UT Medical Group, Inc.'s division of Cardiology in the Department of Pediatrics is comprised of physicians on the faculty of the University Of Tennessee Health Science Center in Memphis who offer both clinical and consultation services and are certified by the American Board of Pediatrics.

In the past two years, UT Medical Group’s and UT’s pediatric cardiology divisions have grown to reach a new level of expertise in treating congenital heart defects and other types of cardiac problems in children.

The appointment of Dr. Thomas Chin as Division Chief in 2001 marked the start of the expansion – the department clinical services have extended further into the surrounding communities and the medical staff has grown to eight specialists. Two invasive cardiologists and a cardiovascular surgeon are the most recent additions to the Pediatric Cardiology medical staff.

Specialized Testing

With such diverse expertise, the multidisciplinary team has the ability to perform many specialized tests and procedures to diagnose and treat heart defects, sometimes even before a child is born.

For instance, pregnant women with a family history of congenital heart disease or other risk factors such as Type I diabetes may also have a higher risk of delivering a child with a heart defect. In such cases, fetal echocardiograms that use ultrasound to record and monitor a fetus’ heart can help doctors diagnose the problem early.

“About 70 percent of heart defects in fetuses are undetected by routine obstetric ultrasound,” says Dr. Chin. “Fetal echocardiography allows us to find these problems early so that appropriate treatment can be determined as soon as possible.”

Cardiac Catheterization

One of the most promising techniques for repairing heart defects is cardiac catheterization, which can be used to open up narrowed arteries and valves as well as to repair holes that have failed to close on their own. Doctors use a thin, flexible tube to reach inside the heart, eliminating the need to open the patient’s chest cavity. The result is generally a shorter hospitalization and recovery time for the patient as well as a reduced risk of complications.

Interventional catheterization, for example, is an effective way of repairing a common heart problem called Atrial Septal Defect (ASD). The condition occurs during pregnancy when a hole develops between the heart’s two upper chambers. Traditionally, open heart surgery has been the only option, but ASD can now be repaired by plugging the hole with a device called an occluder. A catheter is used to put the device in place, eliminating the need for open surgery.

“About 40 percent of what we do in the cath lab is on children who are less than one year old, so one of the challenges we face is finding ways to repair defects in the growing child,” says invasive cardiologist Dr. Joel Lutterman. “We’re working closely with device manufacturers to address this problem by designing stents and devices to accommodate a child’s growth over a broad range of sizes.”

Both Dr. Lutterman and invasive cardiologist Dr. Rush Waller have extensive training in the use of cardiac caths as well as other nonsurgical techniques and are actively involved in research to expand the use of catheterization for complicated procedures. Other techniques include:

• Angioplasty is performed on both the pulmonary arteries and the aorta; if necessary, endovascular stents are implanted through catheters.

• Cardiac Stress or exercise test: a test of the heart muscle's strength and efficiency using regular electrocardiograms, echocardiograms, and nuclear tests.

“Working closely with Le Bonheur Children’s Medical Center, we have developed both a state-of-the-art catheterization lab and a well-trained support staff that offers all currently available technologies for interventional catheterizations,” says Dr. Waller, who serves as Medical Director for the Cardiac Cath Lab at Le Bonheur. “For example, we were one of the first pediatric cardiac labs in the nation to use an intracardiac echo probe to guide interventional procedures. This is an echo probe that actually looks at cardiac structures from within the chambers of the heart; therefore, there is no tissue interference from structures such as ribs.”

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