Stories about: Heart Center

Monitoring mitochondria: Laser device tells whether oxygen is sufficient

Shining a laser-based device on a tissue or organ may someday allow doctors to assess whether it’s getting enough oxygen, a team reports today in the journal Science Translational Medicine.

Placed near the heart, the device can potentially predict life-threatening cardiac arrest in critically ill heart patients, according to tests in animal models. The technology was developed through a collaboration between Boston Children’s Hospital and device maker Pendar Technologies (Cambridge, Mass.).

“With current technologies, we cannot predict when a patient’s heart will stop,” says John Kheir, MD, of Boston Children’s Heart Center, who co-led the study. “We can examine heart function on the echocardiogram and measure blood pressure, but until the last second, the heart can compensate quite well for low oxygen conditions. Once cardiac arrest occurs, its consequences can be life-long, even when patients recover.”

In critically ill patients with compromised circulation or breathing, oxygen delivery is often impaired. The new device measures, in real time, whether enough oxygen is reaching the mitochondria, the organelles that provide cells with energy.

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Can we improve neuropsychiatric outcomes in children with congenital heart disease?

Jane Newburger studies neurodevelopment in children with congenital heart defects
Jane Newburger, MD, has dedicated her career to helping children with heart defects reach their full potential.

About 1 out of 100 babies are born with a congenital heart defects. Thanks to medical and surgical advances, these children usually survive into adulthood, but they are often left with developmental, behavioral or learning challenges.

Children with “single-ventricle” defects — in which one of the heart’s two pumping chambers is too small or weak to function properly — are especially at risk for neurodevelopmental problems. “Single-ventricle physiology creates cerebrovascular hemodynamics that can reduce oxygen delivery to the brain,” explains Jane Newburger, MD, MPH, director of the Cardiac Neurodevelopmental Program at Boston Children’s Hospital.

How does this play out in adolescence? In three recent studies, Boston Children’s Heart Center collaborated with the departments of Neurology and Psychiatry to track neurodevelopmental outcomes after corrective Fontan operations. They evaluated preteens and teens as old as 19 — the longest follow-up to date.

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Preparing patients and families to manage ventricular assist devices

Beth Hawkins ventricular assist devices

Children in severe heart failure sometimes have a ventricular assist device (VAD) implanted in their chest. VADs are electrically-powered heart pumps that can tide children over while they wait for a heart transplant. They can also be implanted long term if a child is ineligible for transplant, or simply buy children time to recover their own heart function.

Because problems with VADs can be life-threatening, families need extensive training in managing the device and its external controller at home. Nurse practitioner Beth Hawkins RN, MSN, FNP-C, and her colleagues in the Boston Children’s VAD Program begin the training at the child’s hospital bedside while they are still in the cardiac ICU. But despite lectures, demos and practice opportunities, the prospect of maintaining a VAD remains terrifying for many parents and children.

“A lot of families feel their child is attached to a ticking time bomb that could go off at any time,” says Hawkins. “Many say taking a child home on a VAD feels like having a newborn baby again.”

Hawkins realized that families needed more support.

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Soft robot could aid failing hearts by mimicking healthy cardiac muscle

heart-failure

Every year, about 2,100 people receive heart transplants in the U.S., while 5.7 million suffer from heart failure. Given the scarcity of available donor hearts, clinicians and biomedical engineers from Boston Children’s Hospital and Harvard University have spent several years developing a mechanical alternative.

Their proof of concept is reported today in Science Translational Medicine: a soft robotic sleeve that is fitted around the heart, where it twists and compresses the heart’s chambers just like healthy cardiac muscle would do.

Heart failure occurs when one or both of the heart’s ventricles can no longer collect or pump blood effectively. Ventricular assist devices (VADs) are already used to sustain end-stage heart failure patients awaiting transplant, replacing the work of the ventricles through tubes that take blood out of the heart, send it through pumps or rotors and power it back into a patient’s bloodstream. But while VADs extend lives, they can cause complications.

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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

intravenous-oxygen-delivery
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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Red Zone at Home: Quality and safety beyond the hospital walls

taking meds at home 3 _shutterstock_141046318

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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