Author: Erin Horan

The future of cardiac MRI: 3-D cine

A 3-D motion-capture MRI of the heart

The heart is a dynamic, beating organ, and until now it has been challenging to fully capture its complexity by magnetic resonance imaging (MRI). In an ideal world, doctors could create a 3-D visual representation of each patient’s unique heart and watch as it pumps, moving through each phase of the cardiac cycle. Andrew Powell, MD, Chief of the Division of Cardiac Imaging at Boston Children’s Hospital, and his physicist colleague Mehdi Hedjazi Moghari, PhD, have taken steps toward realizing this vision.

The standard cardiac MRI includes multiple 2-D image slices stacked next to each other that must be carefully positioned  by the MRI technologist based on a patient’s anatomy. Planning the location and angle for the slices requires a highly-knowledgeable operator and takes time.

Powell and Moghari are working on a new MRI-based technology that can produce moving 3-D images of the heart. It allows cardiologists and cardiac surgeons to see a patient’s heart from any angle and observe its movement throughout the entire cardiac cycle.

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Intravenous oxygen delivery edges toward the clinic

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Engineered microparticles that deliver oxygen straight to the bloodstream in emergency situations

Sudden oxygen deprivation can happen for many reasons, from choking to aspiration to cardiac arrest. In these emergency situations, rapid oxygen delivery can mean the difference between life and death. But what if the person cannot breathe?

In the summer of 2012, John Kheir, MD, of the Heart Center at Boston Children’s Hospital, published a study in Science Translational Medicine describing an alternative oxygen delivery system. Kheir used tiny, gas-filled microparticles with a thin outer layer of lipids (fatty molecules) that combined to form a liquid foam-like substance. Injected into the bloodstream, the particles rapidly dissolved and delivered oxygen gas directly to the red blood cells in animal models. But the bubbles were very unstable and not suitable for clinical use.

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Using newborns’ own umbilical cords as shunts for heart surgery

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Cardiac surgery is reducing the use of plastic — starting with an operation for newborns who have life-threatening heart disease generally called single ventricle.

Single ventricle is so dangerous because it means only one of the heart’s two ventricles can adequately pump blood. Typically, affected infants undergo open-heart surgery to receive a Blalock shunt, which is a skinny tube made of PTFE — a synthetic polymer — that re-routes their blood flow to the lungs so enough oxygenated blood can get to their bodies. But when blood is exposed to foreign material, such as a plastic shunt, clots can form very easily.

This fall,a clinical trial at Boston Children’s Hospital will use patients’ own umbilical veins to create the shunt instead of plastic tubing.

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Red Zone at Home: Quality and safety beyond the hospital walls

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In an age where mobile apps, big data and sophisticated technology seem to dominate every conversation about health care innovation, Jamie Harris’s quality improvement project might not seem so revolutionary. But Harris, a nurse in the cardiac electrophysiology program at Boston Children’s Hospital, saw an opportunity to take an existing patient safety initiative and use it in a new way.

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An energy boost to the heart: Infant’s own mitochondria save her life

20160606_AveryHeart-12_with MomShe’s small for a 6-month-old, but otherwise Avery Gagnon looks perfectly healthy. She smiles, kicks, laughs and grabs her toys and pacifiers. What you’d never know is that Avery has complex congenital heart disease and might not be alive today if it weren’t for an innovative procedure that used mitochondria from her own cells to boost her heart’s energy.

The procedure is the brainchild of James McCully, PhD, a cardiovascular research scientist at the Heart Center at Boston Children’s Hospital, who spent most of his career working to solve a common complication of heart surgery: damage to heart muscle cells.

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Making ‘simple’ heart surgery simpler, with minimally invasive techniques

minimally invasive heart surgeryTertiary care centers such as the Boston Children’s Hospital Heart Center have led the way in groundbreaking surgical innovations for years, pushing boundaries and correcting ever more complex abnormalities.

But innovation is also making a difference when it comes to more “common” procedures.

“We’re always trying to make the less complex procedures shorter and less invasive,” says Sitaram Emani, MD, director of the Complex Biventricular Repair Program at the Heart Center. “Making surgery and recovery less painful and disruptive for all of our patients is a priority.”

Emani and his fellow cardiac surgeons have pioneered a minimally-invasive “scope” approach, repairing a host of common problems normally requiring open-heart surgery — including ventricular septal defects, atrial septal defects, tetralogy of fallot, aortic valve defects, vascular rings and patent ductus arteriosis (PDA) — through small incisions.

The new method not only decreases pain discomfort, and scarring, but also gets patients in and out of the hospital in half the time.

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Tissue models of heart disease provide testing ground for treatments

Pink heart circuit board EKG-shutterstock_322058528Scientists are now able to create cardiac heart muscle cells from patients with heart disease. But cells alone aren’t enough to fully study cardiac disorders — especially rhythm disorders that require the activity of multiple cells assembled into tissues.

William Pu, MD, of Boston Children’s Hospital’s Heart Center and his team are honing the art of modeling heart disease in a dish. With an accurate lab model, they hope to test drug therapies without posing a risk to living patients (or even live animals).

Together with researchers at Harvard’s Wyss Institute, Pu’s lab recently modeled a rare rhythm disorder called catecholaminergic polymorphic ventricular tachycardia (CPVT). CPVT is a dangerous disease in which the heart’s rhythm can suddenly jolt abnormally without warning. Undetectable on a resting electrocardiogram (EKG), CPVT does not affect patients at rest. However, exercise or emotional upset trigger high levels of adrenaline, which can lead to life-threatening arrhythmia, cardiac arrest and possibly sudden death.

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3-D printed hearts of hope

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Jason Ayres with son Patrick, Dr. Emani, and Patrick’s 3-D printed heart

Jason Ayres, a family doctor in Alabama, was speechless as he held his adopted son Patrick’s heart in his hands. Well, a replica of his son’s heart — an exact replica, 3-D printed before the 3-year-old boy had lifesaving open-heart surgery.

Patrick was one of the first beneficiaries of 3-D printing technology at Boston Children’s Hospital, which last year helped open a new frontier in pediatric cardiac surgery. Patrick was born with numerous cardiac problems; in addition to double outlet right ventricle and a complete atrioventricular canal defect, his heart lay backwards in his chest.

“We knew early on that he’d need complex surgery to survive,” says Jason.

Finely detailed models of Patrick’s heart created by the Simulator Program at Boston Children’s gave surgeon Sitaram Emani, MD, at the Boston Children’s Heart Center an up-close-and-personal look at his complex cardiac anatomy.

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Cardiac RESTORE: Decreasing medication dependency in the cardiac intensive care unit

child getting medicineChildren undergoing heart surgery need strong sedation and pain medications. Weaning them off these medications is complicated; many have withdrawal symptoms that require additional medications. Unfortunately, says Patricia Lincoln, RN, MS, CCRN, CNS-BC, “the medications we use to manage withdrawal may keep patients in the hospital longer.”

Last spring, Lincoln and her nursing colleagues in the Boston Children’s Hospital Cardiac Intensive Care Unit (CICU) launched an initiative called Cardiac RESTORE to help wean patients from pain and sedation medications according to a carefully designed algorithm.

“Cardiac RESTORE helps us continually assess what patients need and regulate their physiologic response to changes,” says Lincoln. “Medication doses are constantly being titrated or weaned unless the patient has an acute deterioration.”

Early results show decreased usage of pain and sedation medications with no ill effects.

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Q&A: Mosquitos, Zika virus and microcephaly in Brazil

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As you may have heard, Brazil is facing a startling outbreak of microcephaly, a rare condition in which a child is born with a head and brain that are much smaller than normal. Microcephaly is almost always associated with neurologic impairment and can be life-threatening.

The epidemic has been linked to an influx of the mosquito-borne virus Zika, first detected in Brazil last April. This past Friday, January 16, the Centers for Disease Control and Prevention issued travel warnings advising pregnant women to avoid visiting El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and Puerto Rico. And over the weekend, the first U.S. case of microcephaly linked to Zika reportedly surfaced in Hawaii.

Why this virus, why now? And how can a virus affect someone’s head size? In this Q&A on our sister blog, Thriving, Ganeshwaran Mochida, MD, of Boston Children’s Brain Development and Genetics (BrDG) Clinic, who specializes in microcephaly, and Asim Ahmed, MD, an infectious disease specialist at Boston Children’s, offer their insights.

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