist (cardiologist or nurse practitioner), a dietitian and an exercise specialist.

Patients are evaluated for presence of risk factors associated with the development of premature cardiovascular disease (CVD). Additional testing may be offered for secondary causes of hyperlipidemia, early indicators of heart disease. Found risk factors are then managed via pharmacologic and non-pharmacologic treatment, and referral to appropriate specialty service. Specialists and families discuss risk factor prevention including educating both the child and family about the pathophysiology of premature CVD, risk factor prevention through lifestyle modification, and the role of diet, nutrition, and physical activity in both the development and treatment of premature CVD. After initial consultation specialists follow patients at least annually (more often in higher risk patients) and provide complete reports detailing findings and a plan of care to the referring physician following each clinic visit.

The U.S. Food and Drug Administration (FDA) approved use of the Berlin Heart, the first ventricular assist device made specifically for pediatric patients. Ventricular assist devices are used when a patient needs a heart transplant but can’t wait for a donor heart to become available. The Berlin Heart assists the failing heart until an appropriate donor heart can be found. Surgeons on staff at Children’s Hospital of Michigan are leaders in the use of this advanced technology and testified to the FDA about its life-saving benefits. In larger patients, it is sometime possible to use the HeartWare ventricular assist device. The pump and connecting tubes for this centrifugal flow device are contained with the patient’s chest with only a small driveline exiting the body. And connecting to the portable controller and battery packs. Under the right circumstances, it is possible for patients to go home with this portable device to await their heart transplant.