LEXINGTON The pediatric cardiology division of UK HealthCare is led by Division Chief Douglas J. Schneider, MD. “Congenital heart disease is the most common birth defect that children are born with,” he states. “Approximately eight out of 1,000 children are born with some form of heart defect, ranging in severity from minor to very complex.”
Congenital heart disease cuts across all geographic and socio-economic classes in Kentucky. In answer to the question of nature versus random embryonic and fetal development in congenital heart disease, Schneider says, “Yes, it’s sometimes genetic, but it’s not always clear.” And that’s where and when Schneider’s team of cardiologists, electro-physiologists and interventionalists find their work, fulfilling their mission of providing access to the highest quality of care throughout even the most remote regions of Kentucky, a goal started by Jacqueline Noonan, MD, former chair of pediatric cardiology at UK.
Schneider began his career as an engineer before attending the School of Medicine at the University of New Mexico. He says the mechanical aspects of the cardiovascular system appealed to him during his residency in internal medicine and pediatrics at UK, citing Noonan’s mentorship. Schneider did a fellowship in pediatric cardiology at University of Cincinnati Children’s Hospital followed by a fellowship in interventional pediatric cardiology at St. Christopher’s Hospital for Children in Philadelphia.
The era of surgical treatment for congenital heart disease began in the 1930s, says Schneider, when surgeons discovered that they could perform heart surgeries on infants and children to correct abnormalities. Advancements in the specialty continued through the end of the 20th century towards a progression of repair and management of congenital heart defects. “In the catheterization laboratory, we can now close holes in the heart, open and even replace abnormal heart valves, and enlarge narrow or occluded blood vessels to both prolong life and greatly increase the quality of life,” says Schneider.
The UK Pediatric Cardiology Team
Schneider estimates that his division sees between 200 and 300 patients a week. “Everyone in the group does general cardiology. We’ll all see a new patient with a heart murmur or chest pain, or follow up on a bypass valve operation. It’s important that we all stay grounded in general cardiology but utilize the expertise of the other team members,” he says.
Members of the UK Pediatric Cardiology team form a diverse and highly trained group. It includes: Carol Cottrill, MD; Kristopher Cumbermack, MD; Abeer Hamdy, MD; Joshua Hayman, MD; Melissa Lefebvre, DO; Majd Makhoul, MD; Shaun Mohan, MD; Callie Rzasa, MD; Mark Vranicar, MD; Kelly Van Metre, APRN; and Laura Murphy, APRN.
The pediatric cardiothoracic surgery team includes: James Quintessenza, MD (pediatric and adult congenital cardiac surgeon); Jennifer Davis, PA-C (surgery physician assistant); and Andrew Parker (pediatric perfusionist).
“I could talk for hours about our team,” says Schneider. “We go to at least 20 or more locations throughout the state to do outreach clinics.” Telemedicine is used in addition to clinical visits, using digital transfer of echocardiography for ultrasound interpretation. “We consult with local pediatricians so that the families don’t always have to drive to Lexington from remote rural locations. That’s a very important part of what we do,” says Schneider.
Lifestyle of the Congenital Heart Patient
A heart healthy lifestyle is vital to the pediatric patient as well as the adult, say Schneider, and what is considered healthy has evolved. “Through the years, we’ve told the congenital heart patient not to strenuously exercise or exert themselves. It’s clear now that regular exercise and a healthy diet are essential for these patients.” Schneider envisions developing a heart healthy program for children for his division’s patient population in conjunction with its new partnership with Cincinnati Children’s Hospital, which will help patients get the best quality care as close to home as possible.
Congenital heart patients also have different psychological challenges, similar to post traumatic stress syndrome. “Not encouraging these patients to exercise has sometimes led to obesity, depression, and a sedentary lifestyle. This is not in their best interest,” says Schneider.
Advancement in Prenatal Diagnosis
Fetal echocardiograms have been one of the most significant advancements in saving the pediatric patient’s life. “It’s not uncommon for patients to come to us from obstetricians who have suspected a potential heart malformation through a fetal ultrasound,” says Schneider. Cumbermack is the director of the pediatric and fetal echocardiography lab at UK. “Our fetal echocardiography specialists, Dr. Cumberback and Dr. Makhoul, will read the echo and prepare us and the parents, so that the baby is delivered into a situation where it will receive immediate care,” says Schneider.
Babies born with Down syndrome or DiGeorge syndrome have a higher probability of congenital heart defects, and although most congenital heart defects occur in isolation, occasionally they are associated with defects of other body organs, such as gastrointestinal malformations or skeletal abnormalities. It’s important that these patients are cared for in a multidisciplinary environment like Kentucky Children’s Hospital, which has a full menu of expert subspecialty children’s services.
Cardiac Arrhythmia Management
Mohan is the electrophysiologist of the group. He manages patients with heart rhythm abnormalities, including those that are life-threatening and those that are less dangerous such as supraventricular tachycardia (SVT). Schneider says that SVT is typically not life-threatening but can be life-altering. “In most cases Dr. Mohan can identify the pathway causing the SVT and correct it via radiofrequency ablation or cryoablation. This allows patients to get off their medications, play sports, and choose hobbies and careers that their conditions might have otherwise prevented,” says Schneider. Dr. Mohan also manages patients with cardiac pacemakers and implantable cardiac defibrillators.
Scope of Pediatric Cardiology
Fortunately, not all the patients seen in pediatric cardiology clinic have congenital heart disease. Many patients are seen for “screening” for underlying heart disease due to a symptom that might possibility represent a cardiac problem (such as passing out or palpitations) or the finding of a heart murmur by their primary care physician. Although some heart murmurs are indicative of a structural heart problem, many are “normal” heart noises heard in healthy patients with completely normal hearts. The role of the pediatric cardiologist is oftentimes to rule out or exclude an underlying cardiac condition and offer reassurance to the patient and family if there is no heart disease.