Adult & Pediatric Cardiology & Cardiac Surgery

Adult & Pediatric Cardiology & Cardiac Surgery- Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit ranges from age 14 to 21, depending on the country. Pediatrics differs from adult medicine in many respects. The obvious body size differences are paralleled by maturational changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and a host of other issues are of greater concern to pediatricians than they often are to adult physicians. Some diseases, such as sickle cell anemia and cystic fibrosis are more often treated by pediatricians because only recently did the majority of these patients survive into adulthood. Issues revolving around infectious diseases and immunizations are also dealt with primarily by pediatricians. Put simply, treating a child is not like treating a miniature adult. Childhood is the period of greatest growth, development and maturation of the various organ systems in the body. Years of training and experience (above and beyond basic medical training) goes into recognizing the difference between normal variants and what is actually pathological. Another major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. In a sense, pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances only, though this is in legal flux and varies by region.

Minimally Invasive Surgery- Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. These procedures involve use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are carried out through the skin or through a body cavity or anatomical opening. This may result in shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials.

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Robotic Cardiac Surgery

Robotic Cardiac Surgery- Robotic Cardiac Surgery is performed with the help of da Vinci telemanipulation system (Intutive Surgical, Inc, Mountain View, California, USA). The da Vinci system is computer enhanced system that consists of surgeon’s console and cart mounted manipulators. Such endoscopic surgery works well for several types of operations (such as gall bladder removal and knee repairs) where part of the body to be operated upon motionless and surgical maneuvers to be performed are relatively simple. Thus endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers are complex. The console houses the display system showing three dimensional pictures of the patient's chest cavity, the surgeon sits away from the patient at the console and gets the view of inside of the patient's chest cavity. The manipulators hold the tiny instrumentswhich go inside the patient's chest. Surgeon's hand movements are transmitted to these instruments facilitate different cardiac operations. Coronary artery bypass grafting (CABG), mitral valve repairs and closure of atrial septal defects have been performed successfully through this technique.

Electrophysiology- Electrophysiological studies have been used for decades to evaluate cardiac arrhythmias and to have basic understanding of their mechanisms. Insight helped the electrophysiologists to treat various arrhythmias and obtain permanent cure. Supraventricular tachycardia with accessory pathway or dual AV nodal pathway can be treated with over 90% success. Atrial flutter can be cured by ablation of isthmus between IVC and tricuspid valve with relative freedom from systemic embolization.

ICD Implant- ICD (Implantable Cardioverter Defibrillator) is an electronic device, which has A very advanced cardiac rhythm monitoring system. The device can diagnose various rhythm disorders of heart, and deliver a pre-programmed therapy for specific arrhythmias. These therapies include pacing or delivery of a DC shock to terminate dangerous arrhythmias. The device has a built-in pacemaker, which can take care of slow heart rhythms also should the patient need it.

Intensive Care Management - Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill and who usually require intensive monitoring. Patients requiring intensive care usually require support for hemodynamic instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac dysrhythmias, and frequently the cumulative affects of multiple organ system failure. Patients admitted to the intensive care unit not requiring support for the above are usually admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit.

Cardiac Rhythm Management- Cardiac rhythm management is a field of treatment in cardiology. The purpose is managing cardiac rhythm disorders. Usually it involves artificial pacemakers and/or implantable cardioverter-defibrillator therapy as well as antiarrhythmia drugs. Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. Some arrhythmias are life-threatening medical emergencies that can cause cardiac arrest and sudden death. Others cause aggravating symptoms, such as an awareness of a different heart beat, or palpitation, which can be annoying. Some are quite minor and can be regarded as normal. Sinus arrhythmia is the mild acceleration followed by slowing of the normal rhythm that occurs with breathing. In adults the normal resting heart rate ranges from 60 beats per minute to 100 beats per minute. The normal heart beat is controlled by a small area in the upper chamber of the heart called the sinoatrial node or sinus node. The sinus node contains specialized cells that have spontaneous electrical activity that starts each normal heart beat.

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