Pediatric interventional cardiology has had meaningful advances over the past decade that are changing how children with congenital heart disease are treated at

Congenital heart defects, which arise from abnormal or incomplete formation of the heart, valves and blood vessels, are among the most common birth defects worldwide. The condition affects approximately 40,000 babies each year in the United States.

From less invasive, catheter-based procedures to improved imaging and emerging technologies, innovations are helping reduce risk, shorten recovery times and expand treatment options for the smallest patients with heart problems.

The Cedars-Sinai Newsroom recently spoke with Stephen Nageotte, MD, MBA, an interventional cardiologist and director of the Congenital Catheterization Laboratory at Cedars-Sinai Guerin Children’s and the Smidt Heart Institute. Nageotte treats children and adults using minimally invasive procedures. He shared what’s new in the field and what families need to know:

What are the most significant advances you’ve seen in pediatric interventional cardiology in recent years?

Over the past five years, there have been major advances in three key areas:

• Premature patent ductus arteriosus [PDA] closure. It’s a congenital heart condition in which a connection between two blood vessels in an infant fails to close after birth. This can cause abnormal blood flow to the lungs and breathing difficulties, particularly in premature infants.
• Transcatheter pulmonary valve replacement, which is a minimally invasive procedure in which we replace a faulty heart valve using a catheter instead of surgery.
• PDA stenting. Sometimes babies have heart problems that limit blood flow to the lungs. We can keep a small vessel called the ductus arteriosus open by placing a tiny tube, or stent, inside it to improve blood flow.

All three procedures have evolved significantly and are allowing us to treat patients in less invasive ways, often replacing or delaying the need for surgery.

How has transcatheter PDA closure changed care for premature infants?

Transcatheter PDA closure has become an important option for premature infants with a hemodynamically significant PDA—meaning the vessel is causing strain on the heart and lungs. In fact, Evan Zahn, MD, of the Smidt Heart Institute, helped develop the device cardiologists use to close a PDA during a transcatheter procedure.

The procedure is quick and can be done at the bedside in the Neonatal Intensive Care Unit [NICU], which helps us avoid transporting fragile infants. Research also suggests many babies show respiratory improvement after closure, which may reduce complications associated with long‑term ventilation.

Who is typically a candidate for the transcatheter PDA closure?

These procedures are generally for premature infants who are showing signs that the PDA is affecting their health, such as needing increased respiratory support or showing enlargement of the heart. There’s no strict minimum weight requirement, and the focus is really on whether the PDA is having a meaningful impact on the baby’s heart and lungs. Transcatheter PDA closure is also performed on older kids and adults.

What impact has new device technology had on how these procedures are performed?

One recent advancement is an improved delivery system for PDA closure devices. The device, known as the Amplatzer Piccolo Delivery System, recently received FDA [Food and Drug Administration] clearance to treat premature infants with PDA, including babies weighing as little as 2 pounds. Previously, the procedure required exchanging multiple catheters during the case, which could introduce instability; the newer system allows physicians to navigate and deliver the device using a single, shorter, softer catheter, potentially improving patient stability and precision.

How has transcatheter pulmonary valve replacement expanded treatment options for patients?

The development of newer self‑expanding valves has significantly increased the number of patients who can receive pulmonary valve replacement through a catheter instead of surgery. These procedures are typically considered from late childhood through adulthood and are used for patients with pulmonary valve disease related to congenital heart conditions. Early outcomes have shown good durability and high success rates.

Imaging plays a big role in heart care. What improvements are making the biggest difference?

There have been significant advances in cardiac CT and MRIs. Imaging is faster, clearer and uses lower radiation doses than in the past. These tools help us better understand heart anatomy, blood flow and timing for interventions. There’s also growing interest in using virtual or augmented reality to create 3D heart models for procedure planning, allowing teams to better visualize anatomy before a procedure.

What should families know as they navigate a congenital heart diagnosis?

Early detection and screening are incredibly important, ideally before birth, so families can meet the care team and understand what to expect. At Cedars-Sinai we can identify a defect while a baby is still in the womb and will continue to care for the baby at birth, during childhood, and all the way through adulthood, so the patient never needs to transfer to another institution.

Congenital heart care is lifelong and truly a team effort. Families aren’t expected to understand every technical detail—our role is to guide them, answer questions and be there every step of the way. Building long‑term relationships with patients and families is one of the most meaningful parts of this work.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

“We continue to expand the number of clinicians, surgeons and physician-scientists coming together to address the most challenging heart conditions,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute. “As our program grows, we remain committed to delivering care guided by extensive research.”

Fetal Cardiology

Mark Sklansky, MD, is a leader in fetal echocardiography, the detailed evaluation of the heart prior to delivery. He is medical director of Pediatric and Fetal Cardiology Outreach in the Smidt Heart Institute and Guerin Children's, where he uses ultrasound to identify heart conditions before birth and brings his expertise to the broader community.

Prenatal detection of heart problems allows fetal cardiologists, in partnership with obstetricians, maternal-fetal medicine specialists and neonatologists, to create a treatment plan for when the baby is born. In some cases, pediatric cardiac interventionalists, working with maternal-fetal medicine specialists, can perform a minimally invasive procedure to correct the heart defect before birth. In other cases, newborns can undergo lifesaving surgery or catheter-based therapies within hours after delivery.

Prior to joining Cedars-Sinai, Sklansky founded the Children’s Heart Center at UCLA where he was also chief of Pediatric Cardiology. He has authored or co-authored more than 100 scientific papers, including the American Heart Association’s scientific statement on the diagnosis and treatment of fetal cardiac disease.

Cardiac Surgery

Laura DiChiacchio, MD, PhD, is director of Extracorporeal Membrane Oxygenation, a form of life support that temporarily does the work of a person’s heart or lungs.

DiChiacchio also directs the Ex Situ Perfusion Program. Under DiChiacchio’s leadership, the team uses specialized machines to keep donor organs alive outside of the body and to improve the function of thoracic organs following transplantation. The team also conducts translational research on thoracic organ recovery and reconditioning. 

DiChiacchio is a cardiac surgeon who focuses on adult heart and lung transplantation. DiChiacchio completed a fellowship in thoracic transplantation and mechanical circulatory support in the Smidt Heart Institute Department of Cardiac Surgery and a fellowship in cardiothoracic surgery at the University of Utah.

Organ Preservation

As director of Heart and Lung Protection and Management, Yoshikazu Suzuki, MD, procures donor organs for patients awaiting transplant, ensuring safety and reliability through each step. He uses the latest technologies to ensure organs are well-preserved, and he is tasked with creating an accessible database of donor hearts and lungs.

Previously, Suzuki was clinical associate professor in the Division of Cardiovascular Surgery at the Perelman School of Medicine at the University of Pennsylvania.

Pediatric Interventional Cardiology

Stephen Nageotte, MD, is an interventional cardiologist, an expert in using minimally invasive procedures to diagnose and treat children and adults born with a heart condition. These procedures involve using a thin, flexible tube called a catheter to view the heart and repair anatomical abnormalities, such as narrowed blood vessels or an unclosed hole in the heart. Nageotte directs the Congenital Catheterization Laboratory in the Smidt Heart Institute and Guerin Children’s. 

Nageotte joins Cedars-Sinai from Loma Linda University Children’s Hospital, where he was director of the Pediatric Cardiac Catheterization Laboratory and an associate professor. Nageotte also conducts research and has authored several peer-reviewed papers on congenital heart disease and treatments.

The Smidt Heart Institute’s cardiology, heart and vascular surgery programs are rated in the top 10 in the U.S. and #1 in California by U.S. News & World Report.

Read more from the Cedars-Sinai Blog: Why Accreditation Matters in Choosing a Congenital Heart Program