CHOC Doctor’s Expertise Gives Boy Improved Heart Health

Alex Puck

Thanks to the expertise and skill of one CHOC Children’s cardiologist, a seventh grader with a longstanding heart condition has a renewed chance for health and happiness.

Several months after undergoing Melody Transcatheter Pulmonary Valve (TPV) therapy, Alexander Puck of Lake Forest is energetic and active – a marked change over the lethargy and decreased energy that he experienced last year.

“I feel good. I’m just trying to get used to things like running faster and having more energy,” said Alexander, who just started practice with his Little League team.

Alexander’s procedure marked Dr. Farhouch Berdjis’ 25th such procedure – a fitting milestone given the patient’s and doctor’s longstanding relationship. Dr. Berdjis began treating Alexander when he was just 4 years old, and calls the boy “Alexander the Great.”

During the minimally invasive procedure, a thin, hollow tube holding a specially designed heart valve is inserted into a vein in the leg and is guided to the heart. Even better, Melody TPV therapy increases the likelihood that Alexander will experience fewer significant surgeries as he ages.

“Melody TPV is an example of the groundbreaking therapies that make CHOC a leader in pediatric medicine, and we are proud to be at the forefront of this technology,” Dr. Berdjis said.

Dr. Berdjis is among the 50 physicians nationwide certified to perform Melody TPV therapy. The CHOC Children’s Heart Institute is one of approximately 35 centers in the United States that is certified to perform the therapy.

Named after its inventor’s love of music, Melody TPV therapy was first used in Europe in 2000 and in the United States in 2007.

Alexander – who was born with several heart defects, including a pulmonary valve that would not close – had his valve replaced at 3 months old.

Last year, Alexander began experiencing decreased energy and difficulty climbing stairs. Dr. Berdjis informed Alexander’s parents that the valve would again require replacement – but the good news this time was that Melody TPV treatment could accomplish the task without open-heart surgery.

“It was a great relief because we were worried since he was 3 months old that they’d need to do another surgery,” said Kristi Puck, Alexander’s mother. “We were very excited to learn about the alternative. There are just so many complications that we wouldn’t have to deal with. We were in the hospital, and out the next day.”

These days, the Los Alisos Intermediate School student is focused on church, school and baseball – an activity that Dr. Berdjis has encouraged so long as Alexander wears a chest protector.

“I could see a big decrease in his performance over the season last year,” Kristi said. “We thought it might take some time before he could play again, but Dr. Berdjis was encouraging him to live and enjoy life. He wants him to stay active.”

A Mission Viejo resident, Dr. Berdjis is the Medical Director of the CHOC Cardiac Catheterization Lab. He has specialized expertise in cardiac catheterization and therapeutic cardiac catheterization.

Dr. Berdjis completed his fellowship and residency at Children’s Hospital Los Angeles and Wyler’s Children’s Hospital/University of Chicago. He received his medical training at the University of Wurzburg in Germany and completed his internship at Children’s Hospital of the University of Munich.

Watch a video of Dr. Berdjis explaining how Melody TPV therapy works:
Hear Dr. Berdjis explain the advantages of Melody TPV therapy:

Watch Dr. Berdjis explain about the certifications and approvals required to perform Melody TPV therapy:

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Heart Imaging Goes 3-D

And no special 3-D glasses are required. Magnetic resonance (MR) angiography gives our CHOC pediatric cardiac specialists an unprecedented, crystal-clear view into our patients’ hearts and surrounding blood vessels.

If a single picture is worth a thousand words, consider the value of a complete 3-D reconstruction of the heart and the major blood vessels that may be viewed from any angle. These images may also be magnified, flipped, rotated, color-enhanced and even animated into a movie, showing every precise detail in motion.

In children with complex, congenital heart disease, no two hearts are alike. MR angiography has become an indispensable diagnostic tool, providing unparalled views into the deepest abnormal, anatomic structures within a child’s heart. And best of all, this procedure is noninvasive and free of radiation. It is better tolerated by patients than diagnostic cardiac catheterization and does not usually require sedation or anesthesia.

Pierangelo Renella, M.D., CHOC Pediatric Cardiologist

“When standard imaging is not enough, MR angiography offers a way to obtain critical information needed to make complex cardiac diagnoses,” says Pierangelo Renella, M.D., pediatric cardiologist and advanced cardiac imaging specialist at CHOC Children’s. This technology helps surgeons plan safer and more effective procedures, and can be used to follow patients over time as it provides details for making decisions about medication and possible future surgeries.”

“State of the Art” is Our Standard of Care

Pictured is a 3-D volume rendered MR angiogram of the major blood vessels of the chest and abdomen.

The CHOC Children’s Heart Institute is the only center in Orange County providing pediatric MR angiography. Our hospital has two magnetic resonance imaging systems, featuring 1.5 and 3 power Tesla magnets — the strongest magnets available for MR magnetic resonance imaging. Just two more reasons why when it comes to caring for infants, children and adolescents with complex, congenital heart conditions — there’s no place like CHOC.

Find more information about the CHOC Children’s Heart Institute‘s programs and services.

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Chest Pain – What Parents Should Know

In honor of American Heart Month, check out these important guidelines to help you determine whether your child’s chest pain could be associated with heart disease. In this Q&A, Dr. Pierangelo Renella, a pediatric cardiologist at CHOC Children’s, explains the signs and causes of this common condition, rarely associated with the heart.

Q: What causes chest pain in children?
A:  The most common cause of chest pain in children is pain in the muscles that make up the chest wall and not the heart itself.  This type of pain is usually referred to as “musculoskeletal pain.”  Another common cause of childhood chest pain is costochondritis, which is inflammation in the cartilages at the ends of the ribs.  Other causes may include respiratory infections, asthma, acid reflux (“heartburn”), or a partially collapsed lung, for example.  These are usually not life-threatening.  However, in rare situations, there are serious forms of heart disease that can cause chest pain, and these usually require a pediatric cardiologist’s assistance to diagnose and treat.

Q: How often is chest pain in children due to a heart problem?
A:  Although childhood chest pain is the second most common reason for referral to a pediatric cardiologist, it only rarely means the child has actual heart disease.

Q: How do I know when my child’s chest pain needs medical attention?
A:  Chest pain that occurs with, or immediately after, exercise should be evaluated further, starting with your child’s pediatrician.  In addition, for chest pain that is associated with fast heartbeat, dizziness, or fainting, or if there is a family history of sudden cardiac death, your pediatrician may refer your child to a pediatric cardiologist.

Q: How can I help prevent my child’s chest pain?
A:  Again, the vast majority of childhood chest pain is not heart-related.  Since the most common causes involve the muscles and bones of the chest wall, the pain should improve with rest and anti-inflammatory medications such as acetaminophen or ibuprofen.  If these treatments do not work, and if the pain is significant, worsening, or associated with other signs and symptoms such as dizziness, fainting, shortness of breath, fast heartbeat, or exercise, make an appointment with your child’s pediatrician immediately.

Learn more about the CHOC Children’s Heart Institute.

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  • Causes of Chest Pain in Children
    February is American Heart Month. Check out these important guidelines to help you determine whether your child’s chest pain could be associated with heart disease. Dr. Pierangelo Renella, a pediatric ...

Be Good to Your Heart – And Your Children’s Too!

By Katherine Phillips RD MPH, clinical dietitian at CHOC Children’s

Did you know that heart disease is the leading cause of death for both men and women in the United States? In 2010, heart disease services, medications and lost productivity cost the United States $316.4 billion, making it an expensive yet very preventable disease. The most common type of heart disease is coronary artery disease, which can cause heart attack, angina, heart failure and arrhythmias. According to the Centers for Disease Control and Prevention, heart disease is the cause of death for one in every four adult Americans.

However, adults aren’t the only ones at risk. Children are now developing cardiovascular disease risk factors that were previously only seen in adults. Children who are obese are at a higher risk of cardiovascular disease risk factors such as high blood pressure, type 2 diabetes and elevated blood cholesterol levels. One study estimated that as many as 70% of obese children have at least one risk factor for cardiovascular disease.

Prevention and early action are the keys to decreasing your risk and your children’s risk of developing heart disease.  The highest risk factors for heart disease include inactivity, obesity, high blood pressure, cigarette smoking, high cholesterol and diabetes.  Here are some ways you can reduce the risk of heart disease in your family:

Know your family history
o Genetic factors can play a role in the development of heart disease.

Know your numbers (and your children’s numbers too!)
o High cholesterol, blood pressure and diabetes are three of the six top risk factors for developing heart disease, so keep them under control.
o New guidelines endorsed by the American Academy of Pediatrics state that all children, with or without a family history of heart disease, should have their cholesterol levels tested between the ages of 9 and 11, and then again between the ages of 17 and 21. Doctors think that this early testing and control of cholesterol levels in childhood can help reduce the risk of heart disease in adulthood.

Stop smoking
o Smoking increases the risk of cardiovascular disease by two to four times!

Improve your diet
o Diets high in saturated fats and cholesterol can raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.
o Choose lean meats, low-fat or fat- free dairy products; decrease foods high in saturated fat, cholesterol, sugar, and salt/sodium; and watch portion sizes.
o Increase fruit, vegetable and whole grain intake.
o Plan your meals ahead of time so you aren’t scrambling for something quick and unhealthy at the last minute.
o Do not use food as a reward for good behavior or good grades.
o Limit snacking and be aware of the snack foods your children are eating.
o Know what your child eats at school.
o Eat meals as a family so it is easier to know what and how much your child is eating.

Be active
o 150 minutes of moderate intensity physical activity every week (or just 20 minutes each day) can decrease your risk of heart disease.
o Aim for 60 minutes of physical activity for your child every day.
o Find fun exercise activities you can do as a family.
o Limit the amount of time you and your child spend watching TV and playing on the computer.

Control your weight
o Losing just 5–10 percent of your current weight over 6 months will lower your risk for heart disease and other conditions.
o If your child is overweight and there is no illness or condition causing the obesity, ask your doctor or a registered dietitian to provide you with some resources to help your child either lose weight or control their rate of weight gain while they grow.

Drink less alcohol
o Excessive alcohol use leads to an increase in blood pressure, and increases the risk for heart disease. It also increases blood levels of triglycerides, which contribute to atherosclerosis.
o Drink no more than one alcohol drink per day if you’re a woman and two alcohol drinks per day if you’re a man.

Be a good role model for your children. Parents who model healthy eating and physical activity can positively influence their children’s health.

For more information:
Harvard School of Public Health-The Nutrition Source:
Center for Disease Control and Prevention:
American Heart Association:

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Tips for a Happy, Healthy Heart

American Heart Month is coming to a close, but please keep these helpful tips in mind to keep your and your family’s heart healthy year-round!

  • Choose heart healthy foods: Eat foods that are high in fiber, such as fruits, vegetables and whole grains. Substitute healthy foods for unhealthy ones, such as fried chicken for grilled chicken. Pack healthy snacks such as nuts, baby carrots, or air-popped popcorn. 


  • Limit your intake of fats and salt, especially foods that are high in saturated fats and cholesterol such as whole milk, cheeses and red meat.


  • Encourage your child to get 30-60 minutes of physical activity every day. Exercise helps to increase the amount of “good” cholesterol (HDL) in your body which helps to lower the risk for heart disease. Join in the fun with them. A walk around the block after dinner will do your heart and body good.


  • Limit the amount of time that your children watch TV, use the internet or play video games. Encourage them to go on a bike ride or play an outdoor game instead.


  • Shake off negative emotions. Managing stress properly is critical to preventing future heart problems. Talk openly with your kids and teach them methods for coping with stress. For a young child, that may be a fun game or comic book; for a teen that may be taking up a sport or relaxing hobby.