Pediatric Heart Center

Four pediatric cardiologists staff the Heart Center at Brenner Children’s Hospital. Specially trained to treat children with heart defects or conditions that may cause heart failure, these doctors use the latest treatment advances to help place patients on the road to recovery. Many offer treatment options only available here.

Our pediatric cardiologists work in outreach clinics throughout western North Carolina and Virginia, treating such conditions as heart anomalies and cardiac arrhythmias. Using telemedicine in five sites across the region, state-of-the-art diagnostic imaging and monitoring tools, this experienced group of physicians helps treat patients in their home communities.

Cardiac researchers at Brenner Children’s Hospital are part of the National Institutes of Health (NIH) Pediatric Heart Network and join other children’s hospitals in the nation to find new treatment options for children with heart diseases and abnormalities.  

Searching for better treatment options

Brenner Children’s Hospital participates in the National Institutes of Health (NIH) Pediatric Heart Network and joins 10 other children’s hospitals in the nation conducting clinical trials on patients with heart defects.

“This is a real honor for Brenner Children’s Hospital,” said Wesley Covitz, M.D., chairman of pediatric cardiology at Brenner Children’s Hospital. “This allows us to merge resources with other prestigious academic medical centers and find ways to improve care for children with heart problems.”

Brenner Children’s joins Boston Children’s Hospital, Children’s Hospital of Philadelphia and other leading academic medical centers who are part of the network.

Researchers conduct clinical trials to find the best treatment methods for children suffering from heart conditions such as single ventricle atrioventricular canal, hypoplastic left heart and dilated cardiomyopathy. They will test both medications and surgical interventions to find the best treatments. Brenner Children’s Hospital will conduct four clinical trials in 2007 as part of their participation in the network.

“By conducting clinical trials, we are able to offer our patients the very latest treatment advances, placing them on the road to recovery with better outcomes,” Covitz said.

Brenner Children’s Hospital competed for a permanent slot in the NIH Pediatric Heart Network and was renewed for another five years. “It was a very competitive field and we were happy to be selected,” Covitz said.

Fetal Diagnostic Clinic

Pregnant women benefit from the Fetal Diagnostic Clinic, where pediatric cardiologists can diagnose and treat many heart defects in utero or before the child is born. Similar to the normal ultrasound performed in your obstetrician’s office, fetal echocardiography is a special test that helps doctors study the structure of your baby’s heart. Doctors can determine if your child has a heart defect or may need special care upon delivery.

“Heart defects are the most common birth defects,” said Jim Cnota, M.D., a pediatric cardiologist on staff at Brenner Children’s Hospital. “Studies have shown that early diagnosis of a severe heart defect can improve the chances of treating that child successfully upon birth. By completing the testing during pregnancy, parents have time to process the diagnosis and make decisions about their child’s care before going into labor.”

At Brenner Children’s Hospital, we have physicians, surgeons, and nurses trained to not only treat the child but help the family through the entire process, he said. “We take the family on a tour of our NICU and have them meet with cardiothoracic surgeons and other key members of their treatment team to answer any questions they might have and explain what they can expect upon delivery of their child,” Cnota said.

Common conditions diagnosed at the Fetal Diagnostic Clinic include an abnormal fetal heart rhythm, defects in the structure of the heart or function of the heart.

Metabolic Syndrome Clinic

Brenner Children’s Hospital offers a clinic to treat children suffering from Metabolic Syndrome. The clinic was developed after pediatric cardiologists began seeing increasing numbers of children suffering from high blood pressure.

Dr. Wes Covitz, a pediatric cardiologist, works with a pediatric patient in one of the many cardiology clinics offered at Brenner Children's Hospital.

 “In years past when children came in to be treated for hypertension, we would look for kidney disease to explain their high blood pressure,” said Wesley Covitz, M.D., director of the Metabolic Syndrome Clinic. “Today with the increase in obesity rates, we look at a patient’s overall health status. Many of our pediatric patients with high blood pressure are overweight, have high cholesterol levels and mirror an adult suffering from the same health concerns.”

Children are diagnosed with Metabolic Syndrome when they have high blood pressure, high cholesterol levels, are overweight and at risk for diabetes. This condition places them at increased risk of coronary heart disease and diabetes.

“In a short period of time, these children are at risk for developing heart disease and diabetes – serious medical conditions that could shorten their life,” Covitz said. “Many people don’t view obesity as a serious health problem, but it is a huge problem that we need to address.” 

Pediatric cardiologists, nutritionists and exercise physiologists work with each patient to identify areas for improvement in their diet and exercise programs. A dietitian who is fluent in Spanish is available to help the Hispanic population – a population in which Metabolic Syndrome is more prevalent.

          “We hope by addressing these weak areas at an early age, many of these children can avoid life-long health complications and lead active, healthy lives,” Covitz said.

Fifteen percent of adolescents are obese and 30 percent of obese adolescents have Metabolic Syndrome, Covitz said.

“We hope to work with YMCAs and other agencies in a patient’s home community to keep them motivated and on-track,” Covitz said. “We want the patient to leave Brenner Children’s Hospital feeling energized and empowered about making positive lifestyle changes. At home, we want them to have the necessary resources to continue to move toward better health.”

Repairing heart defects in only a few days

Atrial Septal Defects

A procedure that helps children recover quickly from a common heart defect is offered at Brenner Children’s Hospital. Pediatric cardiologists use the Amplatzer Septal Occluder to repair atrial septal defects. One of the more common birth defects found in otherwise healthy children, an atrial septal defect is a hole in the heart between two of the chambers that allows blood to flow where it should not.

Before this procedure was approved for use in the United States, children suffering from atrial septal defect underwent open heart surgery, spent a week in the hospital and several weeks at home recovering. They also had a large scar on their chest. With the new procedure, children now spend less than 24 hours in the hospital and can return to normal activities within several days.

Atrial Septal Defects (ASD) Atrial Septal Defects are one of the more common heart defects found in children. It results when an opening between the chambers of the heart does not close during the child’s development in the mother’s womb.  Often the defect is found during a routine examination by a pediatrician and is not detected until the child is a toddler. In many cases, the hole closes on its own and additional treatment is not required. However, if it does not, the child must undergo a procedure to close the hole and restore normal blood flow inside the heart. If left untreated, the patient could have heart rhythm abnormalities, respiratory problems and elevated pressure in the lungs in adulthood.

Using a catheter, the physician inserts the device, called an Amplatzer Septal Occluder, into the heart, where it opens like an umbrella to plug the hole. The device is very pliable and allows the heart tissue to grow around and over it and can be inserted through an extremely small catheter and can be removed if placement isn’t perfect.

The Amplatzer is an FDA approved device has been used in other countries for many years. The results from this procedure compare with the success rates we’ve had with surgery -- without the complications that can result from open heart surgery. This procedure and device are safe and allow the patient to return to his or her normal activities much more quickly.

Patients also benefit from lower healthcare costs because the procedure doesn’t require extensive hospitalization or open heart surgery.

Cardiologists perform about 15-20 of these procedures each year.

Patent Foramen Ovale (PFO) Closures

Pediatric cardiologists at Brenner Children’s Hospital use a PFO Occluder device to close a common birth defect called a PFO. About 25% of the normal, adult population has a PFO, a flap that does not close properly between the left and right chambers of the heart, resulting in a hole between the two chambers. Most patients do not know they have a PFO, but some patients can have strokes due to the abnormal blood flow patterns in the heart.

Patent Foramen Ovale (PFO) PFO is a naturally occurring hole in the wall separating the left and right side of the heart. In most cases, the hole closes on it’s own as a person grows into adulthood. But for a third of the population, the hole does not seal and blood can flow from the left to the right side of the heart. In most cases this does not require treatment. However, a small percentage of patients begin to have small strokes. Pediatric cardiologists at Brenner Children’s Hospital are able to treat this condition with a PFO occluder device. Why would adults be treated by a pediatric cardiologist for this condition? Pediatric cardiologists are specially-trained to understand birth defects in the heart. They are the experts in the structure of the heart, so they are best suited to perform the procedure.

Using an intracardiac echocardiogram (ICE), pediatric cardiologists can pinpoint the exact location of the defect and correct it using a PFO occluder device. The intracardiac echocardiogram gives pediatric cardiologists a clear view from inside the heart’s walls and helps place the device accurately. The PFO occluder differs from the ASD occluder based on the smaller size of the hole it has to close and its basic design, which allows it to have a lower profile in the heart.

The patient avoids open heart surgery and the recovery time associated with that. Most often, the patient can return to work in a couple of days. Other benefits to patients include: lower costs, lower risk for complications and no scar.

Pediatric cardiologists have inserted about 20 PFO devices in patients ranging from 5 to 75 years old.

Outreach clinics

Brenner Children’s Hospital pediatric cardiologists work in eight outreach clinics throughout western North Carolina. Treating such conditions as heart anomalies and cardiac arrhythmias, this experienced group of physicians helps treat patients in their home communities. Other specialties offered at the clinics vary but include genetics, nephrology, allergy/pulmonology, and gastroenterology.

“Our satellite clinics provide our patients the opportunity to receive state-of-the-art care in their own neighborhood,” said Dr. Wesley Covitz, director of the satellite clinics. “Part of the mission of Brenner Children’s Hospital is to provide unsurpassed care that meets both the physical and emotional needs of our patients. This is one way we strive to fulfill our mission.”

Click here to see our outpatient clinic locations and office hours. Brenner Children's Cardiac Outpatient Clinics. Follow this link to get directions from our pediatric clinics to our BCH satellite clinics.

Mended Hearts Support Group

Brenner Children’s Hospital established North Carolina’s first Mended Little Hearts support group for families and caregivers of pediatric heart patients. Mended Little Hearts is part of a national nonprofit organization affiliated with the American Heart Association. Created 50 years ago, Mended Hearts was established to promote a positive patient-care experience for adults treated for heart disease. Mended Little Hearts was created for families of pediatric heart patients.

Mended Little Hearts offers:

• Support to family members and/or caregivers of children affected with congenital heart defects and heart disease.
• Educational and health resources relating to congenital heart disease and heart disease and well-being.
• Public information to raise awareness in the community about children with congenital heart defects and heart disease.

Kari L. Crawford, R.N., P.N.P., program coordinator, said there is a unique bond for families of children with a heart defect.

“No matter what the defect is or the struggles they endure, they all have one thing in common—a sick child,” she said. “They fear the unknown and want to protect their children.  The support group offers hope and a hug.”

Mended Little Hearts meets quarterly at night at various locations in the western region of the state. For more information and directions to the meeting place, contact Crawford at (336) 713-2228.

Pediatric Cardiothoracic Surgery

Pediatric cardiothoracic surgeons use minimally invasive techniques whenever possible to correct heart defects in infants and children. Brenner Children’s Hospital is the only children’s hospital in North Carolina to offer a better technique to fix a common childhood heart defect. The outpatient procedure – which requires only three or four small incisions in the chest – replaces major surgery to make the repair and correct the condition known as patent ductus arteriosus (PDA). It is offered at only a handful of hospitals in the United States. Dr. Michael Hines, a pediatric heart surgeon, has performed the procedure at Brenner Children’s Hospital since 1995.

Dr. Michael Hines, a pediatric heart surgeon, perfected a minimally-invasive surgical technique to repair a common heart defect. He is one of a handful of cardiothoracic surgeons nationwide to offer the procedure to his patients. Dr. Hines is pictured here with Xavier Johnson, and his dad, Terrance, following the toddler's surgery.

The surgery closes a channel, called the ductus arteriosus, between the two major vessels that leave the heart. During fetal development, the channel allows blood to bypass the lungs – which aren’t being used – and go to the rest of the body. After birth, when the baby must use the lungs to take in oxygen, the channel normally closes. In many premature infants, the channel remains open and causes excess fluid in the lungs.

“If the channel is large, it allows excessive blood flow through the lungs and back into the heart unnecessarily and the result is heart failure,” said Hines. “If the channel is smaller, then the child is at risk for getting endocarditis, an infection of the ductus or pulmonary artery, and would need to take antibiotics before having a routine procedure such as dental surgery to help prevent this infection as long as the ductus is open.”

The defect affects about 1 in 2,000 children in the United States. Often it can be corrected with medication, but surgery is recommended when medication does not close the vessel.

For the outpatient procedure, Hines inserts a tiny camera, called a thoracoscope, and instruments through small incisions in the chest. He uses a metal clip to close the channel. The clip lasts a lifetime and the surgery does not have to be repeated.

“The child spends a few hours in the hospital and then goes home the same day,” said Hines.
Hines is the only cardiothoracic surgeon in the Southeast who uses this outpatient procedure to close the defect.

ECMO program

Brenner Children’s Hospital operates one of the nation’s busiest ECMO (extracorporeal membrane oxygenation) programs and houses one of two cardiac ECMO programs in North Carolina. For patients with respiratory, heart and/or lung failure, ECMO does the work of the heart and/or lungs, giving them time to heal. The program is directed by a pediatric cardiothoracic surgeon and pediatric surgeons, who provide around-the-clock care.