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Cardiology Programs

Fetal Cardiology Program

The Duke Fetal Cardiology Program was established to provide comprehensive diagnostic and consultative services for fetuses with known or suspected cardiac disease. Our multidisciplinary approach aims to minimize any disruption to the family by coordinating care as much as possible, while maintaining the referring obstetrician’s primary involvement in the care of the mother.

In the vast majority of cases, the mother will continue her obstetrical care with the referring obstetrician, although the Duke Fetal Cardiology Team will remain available for questions or additional assistance.  For complex fetal congenital heart disease, the recommendation will often be that the child be delivered at a tertiary care center with a dedicated Pediatric Cardiac ICU, level III NICU, prostaglandin and pediatric cardiology/cardiac surgery availability.  Maternal-Fetal Medicine, Pediatric Cardio-thoracic Surgery and Genetics consultation can be arranged prior to delivery as an adjunct to the  obstetrical care that will continue with the referring obstetrician.  In intermediate cases, it may be possible for a child to be delivered and evaluated at the primary medical center, and then transferred for further care if necessary.

What you can expect from us:

  • Prompt scheduling of fetal cardiology appointments, with flexibility for emergencies.
  • Full fetal consultation, including detailed history, fetal echocardiography, discussion with families and explicit recommendations.
  • Faxed preliminary report on day of appointment.
  • Prompt formal consultation and fetal echocardiography report.
  • Telephone notification on day of appointment in cases of severe fetal heart disease or complex fetal diagnosis.
  • Ready availability (including on call) for fetal cardiology questions or concerns.

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Electrophysiology Program

Located in Duke University Hospital North, the Duke Pediatric Electrophysiology Program is an integral part of the Congenital Heart Program at Duke University Medical Center and offers a comprehensive array of diagnostic and treatment services related to disorders of cardiac electrical function in infants, children, adolescents, and young adults with or without congenital heart disease. These disorders include the following:

  • tachyarrhythmias (atrial flutter, atrial fibrillation, atrial tachycardia)
  • supraventricular tachycardias (SVT)
  • ventricular tachycardias (VT)
  • ventricular fibrillation
  • genetic disorders (Long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy, and others)
  • heart block
  • autonomic dysfunction such as neurocardiogenic (vasovagal) syncope and postural orthostatic tachycardia syndrome (POTS)

Complete Diagnostic Services

Comprehensive diagnostic services are tailored to the patient’s symptoms and range from standard electrocardiography, exercise testing, and 24-hour ambulatory rhythm monitoring (Holter monitoring) to ambulatory event recording by pocket monitors, attached monitors (“loop recorders”), and even surgically implanted monitors. If indicated, out-patient diagnostic esophageal electrophysiologic testing or intracardiac testing may be very valuable.

Newer modalities, such as signal-averaged electrocardiography, heart rate variability, epinephrine infusions, and cardiac magnetic resonance imaging (MRI) are helping assess risk of sudden death in some circumstances. Finally, an active program in cardiovascular autonomic nervous system testing, including head-up tilt table testing, is frequently used in older children and teenagers. For patients, especially babies and young children, requiring in-patient initiation of antiarrhythmic medications, all pediatric beds are in private rooms with continuous rhythm telemetry capability. A central telemetry headquarters ensures continuous human monitoring in addition to automated alarms.

Catheter Ablation of Tachyarrhythmias

Catheter-directed, potentially curative treatment of many tachycardias has largely replaced chronic drug therapy. The Pediatric Electrophysiology Program began using radiofrequency energy for catheter treatment in 1991, and more than 1,000 procedures in young patients have been performed to date.  Our physicians use state-of-the-art three dimensional catheter tracking and electroanatomic mapping to aide in all procedures, from SVT to complex arrhythmias occurring after congenital heart surgery. Newer energy sources, such as cryo-energy, are being used to make these procedures even safer for patients. Rarely, serious arrhythmias do not respond to catheter-based modalities, and surgical treatment is necessary. For such arrhythmias as post-congenital heart surgery refractory atrial flutter and atrial fibrillation, the intra-operative maze procedure has proven to be highly efficacious.

Pacemaker and Defibrillator Implantations

Our highly qualified physicians also perform transvenous single and dual-chamber pacemaker and cardioverter-defibrillator implantations (ICD), generator changes, and lead-extractions. When epicardial or hybrid epicardial-transvenous pacing systems are necessary, collaboration with the Congenital Heart Surgery Program provides precise therapy for these often complex problems.  Newer modes of pacing for young persons using biventricular pacing is on the horizon and will be approached using robotic technologies.

The Pediatric Electrophysiology Program follows nearly 200 patients with permanent pacemakers and implantable cardioverter-defibrillators. Clinics dedicated to pacemaker and ICD follow up are scheduled twice monthly. In addition, the program features 24 hour transtelephonic call-in services.

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Non-Invasive Diagnostic Imaging

The Non-Invasive Diagnostic Imaging Program is a leading provider of transthoracic, transesopageal, and fetal echocardiography services in the southeastern United States. We serve children from newborn to 18 years old.

Type of Service/Level of Care

The Pediatric Echocardiography Laboratory performs diagnostic cardiac ultrasound on children with known and suspected congenital and other cardiac lesions. The procedures performed are transthoracic, fetal and transesophageal echocardiograms. Studies are performed in the Duke North Hospital and Children’s Health Center labs, a clinic in Raleigh, intensive care units and in the operating room.

Procedures performed in the Pediatric Echocardiography Laboratory, or the Echo Lab, are necessary for the diagnosis of patients with congenital or acquired cardiovascular disease. Non-invasive transthoracic diagnostic procedures performed include:

  • Doppler Echo
  • Color Doppler
  • 2D/M-Mode

Invasive procedures performed in the Pediatric Echocardiography Laboratory include intraoperative and nonoperative Transesophageal Echocardiograms.

We also provide cardiovascular magnetic resonance image (MRI) services. MRI has proven useful in diagnosing certain cardiovascular problems, including cardiac tumors and congenital heart disease.  Duke offers cutting-edge technology in the form of ultrafast CT (computed tomography) angiograms.  These procedures give us information that often makes diagnostic heart catheterization unnecessary.  We are thus able to offer noninvasive means of diagnosis in settings where most programs would require a heart catheterization to derive the same data. Nuclear Cardiology provides important diagnostic and prognostic information for optimal management of the cardiovascular patient.

Goals of the program include:

  • A friendly and caring atmosphere for patients and their families through respect and sensitivity to patient needs
  • Accurate and timely diagnostic information to the referring physician(s)
  • Diagnostic support during operative and other invasive procedures
  • Educational opportunities for pediatric cardiology fellows

The Echo Lab is staffed 24 hours a day, 365 days a year. Procedures are scheduled Monday through Friday from 8:00 am to 5:00 pm or until completed. A call team, consisting of a senior physician and a sonographer or senior pediatric cardiology fellow, are available for emergencies after hours and on weekends and holidays. A registered nurse is available to administer conscious sedation during regular work hours. If an emergency procedure is required during normal working hours, it is given priority and responded to immediately; scheduled cases then follow the emergency.

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Interventional Catheterization

Under the direction of Medical Director John F. Rhodes, MD, the Pediatric and Adult Catheterization Laboratory performs diagnostic, interventional, and electrophysiology catheterizations. Procedures generally fall into either diagnostic or interventional cardiac catheterization studies. We serve children from newborn to 18 years old.

Therapeutic treatments include:
  • Coil Occlusion Procedure
  • Atrial Septal Defect Closure
  • Blade and Balloon Septostomy
  • Angioplasty
  • Valvuloplasty
  • Stent Implantation
  • Ventricular Septal Defect Closure
Patients are admitted to the clinical area as outpatients, “same day catheterizations,” or as inpatients. They may receive general anesthesia or conscious sedation. After the procedure and being cleared from the Hospital Conscious Sedation protocol, patients may be transferred to an inpatient ward, an observation unit or discharged home. Patients who have undergone general anesthesia are transferred to the recovery unit.

Procedures are scheduled in the Pediatric and Adult Catheterization Laboratory from Monday through Friday, 7:00 am to 3:30 pm. The lab is available 24 hours a day, seven days a week, for emergency procedures.

Pediatric Cardiothoracic Surgery Program

Cardiology surgery services are provided by a multidisciplinary team of professionals that are among the best in their profession. The cardiothoracic surgery program emphasizes neonatal correction of complex congenital heart defects with results rivaling the largest centers in the country. 

Results for single ventricle anatomy including Hypoplastic Left Heart Syndrome (HLHS) and Tricuspid Atresia are outstanding. Other areas of expertise include aortic root surgery and extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation. 

Cardiology physicians, nurses, nurse practitioners, registered dieticians, respiratory therapists, and social workers provide services to all surgery and other inpatients on the ward as well as acute care to pre- and post-operative patients in the intensive care units.