High Tech, All Heart

“It looks like something out of Star Trek!” That’s what visitors have been saying as they tour the control room of the new CHOC Children’s Cardiac Catheterization Laboratories, which open next month. And yes, our state-of-the-art facilities are quite impressive. In fact, the CHOC Heart Institute is one of the few pediatric facilities in Southern California equipped with completely brand-new, state-of-the-art, pediatric-focused medical technology. Girl on her bike

CHOC Children’s treats virtually all forms of congenital and acquired heart disease, from before birth through adolescence. Our pediatric cardiologists are pioneering catheter-based techniques that replace conventional open-heart surgery for some complex disorders. What’s happening at CHOC is far more exciting than science fiction.

Congenital heart disorders occur in about nine of every 1,000 newborns. Of these, 25 percent will require invasive treatment within the first year of life. CHOC pediatric cardiologists perform 400 interventional procedures each year with outcomes exceeding the national average for quality and safety.

State-of-the-art cardiac catherization lab
State-of-the-art cardiac catherization lab at CHOC Children’s

Many heart conditions that formerly required open-heart surgery may now be treated using less-invasive, catheter-based techniques. The CHOC Children’s Heart Institute features two cardiac catheterization labs, including a “hybrid” lab that may incorporate aspects of conventional surgery, as needed. Each cardiac catheterization lab is equipped with the most advanced medical imaging technology available:

• Toshiba Infinix-i biplane cardiac catheterization system, providing multiple views of the heart while reducing radiation exposure to the patient.
• Philips iE33 3-D echocardiography, for noninvasive 3-D images of the heart.
• 1.5 and 3.0 TESLA 3-D magnetic resonance (MR) and computed tomographic (CT) angiography, showing blood flow within arteries and veins around the heart and lungs.

And if one picture is worth a thousand words, how about 16 clear images displayed on a 65-inch, medical-grade, LED screen? Our cardiology team will be able to view any diagnostic image, plus other vital information live from a patient’s electronic medical record while performing procedures.

New “Home” For All CHOC Heart Services
Opening in mid-March, the CHOC Heart Institute in the Bill Holmes Tower provides all cardiology services within one convenient, pediatric-focused environment. This includes our specialty outpatient cardiology programs:

Pictured is the main reception area of the 3rd floor, which houses the Robert L. Tidwell Procedure Center and Heart Institute outpatient services. The 2000-square-foot reception provides a space for families to remain close to their children undergoing surgeries and other procedures on the floor.
Pictured is the main reception area of the 3rd floor, which houses the Robert L. Tidwell Procedure Center and Heart Institute outpatient services. The 2000-square-foot reception provides a space for families to remain close to their children undergoing surgeries and other procedures on the floor.

Arrhythmia Device Center —pacemaker management, implantable event recorders and miniature ambulatory EKG monitors.

Diagnostic Cardiac Stress Testing —pediatric ergometer and treadmill stress-testing, and cardiopulmonary exercise testing.

Interdisciplinary Clinics — for children experiencing cardiac effects related to other medical conditions, including muscular dystrophy, cancer, metabolic disorders and red blood cell disorders.

Maternal-fetal diagnostic testing —for high-risk pregnancies.

Sports Medicine & Community Education —our Life-Threatening Events Associated With Pediatric Sports (LEAPS) program is a unique, nationally recognized sudden cardiac arrest screening, prevention and surveillance program for active youth in Orange County.

Additionally, every detail of the CHOC Heart Institute has been designed with patients and their families in mind. Colorful floor tiles, soothing bubble-columns and natural lighting, along with our certified cardiac nurses, cardiac nurse practitioners, social workers and Child Life specialists, help ease the stress and anxiety of a hospital visit.

For more information about the CHOC Heart Institute, visit http://www.choc.org/heart/index.cfm or call 714-509-9200.

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Heart Murmurs in Children


Nita Doshi, M.D., pediatric cardiologist at CHOC Children’s

As Heart Month comes to a close, check out these helpful facts about heart murmurs in children from Dr. Nita Doshi, pediatric cardiologist at CHOC Children’s.

My pediatrician heard a “heart murmur” in my child.  What is a heart murmur?

A “heart murmur” is an extra noise or sound which can be heard when listening to the heart with a stethoscope.  When blood travels through the veins, arteries, and valves of the heart, the flow of blood can create a sound.  This sound has often been described as having a “swishing” or “whooshing” quality. This sound is frequently referred to as a “heart murmur.”

Does the finding of a heart murmur mean that something is wrong with my child’s heart?

It is very important to remember that a “heart murmur” is simply a noise or a sound.  It is a finding detected by listening through a stethoscope during an examination.  Most of the time, heart murmurs are normal and do not indicate anything is wrong with the heart.

How commonly are heart murmurs diagnosed in children?

Studies have estimated that up to 90% of infants and children will have a heart murmur at some point during infancy or childhood.  But of all heart murmurs, only about 1-3% of children will be found to have a congenital heart problem.

What is an “innocent” murmur?

Innocent heart murmurs have also been called:  “benign,” “physiologic,” “functional,” or “flow-related,” meaning that normal blood flow creates a sound which can be heard during examination.  In younger children, it is often easier to hear a murmur because the distance between the heart and the chest wall is typically closer.  Because innocent heart murmurs are related to blood flow as well as changing chest configuration and heart rate, heart murmurs may disappear and reappear at various times.  As an example, periods of increased activity and fever are common times when a heart murmur may be heard.

What is a “non-innocent” murmur?

Heart murmurs can be termed “non-innocent” or “pathologic,” meaning that the sound may represent an abnormality of the heart muscle, walls, valves, or arteries.  For instance, a pathologic murmur can represent the sound of blockage of outflow from the pumping chambers, which dispenses blood to the lungs and the body.  It may also signify a hole within the wall inside the heart, narrowing or malformation of one of the heart valves, leakage of one of the heart valves, or narrowing of one of the arteries supplying blood to the lungs or body.

What may further evaluation of a heart murmur involve?

Your pediatrician may choose to refer your child with a heart murmur to a pediatric cardiologist.  A pediatric cardiologist is a specialist of heart disease in fetuses, infants, children, and young adults.  Your pediatrician or pediatric cardiologist may decide to order an “electrocardiogram,” which is a non-invasive test that measures the electrical activity or rhythm of the heart.  Your pediatrician or pediatric cardiologist may decide to order an “echocardiogram” otherwise known as an ultrasound of the heart, which is another type of non-invasive test that can further evaluate the structure and function of the components of the heart.

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

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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, explains the signs and causes of this common condition, rarely associated with the heart.

What causes chest pain in children?

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.

How often is chest pain in children due to a heart problem?

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.

How do I know when my child’s chest pain needs medical attention?

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.

How can I help prevent my child’s chest pain?

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 Heart Institute.

Easy Substitutions for a Healthier Heart

In honor of American Heart Month, try these smart substitutions recommended by the American Heart Association, for a healthier heart for the entire family.

When cooking your favorite recipes, you can use these lower-fat ingredients, which can help cut down on saturated fats and cholesterol, without having to substitute the taste:

Instead of butter (1 tablespoon) —   Use 1 tablespoon soft margarine (low in saturated fat and 0 grams trans fat) or 3/4 tablespoon liquid vegetable oil

Instead of whole milk (1 cup) —   Use 1 cup fat-free or low-fat milk, plus one tablespoon of liquid vegetable oil

Instead of heavy cream (1 cup) —   Use 1 cup evaporated skim milk or 1/2 cup low-fat yogurt and 1/2 cup plain low-fat unsalted cottage cheese

Instead of sour cream —   Use low-fat unsalted cottage cheese plus low-fat or fat-free yogurt; or just use fat-free sour cream

Instead of cream cheese —   Use 4 tablespoons soft margarine (low in saturated fat and 0 grams trans fat) blended with 1 cup dry, unsalted low-fat cottage cheese; add a small amount of fat-free milk if needed

Instead of Egg (1) —   Use 2 egg whites; or choose a commercially made, cholesterol-free egg substitute (1/4 cup)

Snack healthier, too, with these yummy substitutions:

Instead of regular potato or corn chips —   Enjoy pretzels or low-fat potato chips (reduced sodium version)

Instead of ice cream bars —   Enjoy frozen fruit bars

Instead of a doughnut —   Enjoy a bagel or toast

Instead of high-fat cookies and crackers —   Enjoy fat-free or low-fat cookies, crackers (such as graham crackers, rice cakes, fig and other fruit bars, ginger snaps and  molasses cookies)


The CHOC Children’s Heart Institute brings hope to children with heart disease and their families, providing state of the art diagnosis and treatment for an entire spectrum of cardiac conditions in newborns to adolescents. For more information on programs and services at CHOC Children’s Heart Institute, please visit: http://www.choc.org/heart/index.cfm