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for mothers with heart issues that may affect the birth of their babies. One of Dr. Zahka's focuses is on genetic forms of cardiovascular disease including hypertrophic cardiomyopathy, aortopathy and connective tissue diseases. He is nation- ally recognized for his work in these areas. "We have a lot of experience with both the medical and surgical approach to aortopa- thy (an enlarged aorta) and hypertrophic cardiomyopathy," says Dr. Zahka. "Our multidisciplinary approach to these diseases includes collaborations with our colleagues on the adult side, as well as the children's side, of the Clinic to try to bring to our pediatric patients all of the novel and cutting edge therapies available for these diseases." He cites, as an example of the latter, a national trial funded by the NIH to look at a medication called Valsartan for the early treatment of hypertrophic cardiomyopathy in children and young adults. Dr. Zahka and his counterparts at Cleveland Clinic's Heart & Vascular Institute participated in this trial. "We also collaborate with local high schools and colleges for the assessment of student athletes who require in-depth cardiac assessment based on their pre- participation screening," says Dr. Zahka. "The sophisticated testing done in Cleveland Clinic Children's cardiopulmonary exercise laboratory allows us to recognize important risk factors for sports participation." Neonatal Heart Care The most complicated congenital heart problems – hypoplastic left heart syndrome, single ventricles, and transposition of the great arteries, for example – are often diagnosed in the fetal stage. This allows management strategies and treatments to be planned before the baby's birth. "About a year ago, we had a baby who was diagnosed in the fetal stage with an extremely restricted atrial septum and transposition of the great arteries," says Dr. Stewart. "He was born in our special delivery unit, right next to our hybrid cath lab which was prepped and ready for him. So we were able to open up the septum literally within minutes of him being born. That emergent procedure in the first minutes of life stabilized the baby, and he was able to have a successful elective operation several days later." The hybrid cath lab in Cleveland Clinic Children's is also an advantage for children with complex heart defects which require multiple procedures to correct. Described as an advanced imaging suite, intervention lab and OR rolled into one, the hybrid cath lab allows cardiologists and heart surgeons to work together to perform two or more procedures on the same patient in the same room. The benefits for children are many, including decreased down time, anesthesia use and patient recovery time. The lab's advanced imaging technology, with its reduced radiation output, also makes a safer environment for both the patient and staff. Cleveland Clinic Children's is reportedly one of only a few pediatric hospitals in the nation to have a hybrid cath lab. Heart Surgery and Transplants In the OR, Dr. Stewart teams up with Dr. Gosta Pettersson. Dr. Pettersson is Vice Chairman of Cleveland Clinic's Department of Thoracic and Cardiovascular Surgery and Section Head, Congenital Heart Surgery. He is an experienced congenital heart surgeon for both children and adults. "Our overall patient mortality has been about half the national average for the last three years. But what I believe is an even more critical benchmark is that our length of stay for almost every kind of operation – from a VSD to an arterial switch to a Norwood operation – has been substantially lower than the national average as reported in the STS database," says Dr. Stewart. "I think that's from excellent comprehensive care from the cardiologist's office, to the OR, to the PICU, and on the ward. It takes a team." Pre- and post-op care is important for heart transplantation, too. In 2014, eight heart transplants were performed at Cleveland Clinic Children's. Five mechani- cal hearts were also implanted that year in children waiting for donor hearts. "In 2010 we were the first in Ohio to successfully implant the Berlin heart, a ventricular assist device for little kids and even infants. It operates outside the body," Dr. Stewart explains. "We still use the Berlin Heart. But in bigger kids and teens with heart failure we've been implanting a device called the HeartWare, which fits entirely inside the chest, while they wait for a heart transplant." Cleveland Clinic Children's has a number of other firsts to its credit, including being one of the first pediatric hospitals to offer percutaneous pulmonary valve replacement. "The collaboration among the cardiolo- gists and heart surgeons at Cleveland Clinic Children's and our colleagues at Cleveland Clinic gives us access to a lot of innovations for children," says Dr. Zahka. "We're working in the shadow of the #1 heart program for adults in the whole country, if not the whole world. And some- times that takes away some of our light," adds Dr. Stewart, "but we actually shine pretty bright when you look at what we do." Cleveland Clinic Children's cardiologists see patients at Cleveland Clinic's main cam- pus, Hillcrest Hospital, Fairview Hospital, and eight family health centers. For more information visit www.clevelandclinicchil drens.org. To schedule an appointment, call the Pediatric Cardiology Department directly at 216-445-5015. ■ In 2013, Cleveland Clinic Children's Pediatric Heart Center registered more than 28,000 outpatient visits, 520 heart related catheterizations and 350 cardiothoracic surgeries. 2 0 1 5 JA N UA RY/ F E B R UA RY ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 7

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