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Paediatric Cardiology

Part of the Paediatric Cardiology service of the Western Cape

Unit profile | Clinical Activities | Teaching and Training | Division Highlights | Research | Publications

Staff


 Consultants
A/Prof Rik De Decker (UCT)
rik.dedecker@uct.ac.za
A/Prof Liesl Zuhlke (UCT)
liesl.zuhlke@uct.ac.za
Dr George Comitis (UCT)
george.comitis@uct.ac.za
Dr Barend Fourie
(Stellenbosch University)
bfourie@sun.ac.za
Part-time Consultants
      
Dr Lenise Swanson Dr Harold Pribut Dr Liesl Andrag
Senior Registrars
Dr Fenny Shidhika Dr Mark Willoughby
 Sessional Medical Officers
Dr Wendy Matthiassen Dr Babs Mostert
 Cardiac Liaison Nursing Sister                      Cardiology Clerk
Sr Charnette Elliot
(021) 658-5366
Ms Eloise Hendricks
  (021) 658-5300
  (021) 685-4933

Contact Numbers    
Ward: E1 E-Floor, Red Cross Children's Hospital (021) 658-5251
OPD:  S27, Red Cross Children's Hospital (021) 658-5002
Cath Lab: Theatre Complex, C Floor, Red Cross Children's Hospital (021) 658-5227
Echo Room: B-Floor, Red Cross Children's Hospital (021) 658-5588

Associated Clinics


Grown-up Congenital  Heart Disease (GUCH) Clinic, E17, Groote Schuur Hospital
Combined Cardio Obstetrics Clinic (CCOC), Maternity Block, Groote Schuur Hospital

Unit Profile


The Paediatric Cardiology Service of the Western Cape is the largest public service unit looking after people with heart disease from birth up until adulthood.  We are a cross-platform unit that serves patients at both Red Cross Children’s Hospital and Tygerberg Children’s Hospital with consultative services and in-patient care available at both sites.  In addition, we also see newborn patients suspected of having heart disease in the neonatal services at Groote Schuur, Tygerberg and Mowbray Maternity Hospitals.

We work closely with our colleagues in the foetal medicine units as well as in the adult cardiology services of Tygerberg and Groote Schuur Hospitals. We help our surgical and critical care colleagues care for the patients who have undergone cardiac surgery at Red Cross Children's Hospital.  Our referral base includes the Western Cape and half of the Eastern Cape Province. In addition, outreach clinics are also run in East London and George Hospital twice a year, in Paarl three times a year and in Worcester four times a year.

 Clinical Activities


  1. Inpatient care and consultation
  2. Echocardiography
  3. Paediatric cardiac catheterisation
  4. Paediatric cardiac surgery
  5. Outpatient clinics
  6. After hours consultation
  7. Surgical meetings
  8. CATHCHAT

Timetable:

  Monday Tuesday Wednesday Thursday Friday
7:30-8:30am ICU ward rounds followed by E1 ward rounds
am Cardiac OPD
clinic at TBH
Cardiac OPD clinic Cardiac Cath Day


Foetal echoes
Discharges &pre-clinic echoes *GUCH clinic
#CCOC clinic
pm Cardiac OPD
clinic
Cath intake Cardiac OPD
clinic
Cardiac surgical
meeting
4:00pm ICU ward rounds followed by E1 ward rounds

* Grown-up Congenital Heart Disease
# Combined Cardiac Obstetric Clinic


Teaching and Training


The unit provides education and training to undergraduates and postgraduate students at both campuses.

Undergraduate:

The unit is involved in providing classroom seminars and clinical bedside teaching to medical students in their fifth and sixth years of study.  Staff members contribute to weekly bedside teaching of 5th year medical students and seminars every 8 weeks to the whole group of students assigned to Paediatrics.  Ward rounds are used to educate 5th and 6th year students.

Postgraduate:

Postgraduate training programs currently offered by our unit include;

  1. A one year full-time or two year part-time postgraduate diploma in clinical paediatric cardiology open to all doctors with an MBChB degree and available through UCT.

  2. A three year MPhil degree for subspecialisation in paediatric cardiology available to qualified and registered paediatricians and culminating in a Certificate in Paediatric Cardiology exit examination. Certification is obtained through the College of Medicine of South Africa (CMSA) and senior registrars are taught at UCT while in the service of the Department of Health.

  3. A (non-compulsory) minor dissertation available upon completion of subspecialist training.

We also provide supervision and mentorship to a number of postgraduate students undertaking Masters or PhD projects.

Fellowships:

The paediatric cardiology unit provides a platform for training paediatricians from other African countries as part of the African Paediatric Fellowship Programme (APFP). The APFP was established in 2007 in the Department of Paediatrics and Child Health at the University of Cape Town.

APFP trainees spend between one to three years training in the paediatric cardiology unit with a focus on clinical and echocardiography skills. This allows them to return to their home countries as generalists with special skills in paediatric cardiology. In the past five years we have hosted trainees from Uganda, Zimbabwe, Zambia and Namibia.

Visiting Scholars/Students:

Our unit plays host to numerous visiting scholars from around the world looking to create collaborative relationships and conduct research. To date we have had scholars visit us from Germany, Australia, the United Kingdom and America amongst others.

Division Highlights


Members of the division are involved in a wide range of clinical and research activities.

Head of Department: Professor John Lawrenson

  • Clinical Interests: Echocardiography and Rheumatic Heart Disease.

  • Research: Professor Lawrenson is the lead investigator of the IMHOTEP (The African Cardiomyopathy and Myocarditis Registry Programme), INVICTUS (Investigation of Rheumatic AF Treatment Using Vitamin K Antagonists, Rivaroxaban or Aspirin Studies) and PROTEA (A North-South Partnership in Congenital Heart Disease) studies at the Tygerberg Hospital site.

Director of the Cath Lab and CATHCHAT: A/Professor Rik Decker

  • Clinical Interests: Interventional Cardiac Catheterisation, Risky Business.

  • Research:  A/Professor De Decker leads the CATHCHAT program at Red Cross Children’s Hospital. CATHCHAT is a novel live online teaching and learning platform for interventional paediatric cardiac catheterisation aimed at stimulating interest in interventional cardiac catheterisation and developing capacity in Africa.

Director of the Children’s Heart Disease Research Unit: A/Professor Liesl Zühlke

  • Clinical Interests: Rheumatic Heart Disease, Global Health, Adolescent Transitional Care, Grown-Up Congenital Heart Disease, Combined Cardio-Obstetrics and Quality Improvement.

  • Research and Interests:  A/Professor Zuhlke is the past-president of the Paediatric Cardiac Society of South Africa, current president of the South African Heart Association, chairperson of the paediatric task-force of the Pan-African Society of Cardiology and director of the Children’s Heart Disease Research Unit. She is an NRF-rated researcher, holder of several major NRF, MRC and MRC-UK grants, has an H-index of 23, H-10 of 33 and has published over 80 peer-reviewed papers in international journals including Circulation, Lancet and the European Journal of Cardiology. Her work is largely driven by an ethos of integrating research and clinical practice in order to improve the lives of those with congenital and paediatric heart disease through conducting innovative, patient-centred and accountable research with a focus on African areas of need.

Director of the Echo Lab: Dr George Comitis

  • Clinical Interests: Echocardiography and Multi-Modality Imaging.

  • Research: Dr Comitis is the co-lead investigator of the IMHOTEP study at the Red Cross Hospital site as well as an investigator on the PROTEA and Panorama-Heart Failure (LCZ) studies.

Full-time consultant at Tygerberg Hospital: Dr Barend Fourie

  • Clinical Interests: Cardiac Catheterisation and Multi-Modality Imaging.

  • Research: Dr Fourie is the co-lead investigator of the IMHOTEP, INVICTUS and PROTEA studies at the Tygerberg Hospital site.

Research


Our unit is involved with the ASAP Rheumatic Fever and Rheumatic Heart Disease program. In addition we are also involved in setting international standards for echocardiographic surveillance in screening studies of populations at risk for rheumatic heart disease. We are a participating centre for the IMHOTEP cardiomyopathy/myocarditis registry and have an ongoing interest in the genetics of congenital heart disease.

We are also strongly affiliated with the Children’s Heart Disease Research Unit (CHDRU) which was established as a key element within the department in May 2015. The CHDRU is based at Red Cross War Memorial Children’s Hospital under the auspices of the University of Cape Town and has firm ties with the Departments of Cardiothoracic Surgery, Adult Cardiology and Medicine. The specific aims of the CHDRU are to facilitate current research activities in congenital and paediatric heart disease whilst building capacity to support such research. Current and ongoing projects include the flagship PROTEA study, the Adole 7C (Adolescents receiving Continuous Care for Childhood-onset Chronic Conditions) study, IQIC (International Quality Improvement Collaborative for Congenital Heart Surgery), LCZ, INVICTUS and IMHOTEP among others.

Publications


There have been numerous articles published in association with and by members of the paediatric cardiology unit in recent years.  Some of the more notable publications are listed below and a full list of publications can be downloaded here.  

  • De Decker HP and Lawrenson JB.  "The 22q11.2 deletion: From diversity to a single gene theory".  Genetics in Medicine, 2001; 3(1): 4-6.

  • Du Toit, Von Oppell UO, Hewitson J, Lawrenson J, Davies J.  "Left ventricular sub-vulvar mitral aneurysms". Interact Cardiovasc Thorac Surg, 2003; 2(4): 547-51.

  • Hatherill M, Levin M, Lawrenson J, Hsiao NY, Reynolds L, Argent A. ‘Evolution of an adenovirus outbreak in a multidisciplinary children's hospital’. J Paediatr Child Health. 2004; 40(8): 449-54.

  • Walker KG, Lawrenson J, Wilmshurst JM. ‘Neuropsychiatric movement disorders following streptococcal infection’. Dev Med Child Neurol. 2005; 47(11): 771-5.

  • Hatherill M, Salie S, Waggie Z, Lawrenson J, Hewitson J, Reynolds L, Argent A. ‘Hyperchloraemic metabolic acidosis following open cardiac surgery’. Arch Dis Child. 2005; 90(12): 1288-92.

  • Rode H, Fieggen AG, Brown RA, Cywes S, Davies MR, Hewitson JP, Hoffman EB, Jee LD, Lawrenson J, Mann MD, Matthews LS, Millar AJ, Numanoglu A, Peter JC, Thomas J, Wainwright H. ‘Four decades of conjoined twins at Red Cross Children's Hospital--lessons learned’. S Afr Med J. 2006; 96(9 Pt 2): 931-40.

  • Roussot MA, Lawrenson JB, Hewitson J, Smart R, De Decker HP. ‘Is cardiac surgery warranted in children with Down syndrome? A case-controlled review’. S Afr Med J. 2006; 96(9 Pt 2): 924-30.

  • Lawrenson JB, Kalis NN, Pribut H, Hewitson J, Shipton S, Stirling J, De Decker R. ‘Why are some South African children with Down syndrome not being offered cardiac surgery?’. S Afr Med J. 2006; 96(9 Pt 2): 914-9.

  • Walker K, Lawrenson J, Wilmshurst JM. ‘Sydenham's chorea--clinical and therapeutic update 320 years down the line’. S Afr Med J. 2006; 96(9 Pt 2): 906-12.

  • Mayosi B, Robertson K, Volmink J, Adebo W, Akinyore K, Amoah A, Lawrenson J, et al. ‘The Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease in Africa’. South African Medical Journal, 2006; 96(3): 246-246.

  • Hatherill M, Salie S, Waggie Z, Lawrenson J, Hewitson J, Reynolds L, Argent A. ‘The lactate: pyruvate ratio following open cardiac surgery in children’. Intensive Care Med. 2007; 33(5): 822-829.

  • Carapetis J and Zühlke LJ. ‘Global research priorities in rheumatic fever and rheumatic heart disease’. Annals of Paediatric Cardiology, 2011; 4(1).

  • Walker KG, Cooper M, McCabe K, Hughes J, Mathiassen W, Lawrenson J, Wilmshurst JM. ‘Markers of susceptibility to acute rheumatic fever: the B-cell antigen D8/17 is not robust as a marker in South Africa’. Cardiol Young. 2011; 21(3): 328-33.

  • Andrag L and De Decker R. ‘Pattern recognition in paediatric ECGs: the hidden secrets to clinical diagnosis’. Continuing Medical Education, 2011; 29(11): 452.

  • Hewitson J and De Decker R. ‘Congenital heart surgery: what we do to our patients’. Continuing Medical Education 2011; 29(11): 467-470.   

  • Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Zühlke L, et al. 'World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline'. Nature Reviews Cardiology, 2012; 9(5): 297-309.

  • Walker K, Brink A, Lawrenson J, Mathiassen W, Wilmshurst JM. ‘Treatment of sydenham chorea with intravenous immunoglobulin’. J Child Neurol. 2012; 27(2): 147-55.

  • Zühlke L, Mirabel M, Marijon E. ‘Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities’. Heart, 2013.

  • De Decker R, Comitis G, Border W and DeGiovanni J. ‘Coronary cameral fistula occlusion: when is better the enemy of good?’. SA Heart, 2013; 10(2): 472-474.

  • Vivian L, Naidu C, Hunter C, Lawrenson J, Comitis G, Argent A. ‘A Qualitative Study of Cardiac Surgery and Perioperative Care At the Red Cross War Memorial Children’S Hospital, Cape Town, South Africa’. Pediatric Critical Care Medicine, 2014; 15(4_suppl): 22.

  • De Decker R, Comitis G, Thomas J, van der Merwe E and Lawrenson J. ‘A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus’. Cardiology in the Young, 2015; 22: 1-7.

  • Engel ME, Haileamlak A, Zühlke LJ, Lemmer CE, Nkepu S, van de Wall M, et al. ‘Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia’. Heart, 2015; 101(17): 1389-94.

  • Zuhlke LJ,Engel ME, Watkins D, Mayosi BM. 'Incidence, prevalence and outcome of rheumatic heart disease in South Africa: a systematic review of contemporary studies'. International Journal of Cardiology, 2015; 199: 375-83.

  • Zühlke LJ, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. ‘Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)’. European Heart Journal, 2015; 36(18): 1115-22a.

  • Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Zühlke LJ, et al. 'Acute rheumatic fever and rheumatic heart disease'. Nature Reviews Disease Primers, 2016; 2: 15084.

  • Watkins D, Zühlke L, Engel M, Daniels R, Francis V, Shaboodien G, et al. 'Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communique'. Cardiovascular Journal of Africa, 2016; 27: 1-5.

  • De Decker R, Bruwer Z, Hendricks L, Schoeman M, Schutte G, Lawrenson J. ‘Predicted v. real prevalence of the 22q11. 2 deletion syndrome in children with congenital heart disease presenting to Red Cross War Memorial Children’s Hospital’. South African Medical Journal, 2016; 106(6): S82.

  • De Decker R, Comitis G, Thomas J, van der Merwe E, Lawrenson J. ‘A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus’. Cardiology in the Young, 2016; 26(7): 1352-1358.

  • De Decker R. ‘Understanding the epigenetic origins of congenital heart disease may lead to its control’. SA Heart, 2016; 13: 90-96.

  • Jankelow D, Cupido B, Zühlke L, Sliwa K, Ntsekhe M, Manga P, Doubell A, Lawrenson J and Essop MR. ‘Prevention of infective endocarditis associated with dental interventions: South African heart association position statement, endorsed by the South African dental association. SA Heart, 2017; 14(3): 170 – 174.

  • Comitis G, Lawrenson J, Van Schalkwyk A, Zühlke L. ‘Refractory, missed and severe Kawasaki disease: Diagnostic and therapeutic challenges’. SA Heart Journal, 2017; 10(2): 462-468.

  • Jankelow D, Cupido B, Zühlke L, Sliwa K, Ntsekhe M, Manga P, Doubell A, Lawrenson J, et al. ‘Prevention of infective endocarditis associated with dental interventions’. SA Heart, 2017; 14(3): 170-174.

  • Vivian L, Comitis G, Naidu C, Hunter C, Lawrenson J. ‘A first qualitative snapshot: cardiac surgery and recovery in 10 children in the Red Cross War Memorial Children’s Hospital, Cape Town, South Africa (2011–2016)’. Cardiology in the young, 2018; 28(2): 322-328.

We strive to work with parents and families to provide family-centred, community appropriate care and treatment. Please contact us for any further information on our department and the work that we do.