Pediatric Interventional Cardiologist Joins Komansky Center for Children's Health: Introducing Dr. Ajay J. Mirani
The Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center is pleased to welcome Ajay J. Mirani, MD, as Site Director of Pediatric Interventional Cardiology.

Dr. Ajay Mirani is also an Assistant Professor of Pediatrics in the Division of Pediatric Cardiology at Weill Cornell Medical College and Columbia University College of Physicians and Surgeons as well as a member of the joint Pediatric Interventional Cardiology team at NewYork-Presbyterian Morgan Stanley Children's Hospital.

Pediatric Interventional Cardiology involves the non-surgical treatment of congenital and acquired cardiovascular disorders. Dr. Mirani and the team of interventional cardiologists are specifically trained in pediatric procedures that require special attention to smaller anatomy, making access to the vascular system often more challenging than those performed in an adult.

"I've always had a love for physiology and for physics in general," says Dr. Mirani, "and the perfect combination of these fields I found in cardiology. These interests along with my passion to advocate for the health and well being of children naturally led me to pursue a career in pediatrics and pediatric cardiology."

Treating Congenital Heart Disease

Dr. Mirani is skilled in performing diagnostic and interventional cardiac catheterizations on patients of all ages with congenital heart disease, including:

catheter based closure of atrial septal defects
device closure of a patent ductus arteriosus
balloon valvuloplasty for aortic valve stenosis and pulmonary valve stenosis
cardiac biopsies for heart transplant patients
balloon angioplasty, and
stent placement for narrowing of the aorta and for pulmonary artery stenosis

Dr. Mirani is also trained in performing diagnostic and interventional cardiac catheterizations for young patients with heart conditions, including:

dilated or restrictive cardiomyopathy (abnormal heart muscle tissue)
ventricular septal defects
Tetralogy of Fallot (a combination of congenital cardiac anomalies)
hypoplastic left heart syndrome
tricuspid atresia or absence of the tricuspid valve
Ebstein's anomaly an anomaly of the tricuspid valve
truncus arteriosus malformation of the large arteries
transposition of the great arteries

"Most of our patients have congenital heart disease with severely malformed hearts, while some patients have minor defects," says Dr. Mirani. "In many cases, it is possible to perform a cardiac catheterization. This type of procedure can diagnose and treat a wide spectrum of disorders, ranging from closing a small hole in the heart to managing a patient in whom a large part of the heart that has not even developed," continues Dr. Mirani. "

New Possibilities for Catheterization

A catheterization is a minimally invasive procedure that can avoid having to make a large incision in the patient's chest or put them on a heart-lung bypass machine thereby avoiding open heart surgery.

"What makes our service unique and innovative are the types of procedures that we're able to do now via catheterization," notes Dr. Mirani. "We utilize various techniques for very specific conditions by accessing one of the blood vessels in a patient's leg. Through that blood vessel we insert tiny plastic tubes called catheters that we thread up to the heart, and through these catheters we are able to measure pressure and oxygen levels inside various chambers of the heart, as well as in the blood vessels around the heart. We are also able to take special x-rays called angiograms during the procedure. Based on the information that we find, we're able to determine whether or not we can do something interventionally for these patients. If we are able to intervene, the entire procedure is then performed through the catheters that are already in place."

Interventional Cardiology -- A Rapidly Changing Field

Interventional cardiology has undergone tremendous expansion and change over the past 20 years, with the introduction of many new techniques and devices. Balloon valvuloplasty has become the treatment of choice for pulmonary valve stenosis at all ages and is also the treatment of choice for aortic valve stenosis in neonates, children, and young adults.

"In recent years, there have been many iterations and changes in interventional procedures, as well as with surgical approaches," says Dr. Mirani. "As a result, patients are starting to survive much, much longer. Patients who would not previously have lived more than a few hours after birth are now able to undergo an emergent, interventional cardiology procedure as well as surgery within the newborn period. It's very gratifying to see these newborn infants recover, go home with their parents, and go on to lead normal lives."

Some young patients are able to wait longer and may eventually have interventional procedures within the first few years of life. "With certain heart defects, we are able wait until the child is a little bit older, usually within the school-age range," says Dr. Mirani. "This is because as the heart gets bigger, we have more room in which to work, thereby further reducing the risk of complications.

More About Dr. Mirani

Dr. Mirani most recently served on the medical faculty at the Robert Wood Johnson Medical School as Clinical Instructor of Pediatrics, where he was actively involved in patient care and in medical education. Simultaneously, he worked as a Pediatric Emergency Department physician at Robert Wood Johnson University Hospital.

Dr. Mirani completed his undergraduate studies at Johns Hopkins University, his Master of Science degree at the University of Pittsburgh, and his Doctor of Medicine at Temple University School of Medicine. He completed his internship and residency training in pediatrics at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School. Dr. Mirani then went on to complete fellowship training in Pediatric Cardiology and Interventional Pediatric Cardiology (cardiac catheterization) in the joint fellowship program at NewYork-Presbyterian Hospital.

For More Information

The Pediatric Interventional Cardiology program at NewYork-Presbyterian Komansky Center for Children's Health is available for urgent and emergent services around the clock.

To make an appointment, refer a patient or for more information, please call (212) 746-3561.

Faculty Contributing to this Article: Ajay J. Mirani, MD, Site Director of Pediatric Interventional Cardiology, Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Assistant Professor of Pediatrics in the Department of Pediatric Cardiology at Weill Cornell Medical College and Columbia University College of Physicians and Surgeons

(This article originally appeared in Children's Health-e-News, NYP's electronic newsletter for pediatric patients and their families. To subscribe, please visit the NYP Komansky Center for Children's Health website.)