Shyam Sathanandam, MD, Chief – Cardiovascular Medicine & Co-Medical Director – Heart Institute, Nicklaus Children’s Hospital

In an interview with Invest:, Dr. Shyam Sathanandam, chief of cardiovascular medicine and co-director of the Nicklaus Children’s Hospital Heart Institute, discussed how pediatric cardiology is becoming less invasive, more precise, and more collaborative. “The way we treat heart defects has evolved significantly, and now we can often address them with very minimal trauma to the child,” Dr. Sathanandam said.

What makes your approach to treating heart conditions in children unique?

I am an interventional cardiologist, so I do procedures on babies, children, and even adults who have heart problems without needing to open them. There is no cutting and no stitching. Most families do not even know how I enter their child’s body because all they see is a little needle stick, usually in one of the veins. These are minimally invasive procedures, yet sometimes we accomplish the same thing that open-heart surgery would accomplish for the patient. The way we treat heart defects has evolved significantly, and now we can often address them with very minimal trauma to the child.

What are the most common congenital heart conditions that you treat, and how have advancements in diagnosis and treatment improved outcomes?

Some of the most common defects we treat are holes in the heart that we close, valve problems that we repair or replace through a catheter, and narrowings in blood vessels that we treat with a balloon or a stent.

Imaging has also evolved tremendously. In the past, we relied mostly on ultrasound imaging. Now we use cross-sectional imaging with CT scans and MRIs, and because we can obtain those images, we can create three-dimensional models. We even use virtual reality headsets, which most people associate with gaming, to build heart structures from CT or MRI scans and practice procedures in advance.

We have developed technology that allows us to do virtual procedures. We can create a model of a patient’s heart and practice the procedure using the same tools we will later use in real life. If I have a case scheduled for today, I can practice that procedure 20 times beforehand. By the time I do it, it feels like I have already done that case. That makes the procedure safer, faster, and less complicated, and it helps us anticipate and avoid complications.

What role does early detection play in pediatric cardiology, and what emerging trends or technologies are improving patient care?

If a child is born with congenital heart disease, we can now often diagnose it in fetal life, before the baby is born. In some cases, we can try to fix problems even before birth, but most of the time treatment happens right after the baby is born. Even when we cannot intervene prenatally, early detection helps families prepare. They are expecting the happiest day of their lives, and then suddenly learn that the baby has a heart defect. That can be devastating. Now we can help families understand what to expect, how we are going to treat the baby, what life may look like afterward, and how they can prepare.

Another important area is prematurity. About 100,000 babies in the United States are born before 27 weeks, which is about three months early. Many of them have a fairly common heart defect called PDA. In the past, we thought the only way to close that defect was with open-heart surgery, which is extremely invasive for these tiny babies. I am talking about babies who weigh less than a cell phone, about a pound and a half.

Now we have a minimally invasive procedure to treat that condition. Again, there is no cutting and no stitching, and it takes about 10 minutes. We can do it at the bedside without even taking the baby out of the incubator. Technology has improved, and our techniques and expertise have evolved to allow us to care for babies that small.

Nicklaus Children’s is also in a unique position because we can offer that procedure beyond our own hospital. These babies are often too fragile to transfer, so we go to them. That is critically important because moving them from one hospital to another may not be an option.

How do you stay at the forefront of innovation in pediatric cardiology and bring new developments into clinical practice?

Earlier in my career, I was always trying to keep up with what was new. Now we are in a position where we are helping create the newest techniques. We are at the forefront. We are leaders and pioneers in some of these areas, so unless we bring the updates, they may not come.

The premature baby procedure I mentioned is one example. I have taught doctors around the world how to do that procedure. I travel internationally and share that expertise. That is one of the ways we move from being students of the field to helping shape it.

Technology is also opening new doors. Virtual reality is a good example. It started as gaming technology, and now we are integrating it into medicine. People used to think cardiologists were plumbers; now we have become gamers, so to speak. The point is that we have to look for opportunities to integrate technology in ways that improve care and lead to new therapies for children.

Industry partnerships are essential in that process. Physicians may have ideas, but turning an idea into a therapy requires collaboration with industry. I have been involved in several devices from the earliest concept stage through preclinical work, animal testing, clinical testing, FDA approval, and eventual use in everyday practice.

How are you collaborating with other stakeholders to develop new therapies and advance the field?

It is absolutely a team effort. One person cannot do everything. We try to build teams of like-minded individuals who may come from different fields. Collaboration does not need to be limited to healthcare. It could involve the gaming industry, chemistry, or other disciplines entirely.

The common goal is to find new cures and new therapies for children. My expertise may not be in every area, so I need others who bring different skills and perspectives. That kind of collaboration is how real progress happens.

There is still a long way to go. For example, if a child has a complex heart defect and needs a heart transplant, a transplant is not really a cure. It becomes another chronic condition. The child may spend a long time in the hospital, take many medications, and require ongoing monitoring to prevent rejection. The transplant may last 15 or 20 years, but not a lifetime. That is why we need to keep pushing for better options and longer-term solutions.

What are the main challenges and opportunities you see for pediatric cardiology in the years ahead, and how is Nicklaus positioning itself?

Pediatric cardiology deals with rare conditions, and that creates both a blessing and a challenge. It is good that not every child is born with a heart defect, but because these diseases are rare, development can move more slowly. When a disease is common, there is more incentive to invest money, resources, and effort into finding solutions. When a disease is rare, that investment often lags.

That is why Nicklaus Children’s has to continue positioning itself as a leader in this space and educating the community about why investment in congenital heart disease matters. Even though these conditions are rare, we know better therapies and cures are possible. Investment is necessary if we want to keep making progress.

We also have to position ourselves as a destination site. With rare diseases, not every hospital can provide the same level of care. Families need centers of excellence where the right subspecialists and experts are all in one place. Before the Heart Institute at Nicklaus Children’s, many patients from South Florida were traveling all the way to Boston for care. Nicklaus Children’s is the leader for children with heart defects in this region, while also building a broader national presence.

We are already doing a great deal, but the final 1% is the hardest. That is the barrier we are trying to break. We have a strong team, and we aim to push past that last barrier so that every child gets the best possible care and the best possible outcome. We are already bringing in new therapies. We are working toward a pediatric heart transplant program, and we have started doing living valve transplants so that the valve can grow with the child. We are also converting procedures that once required open-heart surgery into catheter-based interventions.

There is still more to do, but we have the right team to keep moving forward.