Paediatric Cardiology

The program is a leading pediatric heart program in India, renowned for its dedicated and cohesive team focused solely on the care of children with heart disease. It is a preferred destination for patients from India, South Asia, the Middle East, and Africa due to its high-quality services at an affordable cost, its training program, and research initiatives. The constituent departments include:  

• Pediatric Cardiology 
• Pediatric Cardiac Surgery 
• Pediatric Cardiac Intensive Care and Anesthesiology

• Cardiac Surgical Program: Newborn Heart Surgery, Cosmetic Congenital Heart Surgery, Surgery for Complex Heart Defects 
   
• Catheter Interventions include closure of common heart defects without surgery (ASD, PDA and VSD), newborn interventions, interventions to complement surgery
• Comprehensive Imaging and Diagnostic Services: Echocardiography (trans thoracic, 3D echocardiography, trans-esophageal and fetal echocardiography), Multi-slice CT scan (256 slice CT), MRI (3 Tesla) for congenital heart defects (Amrita has the country’s first cardiac MRI service), diagnostic cardiac catheterization and angiography.
   
• Fetal Cardiac Unit: A comprehensive fetal cardiac program (the only one of its kind in the country) is available at Amrita. The services include prenatal diagnosis and counselling of pregnant mothers with suspected heart defect in the fetus, prenatal treatment for fetuses with cardiac rhythm disorders.
   
• Training Programs: Amrita has a well-established structured training program in pediatric cardiology (DM Pediatric Cardiology). This was the first DM pediatric cardiology in the country to be recognized by the Medical Council of India. This is a 3-year structured training course in pediatric cardiology.
   
• Additionally, there are dedicated training programs in cardiac anesthesiology and intensive care. Amrita offers an ideal opportunity to train pediatric cardiovascular surgeons in their formative years. Six leading pediatric heart surgeons in India have been trained here and overseas programs in Japan, China and Portugal have sent their surgeons for advanced training at Amrita. 
• Research Unit: This is under the Indian Council of Medical Research (ICMR). Community based research projects in all facets of pediatric heart care in developing countries are being conducted here.

Non-invasive 

• Advanced Pediatric and Fetal echo Lab: This lab has Philips APIQ and IE 33 echo machines exclusively for Pediatric cardiac imaging (2D, 3D, 4D, TEE). The lab has a work-station with the advanced Q-lab software for offline processing of 3D images, a digital library for image archiving in DVDs, electronic databases of the echo reports and a dedicated staff consisting of 2 nursing assistants and a secretary. 
• Arrhythmia and Syncope Evaluation: Head up Tilt Test, Holter
• Exercise Machines: CPX machine (Exclusively for pediatric work), Treadmill
• Additional echo machines: Sonosite Machines for Portable echocardiography.
• Dedicated Fetal Cardiac Service
• Additional imaging equipment available through the radiology and nuclear medicine department:
  • Siemens multi-slice 256 slice CT scan
  • Siemens Sonata: MRI and MR angiography
  • Gamma Camera (Siemens)

Invasive 

• Two Siemens Hi-Cor catheterization laboratories (digital flat panel)
• Comprehensive facility for arrhythmia and pacing
  • Advanced EP laboratory
  • Facilities for implantation and follow up of pacemakers and ICD
• Electronic databases and digital library of the catheterization studies

Dedicated Operation Rooms 

• Facilities for newborn, infant and complex congenital heart surgery. 
• State-of-the-art monitoring systems including dedicated pediatric trans-esophageal echocardiography.

Dedicated State-Of-The-Art Pediatric Cardiac Intensive Care Facility  

The pediatric cardiac intensive care unit has 24 beds in total, 12 of which are located close to the operation theater supported with monitors and ventilators, Inhalational Nitric Oxide and facilities for LV assist and extra-corporeal support. 

Pediatric Heart Operations 

The highlights of the pediatric cardiac surgical program at Amrita are the excellent outcomes with heart operations in newborns and young infants. Complex defects (such as double outlet right ventricle, multiple ventricular septal defects) are routinely corrected here with excellent results. The results of surgery are audited by the International Quality Improvement Collaborative (IQIC). Current surgical mortality is less than 2% in spite of a relatively high degree of complexity and a high proportion of neonatal operations. 

The open-heart procedures include: 

• Closure of common heart defects 
• Repair of tetralogy of Fallot  
• Repair of total anomalous pulmonary venous connection 
• Arterial switch operation 
• The Senning operation 
• The Fontan procedure  
• The Glen procedure and 
• Repair of common AV canal defects 

The Norwood operation for hypoplastic left heart syndrome is performed at Amrita and this is one of the few centers in the country that regularly performs this operation.  
The closed heart procedures include: 

• BT shunt 
• Coarctation repair 
• PDA ligation and interruption 

Thus far, approximately 13,000 heart operations have been performed at Amrita in children with heart conditions.  

Catheter Interventions 

Amrita has leadership status in catheter interventions. Cardiac catheterization technology allows closure of selected patients with heart defects without an operation like: 
 

• Atrial septal defects (ASD): Amrita has one of the largest experiences in trans-catheter ASD device closure in India.
• Patent Arterial Ducts (PDA): Using cost-effective techniques developed at Amrita over 2500 PDA closures have been performed in the catheterization laboratory at Amrita. This is one of the largest experiences in the world.
• Ventricular Septal Defects (VSD): The technique has been modified at Amrita to allow closure of some of these defects at reduced cost to the patient
• Other Defects: Coronary artery fistula, pulmonary arterio-venous malformation

Additional procedures performed in the catheter laboratory at Amrita include balloon dilation procedures for valve obstruction at all ages, stenting of coarctation, pulmonary artery and PDA. Recently, we have performed hybrid procedures for complex CHDs like hypoplastic left heart where the surgeon and the cardiologist combine together. 

Pacemaker Implantation in Children  

Amrita has comprehensive facilities for pacemaker therapy in children. 

Pediatric Electrophysiology 

A comprehensive EP facility is available in Amrita for children of all ages. 

• Designated as the first global “Centre of Excellence” in Congenital Heart Disease (CHD) Care by Children’s Heart Link
• World’s first Series on Closure of Patent Ducts (PDA) in Preterm Infants
• First Comprehensive and Dedicated Fetal Cardiac Program in India and South Asia
• Country’s first minimally invasive, non-surgical implantation of a pulmonary heart valve
• Country’s first Transcatheter Implant of Pulmonary Valve
• India’s first Dedicated Cardiac MRI Program for Patients with Congenital Heart Diseases
• First Dedicated Adult Congenital Heart Disease Clinic in India
• South Asia’s first Point-of-Care (POC) Medical 3D Printing Lab and Extended Reality Lab
• India’s first Dedicated Cardiac MRI Program for Patients with Congenital Heart Diseases
• First and most comprehensive paediatric cardiac program in Kerala
• First Norwood Procedure Performed in Kerala
• First Identification of Novel BMPR2 Mutations in South Indian Population

Regular Outpatient Clinics 

All patients undergo comprehensive evaluation and every effort is made to complete the evaluation process including all noninvasive tests and most procedures (surgical or catheter interventions) are scheduled before the patient leaves the hospital. 

Specialty Clinics  

1. Fetal Cardiac Services provide comprehensive diagnosis and counseling besides in-utero treatment for arrhythmias.
2. Pulmonary Hypertension Clinic is one of the nodal centers for the international organization, Pulmonary Vascular Research Institute (PVRI) and this clinic focuses on patients with various forms of pulmonary hypertension.

Outreach Clinics 

Regular outreach clinics are conducted by the pediatric cardiology department in Kozhikode, Palakkad, and Kollam. 

• DM in Pediatric Cardiology: The pediatric cardiology department is the first center in India that has been recognized by the Medical Council of India for DM in pediatric cardiology. This course was started in August 2011 and so far, four pediatric cardiologists have graduated from the program. 
• Overseas Fellowship: The pediatric cardiology program is now training fellows from overseas. We have trained fellows from a number of countries that include Sri Lanka, Bangladesh, Vietnam, Uganda, Germany and the UK.
• PDCC (Post-Doctoral Certification Course) in Cardiac Anesthesiology and Intensive Care: The department of anesthesiology has an intense training program in cardiac anesthesia and intensive care. This one-year course has prepared many candidates to independently deliver pediatric cardiac anesthesia and take care of the operated children in postoperative ICU.
• CME Courses: The department has organized a large number of major conferences and CMEs over the past 17 years. Some of the major ones include the annual conference of the Pediatric Cardiac Society of India (PCSI) in 2000 and 2008, Symposia in postoperative care for CHD (2003, 2006) the first Interventional forum for structural and congenital heart diseases (IFISCH 2008), teaching program in cardiology (2004), fetal echo workshops (2005 and 2006), pediatric echo CME (2002) and CME on neonatal cardiac care (2008).

Several grant Funded Research Projects of the Indian Council of Medical Research (ICMR) and the Department of Science and Technology (DST) have been conducted by the Department of Pediatric Cardiology at Amrita. A dedicated research office has been set up for this purpose.  

• Over 120 papers have been published by the department in peer-reviewed journals. (e.g., Pediatrics, Circulation, Annals of Thoracic Surgery,  
• Cardiovascular and Interventional Radiology, Catheterization and  
• Cardiovascular Interventions, Journal of Thoracic and Cardio-vascular  
• Surgery, Journal of Pediatrics, Heart, National Medical Journal of India. The department faculty have helped initiate a new journal (Annals of Pediatric Cardiology) and edited two books.  

• Children’s Heartlink: The pediatric heart program at Amrita has been a partner site for Children’s Heartlink (www.childrensheartlink.org) For over a decade we are the first among several international sites to acquire the status of a global training site. 
• Children’s Hospital Boston, Harvard Medical School: Collaborations have been initiated between the children’s hospital and Amrita. The areas include cardiac MRI, fellowship exchange and clinical research.
• International Quality Improvement Collaborative: The pediatric heart program at Amrita is now a member of the IQIC (an initiative of the Boston Children’s Hospital) and a number of quality improvement processes have been initiated and monitored through this process.
• Stanford University: Collaborations have been initiated for intensive care and nursing. This has been in the form of frequent visits by leading Nurse Practitioners and Dr. Steve Roth, Chief of Pediatric Cardiac Intensive Care at LPCH.
• Government of Sri Lanka (Sri Lankan College of Pediatrics): The first three dedicated pediatric cardiologists in Sri Lanka have been trained at Amrita.
• UCSF: Annual visits from Dr. VM Reddy, Chief Pediatric Cardiac Surgeon.
• Berlin Heart Institute: Research exchange
• University of Cologne Germany: Academic exchange programs.

Paediatric Cardiology 

Phone: 0484-6683570,0484-2853570  
Email: paediatriccardiology@aims.amrita.edu

Paediatric Cardio-Vascular and Thoracic Surgery

Phone: 0484 2851559, 0484-6681559 
             0484 2851234, 0484-6681234 
Email:   cvtsop@aims.amrita.edu