Pediatric Cardiology

Stony Brook Medicine

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    Overview Caring for children with heart problems is one of our specialties at Stony Brook Children's. Our expert pediatric cardiology team serves more than 2,000 patients a year, most on an outpatient basis. From prebirth to young adulthood, patients are referred to us for comprehensive evaluation and diagnostic services for both congenital heart disease and acquired heart disease. We also have multidisciplinary programs for both the adult with congenital heart disease and separately for families faced with fetal heart disease.

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    Pediatric Cardiology Outpatient or Ambulatory Care
    4 Technology Drive
    East Setauket, New York 11733

    Call (631) 444-KIDS for patient appointments. 

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    Our Team Our pediatric cardiology core team consists of four highly skilled pediatric cardiologists and an experienced pediatric nurse practitioner. They work collaboratively and with colleagues to identify heart diseases, develop and implement a plan of treatment that meets the patient's and family's unique needs, and coordinate follow up — working with a patient from infancy through adulthood.

    James Nielsen, MD - Division Chief
    Stuart Holzer, MD
    Laurie E. Panesar, MD
    Kathleen Walsh, MD
    Marybeth Heyden, DNP, RN, PNP

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    Services Our scope of services includes advanced diagnostics; long-term management of cardiovascular diseases in infants, children and adolescents; adults with congenital cardiac defects; and cardiovascular defects in the fetus.

    Advanced Diagnostics Stony Brook Children’s provides state-of-the-art pediatric cardiac imaging in our new echocardiography laboratory. This facility is equipped with the latest technology and is staffed by highly skilled pediatric cardiology imaging experts. The imaging lab offers safe, non-invasive, pain-free testing in a soothing, family-centered environment.

    Most patients are referred by their primary care physician, who may have noticed something unusual that needs a specialist's evaluation. Examples include heart murmurs, rapid breathing, high blood pressure, certain infections, chest pain, heart rhythm irregularities, fainting episodes or questions about participation in sports. We also see pregnant women referred by their obstetrician to identify some congenital defects prenatally, as early as 18 weeks of gestation. This allows us to educate the family about prognosis and make informed decisions about the management of the baby at and after birth.

    All patients receive a thorough history and examination, and frequently an EKG (electrocardiogram) and ECHO (echocardiogram). In most cases serious heart disease can be definitively excluded based on this evaluation alone.  If more specialized tests are required, an array of noninvasive or minimally invasive options are available, including:

    • Ambulatory EKG
    • Echocardiography
    • Transesophageal echocardiography
    • 3-Dimensional echocardiography
    • Exercise stress testing
    • Fetal echocardiography
    • Cardiac MRI
    • Cardiac CT

    Long-term Management Many heart problems in childhood may need treatment and monitoring only for a limited time. Other problems may require extended care, and management into adulthood. Stony Brook Children's and Stony Brook Medicine coordinate a multidisciplinary treatment and follow-up program for adults with congenital heart disease.

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    Patient Resources
    Support and OutreachStony Brook's pediatric cardiology division includes a pediatric nurse practitioner, Marybeth Heyden, RN, who works closely with families to help them understand and cope with their child's heart issues. She also coordinates support and education programs, including:

    • Know Your Family History-It May Save Your Child's Life. This community-based education program is designed to increase public awareness about the importance of family health history and incorporate family health history information into the Electronic Medical Record.
    • Hope for Hearts. This is support group for families of children with heart problems

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    Research and Education At Stony Brook Children's, all of our pediatric departments are engaged in the search for new and better ways of diagnosing and treating disease, as well as a greater understanding of disease causes and mechanisms. Our team has vast experience in pediatric cardiology clinical research and has contributed significantly to the diagnosis and treatment of congenital heart disease. Articles published in the past year (2011) include:

    1.“Outcomes of mitral regurgitation associated with large ventricular septal defect and a normal mitral valve apparatus. Does intact atrial septum have an impact?” Pediatric Cardiology 2011 Dec. 32:1128-1131. DOI: 10.1007/s00246-011-9994-8.

    2. “Prediction of Hemodynamic Severity of Coarctation by Magnetic Resonance Imaging.” Am J Cardiol. 2011, Nov 1:108(9):1335-40. DOI:10.1016/j.amjcard.2011.06.051.

    3. “Repeatability of Cardiac MRI Measured Right Ventricular Size and Function in Congenital Heart Disease.” Pediatric Radiology, 2011 Aug;41(8):1000-7. DOI: 10.1007/s00247-011-2033-3.

    4. "Utility of Doppler Tissue Imaging-Derived Indices in Identifying Subclinical Systolic Ventricular Dysfunction in Children With Restrictive Cardiomyopathy". Pediatric Cardiology. 2011 June;32(5): 646-651. DOI: 10.1007/s00246-011-9948-1

    5. Normal Values for Left Ventricular Volume in Infants and Young Children by the Echocardiographic Subxiphoid Five-Sixth Area by Length (Bullet) Method". J Am Soc Echocardiogr. 2011 Feb;24(2):214-8.

    Drs. Panesar and Nielsen are full-time faculty of the Stony Brook School of Medicine. Mary Beth Heyden (our pediatric nurse practitioner) has a doctorate in nursing and teaches in the Stony Brook School of Nursing, and also has a faculty appointment in the Department of Pediatrics.

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    Advances and Recognitions

    Echocardiography Accreditation The Pediatric Echocardiography Laboratory at Stony Brook Medicine is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) for Pediatric Transthoracic and Fetal Echocardiography. Accreditation status signifies that the lab has been reviewed by an independent agency which recognizes Stony Brook's commitment to quality testing for the diagnosis of heart disease in children. Stony Brook is one of only a handful of medical centers across New York State to be accredited by ICAEL.

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    Definitions Congenital heart disease - Congenital means "present at birth." A congenital heart defect can involve any of many types of malformations of the heart or the large blood vessels near the heart. Cardiac malformations are the most common major birth defect in babies, affecting about 8 in 1,000 newborns. Less severe congenital heart defects may not be noticeable at birth but are discovered as a child is growing up, or in adulthood. Congenital heart defects with varying degrees of severity. Some have no impact on a child's health. Others may require treatment or monitoring for a limited time others require extended monitoring and care into adulthood.

    Acquired heart disease - In children, the most common acquired heart diseases (those not present at birth) include mucocutaneous lymph node syndrome (Kawasaki's), hypertension, abnormal heart rhythms, heart injury due in infections or viruses, or endocarditis (inflammation of the heart lining.)

    Ambulatory EKG - Records the electrical activity of the heart during daily activities with a small portable device.

    Cardiac catheterization - When used diagnostically, it examines the inside of the heart's blood vessels using special X-rays called angiograms. Contrast visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter. Interventional catheterization involves using the catheter to reach the heart with microtools that can be used to close holes, occlude vessels or clear obstructions.

    Echocardiography - A handheld device is placed on the chest and uses inaudible soundwaves (ultrasound) to create images of the heart and blood vessels.

    Transesophageal Echocardiography - Uses a probe passed with sedation into the esophagus to better image the heart.

    3-dimensional echocardiography - Additional transducers (soundwave producers) and computer processing create detailed, 3-D moving images of the heart.

    MRI – magnetic resonance imaging used to create 2 dimensional and 3 dimensional images of the heart and vessels.

    CT – uses short bursts of X-rays to create images of the heart and vessels. Our high speed multislice scanners keep radiation dose to a minimum.

    Exercise or stress testing - A monitor with electrodes is placed on the skin to record the heart's activity during exercise. 

    Fetal echocardiography - Like echocardiography, this procedure involves ultrasound but performed on a pregnant woman to visualize the fetuses' heart structure. Requiring specialized training and skill, fetal echo has a high rate of identifying heart defects, which can be lifesaving in planning appropriately for labor, delivery and therapies.

    Hyperlipidemia - A high level of lipids (fats) in the bloodstream, which increases the risk of coronary artery disease.

    Non-invasive tests - These don't involve inserting needles, instruments or fluids into the body.

    Minimally invasive procedures - These may include a needle prick for a blood test or shot, insertion of a tube, device or scope.

    Invasive procedures - These involve surgery.

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