One of the most useful diagnostic modalities for assessing congenital heart defects is the echocardiogram, which uses noninvasive, high-frequency sound waves to reveal complex cardiac anatomy and physiology. It’s an essential technology that has eliminated the need for cardiac catheterization for many defects. Riley clinicians with additional specialized training annually perform more than 9,000 pediatric and fetal echocardiograms. Their expertise is widely recognized among other hospitals in the Midwest, which rely on Riley cardiologists to interpret more than 5,000 echos from their own institutions.
Riley was the first in Indiana to have a pediatric echo lab accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories. In addition to traditional echos, Riley cardiologists dealing with more complex cases often perform transesophageal echos (TEE) when they need additional views. A TEE also can guide interventional catheterizations for immediate assessment in the operating room.
Echocardiograms are performed throughout Riley Hospital and the Riley Heart Center, including the operating room and catheterization lab, for intraoperative assessment, to guide surgical interventional procedures. Moreover, the Riley echo lab was one of the first all-digital laboratories in the State. We continue to apply new technologies and systems that ensure studies can be assessed and reviewed 24 hours a day to help with patient care at Riley and throughout the state.
Congenital heart defects are the most common birth defects, occurring in approximately one out of every 125 live births. Many of these defects can be identified in utero with specialized fetal echocardiography. This can allow for immediate treatment if available, or more often counseling and planning that enhances outcomes. Our fetal cardiology specialists work closely with maternal-fetal medicine specialists. We routinely perform detailed fetal cardiac ultrasounds at multiple sites and provide immediate consultation and discussion. We work closely with the referring physicians, as well as the surgical, neonatal and other Riley specialists necessary to help formulate the best course of treatment for the individual patient and specific congenital heart defect.
The cardiac MRI program at Riley is unique in the state of Indiana, providing thorough and in-depth details on cardiac structure and function in children and young adults with all varieties of heart disease. At Riley, we perform nearly 200 highly specialized cardiac MRI exams annually. MRI does not use ionizing radiation and the imaging is not invasive, often providing an alternative to cardiac catheterization. This makes cardiac MRI a very easy procedure for many children to undergo. Cardiac MRI can also answer questions that echocardiography may not be able to answer. Cardiac MRI is often very important in making decisions and planning for heart surgery. Riley has the only pediatric cardiologist and pediatric radiologist in the state qualified to perform and interpret cardiac MRI studies.
Rapidly advancing catheterization technology is allowing for the diagnosis and repair of the most complex cardiac defects. Some defects that only a few years ago would require surgery can now be treated with catheter-based techniques. The interventional pediatric cardiologists of Riley Hospital have been at the forefront of those advancements. Riley cardiologists performed a balloon valvuloplasty on the smallest patient to successfully undergo the procedure – the baby weighed less than 2 pounds. Riley cardiologists were among a small group of experts nationwide involved in clinical research trials for Amplatzer Septal and Duct Occluder and Nit-Occlud that treats atrial septal defects (ASD) and patent ductus arteriosus (PDA). Numerous clinical trials of other medical devices are ongoing.
A team model of care shapes the treatment in the catheterization laboratory and recovery within the Riley Heart Center. Pediatric Interventional cardiologists, anesthesiologists, nurse practitioners and other intensivists are involved at every step.
Combined interventional and surgical techniques (hybrid procedures) have been performed at Riley since 2004. More than 500 pediatric cardiac catheterizations (diagnostic, interventional, biopsy and electrophysiologic) take place each year at Riley Hospital.
Pediatric Cardiology provides the complete range of state-of-the-art services for the diagnosis and treatment of cardiac rhythm disorders, performing and interpreting more than 6,000 electrocardiograms (EKG’s), 450 24-hour continuous EKG monitors and 200 event recorders.
Our EP faculty follow more than 200 patients with various pacemakers and defibrillator devices. Over 60 radio frequency catheter ablations are done annually. With the guidance of pediatric cardiologists specially trained in pediatric electrophysiology, clinicians ensure that patients receive the best and most current care for heart rhythm problems.
More than 350 cardiac exercise stress tests take place at Riley Hospital each year in a laboratory dedicated to sophisticated evaluation of children and their responses to maximal exercise. Reasons for exercise stress tests vary from cardiac clearance for school sports to evaluations after fainting episodes, exercise-induced chest pain, abnormal heart rhythms, cardiac surgery or heart transplantation. State-of-the-art equipment used for exercise testing includes treadmills and bicycles with computer-controlled workload adjustments, measurement of peak oxygen consumption, blood oxygen saturation, continuous heart rate and rhythm, blood pressure, and other respiratory and metabolic parameters. The Riley Pediatric Cardiology department utilizes an exercise physiologist to coordinate exercise stress tests, provide individualized exercise programs for patients and assist in exercise-related research endeavors.
Adult Congenital Heart Disease Program
As a result of extremely successful diagnostic and treatment strategies developed and employed over the past half century, the number of adults with congenital heart defects in the United States is approaching one million. Of these, at least half are complex enough to require ongoing follow-up and treatment by health care professionals with expertise in the care of these patients. Meeting the unique and complex needs of this special population of patients is the mission of Indiana University Health’s Adult Congenital Heart Disease Program. This program was established in 1991 to provide multidisciplinary, continuing care for adolescents and adults with chronic congenital cardiac conditions. The service is jointly staffed by Riley pediatric cardiologists and adult cardiologists from the Krannert Institute of Cardiology, Indiana University School of Medicine. This collaborative effort among leading physicians ensures our expertise in the wide range of cardiovascular problems facing these patients. Specially trained technicians, sonographers, and nurse clinicians complete the team and provide the breadth of services necessary for optimal health care.
Preventive Pediatric Cardiology Program
Riley Hospital for Children’s Preventive Cardiology Program aims to identify and manage risk factors in children that contribute to heart disease as adults. Modifying behaviors and medically managing high cholesterol and blood pressure during childhood will significantly decrease the chances of a heart attack or other cardiac-related concerns in the future. Riley Hospital’s Preventive Cardiology Program treats children with abnormal cholesterol and hypertension, primarily on an outpatient basis. During the course of treatment, patients and their families will meet with a multidisciplinary team, including a pediatric cardiologist, a dietitian, a nurse specially trained in blood pressure assessment and an exercise physiologist.