Surgery for congenital heart disease (CHD) has advanced greatly over the past 30 years and continues to improve, allowing many children with CHD to lead active lives.
“They are likely participating in recreational sports and even competitive sports without anyone knowing that they ever had a heart problem,” said Paul M. Seib, MD, chief of pediatric cardiology at Arkansas Children’s Hospital and associate professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS). “One of my patients was a state champion high school golfer. Other patients have been track stars, baseball players, collegiate sprinters, and even football players. Patients with the most complex problems may have some limitations to their exercise ability, but most do well with normal play in childhood.”
Seib said children with heart problems that were universally fatal in the past now routinely have survival into adolescence and young adulthood. The success with surgery for CHD is reflected in the fact that there are now more adults in the U.S. with repaired CHD than there are children with CHD. He said this has led to a new specialty of physicians trained in adult CHD to meet this need.
While some children with CHD have other medical problems as well, many have only CHD, which, if successfully treated, can restore a full life expectancy and allow a child to grow up to be an adult contributing to society and having a family of his or her own, Seib said. Some children are at risk for developmental problems or learning disabilities, and interventions to maximize the potential of these children is important.
Surgeries are less invasive than in the past.
“Many congenital heart problems which used to require open heart surgery for treatment can now be treated with a cardiac catheterization instead, thus avoiding the use of cardiopulmonary bypass and opening the patient’s chest,” Seib said. “We can close holes in the heart, enlarge narrowed arteries or veins, and even replace valves in the main lung artery by delivering a valve on a balloon catheter (Melody valve). For children with complex CHD, we are focused on not just survival, but long-term development and quality of life. Like many centers, we have established a cardiac neurodevelopmental clinic which provides evaluation, testing, and intervention for children who have undergone repair of CHD.”
Understanding the genetic basis of CHD and the effect of genetics on CHD is an active area of research.
The transplant program at ACH is led by Elizabeth Frazier, MD, and has been active since the 1980’s providing care for children who have a failing heart either from CHD or who have cardiomyopathy in the setting of a structurally normal heart without CHD. Some patients have had a viral illness that damaged their heart, resulting in cardiomyopathy. Since there is a limited supply of donor hearts, some patients require a mechanical pump or left ventricular assist device (LVAD) to support them until a donor heart becomes available.
“We have extensive experience with this and other types of support under the leadership of our surgeon, Michiaki Imamura, MD,” Seib said.
The number of procedures per year varies significantly based on need. The largest number of heart transplants they have done in a year is 31, though over the past two years the numbers have been significantly lower.
“We recently did two transplants in 24 hours, which was quite an accomplishment by our team,” Seib said.
Children receiving transplants range in age from birth to young adults.
Seib now has something in common with many of his patients. He had heart surgery to repair a heart valve in May 2016, after finding a heart murmur on himself while working in clinic.
Seib was born in Lafayette, La., and moved to Brisbane, Australia, for his father’s job when he was five. The family lived there for two years and he started school there before they moved back to the U.S. and settled in New Orleans, where he grew up and completed high school.
He attended Louisiana State University (LSU) in Baton Rouge, earned a degree in zoology, and attended the LSU Health Science Center in Shreveport, for medical school. “I was fortunate to do a rotation at Arkansas Children’s Hospital during medical school and fell in love with the hospital so much so that I returned to do my residency here,” Seib said. “After residency, I did my three-year fellowship at Texas Children’s Hospital in Houston, Tex., and then entered active duty in the U.S. Air Force, stationed at Wilford Hall Medical Center, Lackland AFB, in San Antonio, Tex. After a three-year commitment, I finished my Air Force service and returned to Arkansas in 1993 and joined the UAMS pediatric cardiology faculty practicing at ACH. Most of my clinical practice since then has been devoted to cardiac catheterization, especially interventional procedures, as well as to care of our patients in the hospital and in the outpatient clinic.”
Seib got interested in physiology and science in high school, encouraged by an advance placement science teacher.
“I had a great mentor while in medical school, Dr. Ralph Baucum, a pediatric cardiologist who nurtured my interest,” he said. “I enjoyed the variety, the interesting physiology, and the fact that children are so resilient. If treated for their CHD, they often go on to lead normal lives.”
Seib is married to Loran, who is a nurse who has worked at ACH. They have four children: Hunter, 20, is in the U.S. Navy. Eva is 12, Judson is five and Lucy is four years old. His hobbies including playing golf, hiking, and playing his guitar—though not in public.
Seib is the author and editor of journal articles and book chapters in the field of pediatric cardiology and has presented at local and national meetings.
