The Cook Children's Heart Center team treats all kinds of heart conditions, from those that require minimal medical care, to complex congenital and acquired conditions. Our highly skilled team of recognized pediatric cardiovascular specialists is well known for its expertise and includes heart and vascular specialists, cardiothoracic surgeons, cardiac anesthesiologists, cardiac intensivists, nurses, perfusionists and ECMO specialists.
Cook Children's Heart Center has been awarded the elite distinction of becoming an Accredited Pediatric Heart Failure Institute. Cook Children's is the second pediatric facility in Texas and the seventh pediatric health care facility in the nation to earn this title.
We offer full service cardiology care from before birth through adulthood.Expand panels
Cook Children's cardiothoracic surgical team performs an average of 400 complex surgeries every year. Our program provides comprehensive surgical care, encompassing all diagnoses.
- Repair of complex congenital heart defects, including corrected transposition of the great artery and heterotaxy syndromes
- Staged palliation of complex single ventricular heart defects such as hypoplastic left heart syndrome
- Heart valve repair
- Aortic translocation, also known as the Nikaidoh procedure
- Arrhythmia, pacemaker and defibrillator surgery
- Complex unifocalization
When a child is diagnosed with the rare combination of transposition of the great arteries, pulmonary stenosis and a ventricular septal defect, an aortic translocation or “the Nikaidoh procedure” is necessary.
With the Nikaidoh Procedure, the aorta is switched, along with the aortic valve, and placed in the pulmonary position. This avoids leaks of a faulty pulmonary valve on the right side. Additionally, it is necessary to mobilize the coronary arteries, as is done in the Arterial Switch Operation. The pulmonary root is divided at the level of the pulmonary valve, which is excised. The outlet septum is excised, thereby removing the superior margin of the VSD. The aortic root is transposed posteriorly so that it lies primarily over the left ventricle. The VSD is closed with a patch, which is anchored to the aortic root at its superior margin. The pulmonary artery is connected to the right ventriculotomy with an anterior patch of pericardium.
The procedure was developed by Hisashi Nikaidoh, M.D. in 1983 as a more effective alternative to the Rastelli procedure. Cook Children’s is proud to have Dr. Nikaidoh as part of the cardiothoracic surgery team
From 2011 to 2014, Cook Children's performed 10 of these procedures with 0% mortality, compared to 62 procedures performed nationally, as reported by the STS with a mortality rate of 3.2%.
This procedure repairs a complex and potentially fatal congenital defect known as tetralogy of Fallot with pulmonary atresia and major aorto-pulmonary collaterals in just one procedure. This procedure recreates the child’s pulmonary arteries, making it more likely that the heart can be repaired before the child’s condition worsens which can cause the surgery to be more difficult, or even impossible.
Cook Children's Heart Center is one of a few pediatric heart programs in the country to perform the unifocalization procedure, specifically on neonates and infants.
3D aPPROaCH Lab
The new three-dimensional lab for the planning and printing of congenital heart disease (3D aPPROaCH Lab) uses advanced technology to support pre-surgical planning and family education for patients with complex heart conditions. This is accomplished through the use of both 3D virtual viewing and 3D printing. Cook Children's is one of the only pediatric healthcare facilities in the United States to combine these technologies.
This cutting-edge technology allows cardiologists and cardiothoracic surgeons the ability to fully understand a patient's complex heart defect and plan their procedures and surgeries to the finest of details. It also allows for doctors to practice and perform procedures prior to the patient entering the operating room.
How does it work?
Specialized software called True 3D uses existing medical image datasets to create virtual reality environments of patient-specific anatomy. Using the system, physicians are able to view and dissect these complex structures just as they would real, physical objects. The technology aims to make reading medical images more intuitive, help physicians reach diagnosis, and assist in surgical planning.
For complex cardiac cases, we then use a 3D printer to generate a life-size model of the heart to explore options for repair. The actual surgery can be simulated numerous times, making sure the treatment plan yields the desired results.
What are the benefits?
The benefits of this kind of technology are still evolving but include:
- Comprehensive three-dimensional understanding of a patient's anatomy.
- More informed or detailed surgical or interventional plan.
- Virtual surgery or catheterization procedures.
- Less time in the operating room, leading to fewer complications.
- Possible reduction in follow up surgeries or catheterizations.
- Improved survival rates in complex cases.
- Family consultation and education.
- Medical education for staff and students.
When might this be used?
The application of 3D planning has a wide spectrum of uses. Examples might include:
- Planning palliative repairs in rare forms of complex congenital heart disease.
- Pre-operative evaluation of unique manifestations of common forms of congenital heart disease.
- Creation of pre-operative templates for surgical baffles and septal defects.
- Virtual deployment of transcutaneous valve (Melody, Edwards) in high risk patients.
- Virtual deployment of percutaneous atrial septal defect devices in patients with multiple defects.
- Mapping and unifocalization of patients with tetralogy of Fallot and multiple AP collaterals.
How does 3D printing work?
3D printing (also known as rapid prototyping or additive manufacturing) is a process of making three dimensional solid objects from a digital file. The patient-specific models of the heart are constructed primarily from MRI and CT scans. The scan data is then reviewed by the cardiologist and used to create a digital virtual model with specialized software (Mimics InPrint, Materialise). This virtual model is uploaded to the 3D printer and the printer deposits microscopic layers of the designated material (plastic, rubber or resin) until the model is complete.
How is the image generated?
Cardiac magnetic resonance imaging (cMRI) is performed to evaluate the structure and function of the heart and blood vessels. cMRI is noninvasive and takes pictures of the heart and surrounding structures using a large magnet, radio waves and a computer. The powerful 3-Tesla cMRI technology at Cook Children's enables us to create images of the heart with details so sharp, we are able see very small lesions, tumors and abnormalities in in the structure of the heart. Computers then use the images to provide 3-dimensional images that can be printed out or projected as a movie.
Electrophysiology studies are conducted to determine the type and location of a specific arrhythmia along the conduction pathway. If the arrhythmia is found, radiofrequency catheter ablation (RFCA) and cryoblation can be used to eliminate the arrhythmia.
Magnetic resonance imaging (MRI) is noninvasive and creates images of the heart and surrounding structures using a large magnet, radio waves and a computer. No radiation is used and patients of all sizes can be imaged. This technique is especially useful in diagnosing and managing patients with complex congenital heart disease.
Melody transcatheter pulmonary valve (TPV)
The Melody valve is a procedure that delays surgical intervention of the heart, resulting in fewer surgeries for the patient and a faster recovery time. It provides a treatment option for children and adults with failed pulmonary valve conduits, which prevents adequate blood flow from the heart to the lungs. The Melody TPV helps restore pulmonary valve conduit function, including relief of narrowing (stenosis) and leaking (regurgitation). The Melody TPV shortens the hospital stay to 1-2 days from 1 week for open heart surgery.
Cardiothoracic surgery team
Vincent Tam, M.D. – Medical Director, Cardiothoracic Surgery
Education: University of Massachusetts Medical School, Worcester, Mass.
Hisashi Nikaidoh, M.D. – Cardiothoracic Surgeon
Education: University of Tokyo, Faculty of Medicine, Tokyo, Japan
Dr. Nikaidoh is a world-renowned pediatric cardiac surgeon who pioneered the aortic translocation now called the Nikaidoh procedure.
Vinod Sebastian, M.D. – Cardiothoracic Surgeon
Education: Mahatma Gandhi University Medical College, Jaipur, India
There are multiple services offered to treat the wide array of diseases and ailments that can afflict a child's heart. These include:
- Medical management
- Interventional cardiology
- Cardiac arrhythmia services
- Pacemaker and defibrillator implantation
- Extracorporeal membrane oxygenation (ECMO)
- Surgical treatment
Cardiology diagnostic modalities include noninvasive imaging and various treatment options, such as:
- Electrocardiogram (ECG/EKG)
- Echocardiogram/fetal echocardiography
- Holter and home EKG monitoring
- Stress testing
- Diagnostic cardiac catheterization, including angiography
- Electrophysiology studies (EPS)
- Cardiac magnetic resonance imaging