Diagnosis and treatment: children's cardiac
The children’s cardiac department sees babies and children up to 18 years old. Patients are referred to the department as emergency patients or by GPs and other hospitals.
We work with Oxford Children’s Hospital as part of the Oxford Southampton paediatric cardiac network. This partnership cares for children from a wide area and receives referrals from 23 district hospitals across the south of England, including the Channel Islands.
Both hospitals provide diagnosis, condition management and outpatient services. If your child requires heart surgery or an interventional procedure such as cardiac catheterisation or a transoesophageal echocardiogram, they will have this in Southampton.
Following your child’s referral to the cardiology team, you will receive an appointment to come to our outpatient department or to Ocean ward for assessment. This may include some of the tests and investigations listed below.
Investigations your child may have
This is a paper recording of the electrical activity inside the heart. Sticky electrode pads attached to the skin on the chest, arms and legs record this activity. The test requires your child to be quite still, but doesn’t hurt and only takes a few minutes.
Sometimes it’s necessary to record the electrical activity of the heart for a longer period (usually 24-72 hours) using a small portable monitor. This can be done as an outpatient, so it doesn’t require you to stay in hospital.
Your child may need to have a blood test, especially if they need treatment or an operation. Emla or Ametop cream (‘magic cream’) or cold spray is available to numb your child’s skin prior to the test being performed. Some older children find it helpful to listen to music or watch a TV programme while this is happening.
We use chest X-rays to assess the lungs and heart before surgery, and sometimes before cardiac catheterisation or starting some forms of treatment. Your child will usually go to the children’s X-ray department for this. Babies will need to be placed in a sitting position while being held by a parent or nurse, and we ask children to stand in front of a screen. The X-ray won’t hurt your child. If you’re accompanying your child to an X-ray, please tell the radiographer if you think you might be pregnant.
This is an ultrasound scan that shows images of the heart on a screen. A gel is applied to the chest and a probe is moved over the chest to show images of the heart. We can then take various measurements to get further information about the blood flow and structure of the heart.
If your child is very active and can’t lie still for the scan, we can give you another appointment to come to the hospital for the day. At this appointment, we'll give your child light sedation so that they lie still while the scan is performed, as the scan produces better pictures if the child is still. It can be helpful to ensure you have a book, tablet, PC or magazine to entertain them. A drink, a snack or a comforter can also help them to settle during the scan.
Exercise tolerance test
Sometimes called an exercise stress test, this is an ECG that’s recorded while the child is walking on a treadmill. The idea of this test is to see how your child’s heart works when they’re moving about, as the heart has to work harder during exercise. The test usually lasts between 10 and 15 minutes.
MRI (magnetic resonance imaging)
MRI is a way to take pictures of the body without the use of X-rays. We use it to get more detailed information about the heart and its blood supply. It’s necessary to lie very still for this for up to an hour, so children under eight years of age usually require a light anaesthetic. If your child is awake during their scan, one parent can accompany them into the MRI room.
TOE (transoesophageal echo)
A small probe is passed down the oesophagus (food pipe) to look at the back of the heart. It’s performed under general anaesthetic and is often combined with cardiac catheterisation.
CT (computerised tomography) scan
This scan uses X-rays to take pictures of the internal structures of the body. We use it to get more information about the heart and its blood supply. It’s necessary to lie still for this, so younger children usually require sedation or a short anaesthetic.
This is a procedure that can be used to guide your care or treat a specific problem. A cardiologist passes a fine tube into the heart from one of the big blood vessels, either in the groin or the neck. Through this tube a dye is injected that can be seen on an X-ray. The dye passes into the heart and pictures can be taken. The cardiologist is then able to see the structures of the heart more closely. It’s also possible to measure the blood pressure in the different chambers and vessels in the heart.
In some patients, cardiologists are able to close holes in the heart such as atrial septal defects using a cardiac catheter, and also increase the size of certain vessels and valves by ballooning them. In some cases, they’re able to insert a new heart valve via a cardiac catheter.
Generally, your child will come into hospital the day before their procedure to have blood tests, an echo and sometimes a chest X-ray. They’ll stay on the ward overnight and go to the cardiac catheter lab the next day for their procedure. Following their procedure, some children may be able to go home the same day if they have had a diagnostic catheter. If they have had an intervention such as a ballooning, it may be necessary to stay overnight.
What happens next?
The cardiac team meets every Monday, Tuesday and Wednesday morning to formulate and agree individual treatment plans. If your child has been presented for discussion, their cardiologist will inform you about the various treatment options available in writing and/or during an outpatient appointment.
After your child has been discussed in the meeting and accepted for a catheter, they’ll be added to a waiting list. We list patients in order of the urgency of their condition, but generally all procedures are done within 18 weeks. The current waiting time is within eight weeks. If you haven’t heard about a procedure date after this time, please call the booking coordinator Katie King on 023 8120 5382 for an update. We give around three weeks’ notice, and will send you a letter in the post.
If your child needs a heart operation, we'll arrange an appointment for you to meet the cardiac surgeon in the outpatient department. During this appointment the surgeon will explain in detail why the operation is needed, as well as the associated risks, complications and benefits. Following your meeting with the surgeon, you can also meet with one of the children’s cardiac nurse specialists (CCNS). They can show you around Ocean ward and discuss how to prepare your child for surgery, their stay in hospital, recovery, future treatment and follow-up appointments.
After you’ve met the surgeon, your child will be listed for surgery and a member of the team will contact you to discuss a date for your child’s operation. The timescale of when your child’s operation will be is influenced by many factors, including age, weight and clinical priority. The surgeons and cardiologists will make the decision as a group.
If you haven’t been contacted to discuss a surgical date within four weeks of your consultation with the surgeon, please call 023 8120 5382 (Mon-Fri 9am-5pm) and speak to the paediatric congenital co-ordinator, who will be able to give you an update. If you’re put through to an answer phone, please leave your details and the team will call you back.
If you’re concerned about your child’s symptoms while they’re on the waiting list, please call the children’s cardiac nurse specialists on 023 8120 4659 (Mon-Fri 9am-5pm). There’s an answer phone outside of these hours – if you leave a message, a member of the team will call you back on the next working day.
Outside of these hours, you can contact Ocean ward on 023 8120 6470 during the evening or at weekends if you feel your concerns are urgent. Alternatively, seek appropriate medical advice locally via the 111 service or A&E. In the event of a life-threatening emergency, call 999.