Heart Failure Treatment at Columbia

When a child is diagnosed with heart failure—also called congestive heart failure—it means that his or her heart isn’t working properly. It does not mean that your child’s heart has stopped working altogether. Heart failure is not a specific diagnosis, it is rather a combination of symptoms that can be the manifestation of a severe congenital heart defect or a type of cardiomyopathy.  

Fortunately, there are many options today for treating and managing heart failure in children. Experts at the Program For Pediatric Cardiomyopathy, Heart Failure, and Transplantation have been at the forefront of the development of new and innovative therapies, including the world's first successful pediatric heart transplant in 1984. Your child will have access to clinical trials and treatments that were developed here, along with expertise from some of the best cardiologists and surgeons in the country.

Your child’s treatment will depend on the cause of the heart failure, the prognosis of the underlying disease, family preferences, and your child’s overall health. Therapies can vary and consist of combinations of medications, and sometimes lifestyle changes. The treatment regimen is individualized and tailored to each child and their needs. Our program is designed to manage and monitor your child’s heart condition from diagnosis until adulthood, so that any disease progression can be treated quickly and effectively. Our goal is to keep your child active and involved in normal activities.

Medications

Medications can be very useful in treating heart failure, especially in the early stages. Medications are also sometimes used in conjunction with surgery to correct heart abnormalities that can cause heart failure. Some of the medications currently used to treat heart failure include:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers dilate the blood vessels in the body to make it easier for the heart to pump blood forward.
• Beta blockers slow down the heart rate and lower blood pressure, which allows the heart to pump more efficiently.
• Digoxin helps the heart muscle contract better and controls the rate and rhythm of the heart.
• Aldosterone antagonists reduce the scar tissue of the heart muscle and helps the heart muscle recover
• Diuretics help prevent the buildup of fluid or remove fluid from the body and can help ease breathing by reducing fluid in the lungs.  

Pacemakers and Defibrillators

Pacemakers and defibrillators are tiny devices that are implanted under your child’s skin, where they help monitor and control the heart’s rhythm. Your child may need a pacemaker or defibrillator if he or she has an certain type of abnormal heart rhythm (arrhythmia) that cannot be controlled with medication.  

Procedures That Treat Arrhythmias

These procedures, also called electrophysiology procedures, use long thin tubes called catheters, which are inserted through a tiny incision in the body and guided into the heart. They measure the electrical activity in the heart’s chambers to determine the origin of an abnormal rhythm, and sometimes can correct it. Radiofrequency ablation is a type of minimally invasive treatment in which a small, needle-like probe is inserted into the scarred tissue of the heart muscle, sending out radiofrequency waves that burns away the scar tissue causing the abnormal rhythm. It can be effective for some children with cardiomyopathy that is secondary to a long-standing arrhythmia. 

Ventricular Assist Devices (VAD) 

Children who are experiencing advanced heart failure and are getting worse symptomatically despite the best oral and intravenous medications may be candidates for a ventricular assist device (VAD). A ventricular assist device is a mechanical pump that takes over your child’s heart function until his or her own heart recovers or is replaced by a heart transplant. Different devices are offered depending on the child’s age and size and type of heart disease. Our team has expertise with all the different devices and we have an excellent track record of successful bridging to transplantation. We are one of a few institutions in the U.S. participating in the National Heart Lung and Blood Institute’s PumpKIN trial (Pumps for kids, infants, and neonates).

Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a short-term device that supports the heart and lungs in the very young or in children whose anatomy will not permit a VAD. Our team was among the first in the world to offer this life-saving technology for children.

Heart Transplant  

Our program specializes in transplants for children with end-stage congestive heart failure due to cardiomyopathy and those with complex congenital heart disease who are not candidates for further palliative or corrective surgery. NewYork-Presbyterian Morgan Stanley Children's Hospital is one of the largest and most successful heart transplant centers in the world. We are consistently ranked in the top three hospitals nationally in terms of numbers of children transplanted and have performed more heart transplants in the last five years than any other program with better outcomes than national benchmarks and other highly touted programs.

Pediatric Heart Surgery at Columbia