With the founding of the German Heart Centre Munich in 1974, the concept of treating patients of all ages for heart disease in a highly specialised hospital was put into effect for the first time.
This unique idea has since found many imitators in hospitals in several countries. The Department of Paediatric Cardiology and Congenital Heart Defects provides medical care to patients suffering from congenital heart defects, from the foetus to the adult, and is one of the most active centres in Europe. Head of the department is Prof. Dr. Peter Ewert.
Up to 8000 patients receive state of the art diagnosis and treatment in this department annually (6000 on an outpatient basis and 2000 on an inpatient basis). The department has two state of the art cardiac catheterisation facilities at its disposal that are equipped with a digital, biplane system.
More than 600 cardiac catheterisations are performed annually. 40% of these are therapeutic procedures, such as balloon dilatation of stenotic valves (aortic and pulmonary valve), balloon dilatation and/or stent implantation to treat angiostenosis (pulmonary arteries, coarctation of the aorta), surgical closure of atrial septal defects, ventricular septal defects and patent ductus arteriosus.
"Simple" congenital heart defects, such as ventricular septal defects, atrial septal defects that are not suitable for catheterisation procedures as well as atrioventricular septal defects are diagnosed by echocardiography only and surgically repaired without prior diagnostic cardiac catheterisation.
Even initial surgical management of hypoplastic left heart syndrome (Norwood operation) can take place after ultrasound diagnosis only. One of the specialities of our echo laboratory is the transesophageal ultrasound echocardiogram (pre-, intra and postoperative) for the diagnosis of complex heart defects and for immediate evaluation of surgical outcomes. Annually, 9000 transthoracic and 500 transesophageal examinations are performed.
550 patients are operated on annually and more than 200 of these are under the age of one. All preoperative diagnosis procedures including ultrafast computer tomography and magnetic resonance imaging, if required, are conducted in the Department of Paediatric Cardiology and Congenital Cardiac Defects. Immediately after the operation patients are treated on the intensive care unit of the paediatric cardiology department (ward 3.3) which, with 16 fully equipped beds, is the largest of its kind in Germany.
Great importance is attached to creating a warm and familial atmosphere on both general wards. There are 21 beds for neonates, small children and school children (ward 3.1) while four rooms are specially designed to cater for mother and child. On the other wards eleven beds are reserved for older children and adults (ward 3.2) in five single rooms (hotel standard) and two three-bedded rooms. All beds are monitored centrally (ECG, oxygen saturation, blood pressure and respiration).
Psychosocial support is provided by a specialised nurse and two psychologists. They not only offer help to patients but also to parents in their difficult situation. A teacher gives school children individual tuition so that they will be able to continue their school education after a long hospital stay. 27 apartments located on the grounds of the hospital are available for parents and relatives.
The Department of Paediatric Cardiology and Congenital Heart Defects with a total of 48 beds is located on the third floor (ward 3.1, ward 3.2, intensive care unit 3.3, the two catheterisation laboratories and the two echocardiogram laboratories). The outpatients department and administration are located on the ground floor.
A 24-hour emergency service is available and emergency cardiac catheterisations can be performed at any time. The team of physicians comprises 39 physicians (25 specialists and 14 interns).
As the department is affiliated to the Technical University of Munich, a wide range of research activities are performed: basic research in the field of pulmonary hypertension and its molecular regulation, acute inflammation following cardiopulmonary bypass surgery and capillary leak syndrome, clinical research with particular focus on myocardial perfusion and cell metabolism in congenital heart disease, haemodynamic and morphological correlation in univentricular hearts and specific cardiovascular monitoring on the intensive care unit.
Specific challenges faced by the department
- Interventional cardiac catheterisation
Balloon dilatation of the aortic and pulmonary valves, angioplasty and stenting of pulmonary artery stenosis and descending aorta, percutaneous atrial and ventricular septal defect closure, closure of collateral vessels, coronary fistulas and patent ductus arteriosus (PDA).
Foetal echocardiography (with 3D reconstruction), transthoracic echocardiogram, transesophageal echocardiogram (with intraoperative TEE)
Mapping of all primary and secondary atrial arrhythmias by means of the CARTO system. Ablation of atrial and ventricular tachycardia in normal hearts and in hearts with complex heart defects, for instance, after Fontan operations or after arterial switch operations for transposition of the great arteries (TGA).
- Paediatric heart surgery
Every type of reconstructive and palliative heart surgery, including Norwood palliation, staged univentricular heart palliation, Fallot tetralogy in neonates or infants under the age of one, repair of atrioventricular septal defects, reconstructive surgery of Ebstein's anomaly as well as Ross operations (in neonates as well).