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t m c » p u l s e | j a n / f e b 2 0 1 6 18 18 Add high patient volume, multiple surgeons, strategic multidisciplinary partnerships and emphasis on the importance of a continuum of care, and one begins to see what sets the Texas Children's Heart Center at Texas Children's and the Children's Heart Program at Children's Memorial Hermann Hospital apart from the pack. "There's an increasing appreciation that it's really all part of the continuum and that there is likely a sequence of crucial times during devel- opment that are really important," explained Daniel Penny, M.D., Ph.D., chief of cardiology at Texas Children's and professor of pediatrics- cardiology at Baylor. "For that reason, we work closely with our partners at Texas Children's Pavilion for Women, Texas Children's Fetal Center, TM the Texas Heart Institute, and other pediatric specialists here at Texas Children's Hospital to make sure we're addressing every aspect that impacts the child's wellbeing. One of the big advances over the last 10 years or so is the increasing recognition that heart disease in children isn't just a disease of the heart. It's not just about funny valves and funny hearts, it's a condition that really affects the whole child, it affects the family and ultimately society." Penny and his team at Texas Children's are directing efforts to some of the non-cardiac implications of heart disease in children, includ- ing neurodevelopment delays caused by the abnormal hemodynamics in utero common to patients with CHD as well as symptoms of post traumatic stress disorder observed in children and their families after open heart surgery. And they don't stop there. Thanks to the field's considerable advancements in the last five decades, babies born with CHD are now grow- ing up to be adults. Although many are healthy overall, these individuals do require periodic monitoring and care their whole lives. Rather than send them to adult cardiologists, who specialize in a completely different kind of heart disease, Texas Children's has engaged a large team of specialists to provide dedicated care for these patients. "It is now well-known that there are more adults living with congenital heart disease than children with congenital heart disease in the U.S. today," Penny said. "So we've put a great deal of effort into developing that integration between pediatric care and adult care. It isn't something we can just take for granted—we have to plan and build processes and programs to meet the unique needs of these individuals. We need to prepare and be ahead of it and face these chal- lenges rather than wait for other people to do it." In keeping with this philosophy, Texas Children's offers the most advanced treatment options available, including fetal intervention procedures. Widely recognized as a nascent subspecialty only recently put into practice, fetal intervention has been documented to save fetuses with certain heart abnormalities. Currently, the risk runs high and the level of sur- gical specialization required is equally prohibi- tive, but Texas Children's has performed several procedures on these tiny developing hearts with success, in fact pioneering many of the surgical techniques currently used to correct evolving malformations before they become irreparable and fatal. Preventative cardiology is becoming increasingly important as acquired cardiovascular disease is predicted to be the in the developing world. (Credit: A. Kramer/Texas Children's Hospital) n e x t big glob a l epidem ic He a rt dise a se in chil dr en may also be acquired after birth, with one of the most common being cardiomyopathy, in which the cardiac muscle is weak, resulting in heart failure.