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Pediatric cardiology is the medical specialty dedicated to diagnosing and treating heart conditions from fetal life in the womb, through childhood and adolescence, and sometimes even into adulthood. In contrast to adults, whose heart problems are often related to lifestyle or aging, in children most conditions are linked to the heart’s structure at birth – that is, a congenital heart defect.
Some heart problems are not present at birth but develop during childhood, such as myocarditis or pericarditis.
Pediatric cardiology also includes care for disorders of the heart’s electrical system, known as arrhythmias, which can cause the heart rate to be too fast, too slow, or irregular.
In addition, pediatric cardiologists often monitor heart function as part of broader medical conditions, such as neurological, hematological, or oncological diseases.
Today, a substantial proportion of congenital heart defects can be detected before birth. A fetal echocardiogram is a targeted ultrasound examination performed by a pediatric cardiologist, usually between 19 and 23 weeks of pregnancy. This test allows a detailed assessment of the fetal heart’s structure and function when a concern has arisen on a routine anatomic scan or when there are known risk factors.
Early diagnosis enables parents and the medical team to prepare in the best possible way for delivery and for the baby’s care immediately after birth. In selected cases, intrauterine (fetal) cardiac interventions may even be offered. These procedures do not cure the heart defect but can lessen its severity and improve the chances of a successful surgical repair after birth.
A congenital heart defect is an abnormality in the structure of the heart, its valves, or the great blood vessels. Congenital heart defects occur in about 8 out of every 1,000 live births. Their severity ranges from very mild conditions, such as a small opening in the heart’s septum or a subtle change in a valve, to complex defects that require intervention.
From the time the defect is diagnosed, a pediatric cardiologist follows the child and family in regular clinic visits. Sometimes special feeding plans are needed, as well as medications to reduce the workload on the heart, or specific advice regarding physical activity and dental care. Follow-up continues until the problem resolves on its own or until a catheter-based procedure or surgery is required – and, of course, also afterward. The timing of intervention depends on the type of defect: some require treatment within the first days of life, while others are repaired later, in the second or third decade
Dr. Tal Grupel, MD, is a senior pediatric cardiologist at the Pediatric Heart Institute, Sheba Medical Center.
In many cases, parents are referred to a pediatric cardiologist after their child’s pediatrician hears a heart murmur. It is important to know that most murmurs in children are “innocent murmurs” – sounds caused by normal blood flow in an otherwise healthy heart, with no medical implications.
Other reasons to seek evaluation may include:
Most tests in pediatric cardiology are non-invasive and painless. The most common include:
Additional diagnostic tools may include CT scans, cardiac MRI, holter monitoring, exercise stress testing, and others. These are used when more detailed information is needed to clarify the diagnosis or guide treatment decisions.
When treatment is required, the child is referred for an interventional cardiac catheterization or surgery, always performed in a hospital setting. Today, many defects can be treated using catheter-based techniques, such as closing holes in the heart’s septum, widening narrowed valves, or dilating narrowed blood vessels. These procedures can often be performed without open-heart surgery. In more complex cases, corrective operations are carried out by cardiac surgeons who specialize in caring for children.
Thanks to major scientific and technological advances, most children born with congenital heart defects can now grow up to lead active, fulfilling lives. Appropriate diagnosis and close, ongoing cardiology follow-up are key to safeguarding their health and quality of life from childhood through adulthood.
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