Stories about: heart

#TBT: How hyperbaric heart surgery saved infants’ lives in the 1960s

Boston Children’s surgical team entering the hyperbaric chamber, loaned from Harvard School of Public Health.
Boston Globe clipping about hyperbaric chamber
From the Boston Sunday Globe, Feb. 10, 1963.

In 1962, the Harvard School of Public Health made a critical loan to Boston Children’s Hospital: the Harvard hyperbaric chamber. It established a new approach to pediatric heart surgery at Boston Children’s.

For many children — including a premature infant named Janet, born in 1964 with a heart murmur — the hyperbaric chamber would prove to be life-saving.

At that time, before the invention of the heart-lung bypass machine, hyperbaric chambers offered a way to operate on infants more safely. That’s because hyperbaric oxygenation, coupled with the effects of increased pressure on the respiratory system, seemed to give infants a better chance of surviving heart surgery.

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3-D printed hearts of hope

Jason Ayres Patrick and Emani cropped
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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New and improved device shows promise for pediatric heart surgery

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In the Norwood procedure for HLHS, a graft creates a conduit between the right ventricle and the aorta, diverting blood flow from the underdeveloped left ventricle. But that graft can wear out. (BLUE represents oxygen-poor blood; RED, oxygen-rich blood; PURPLE, a mixture of the two.)

Hypoplastic left heart syndrome (HLHS) is a rare but serious form of congenital heart disease that leaves the left pumping chamber (ventricle) of the heart severely underdeveloped. Children born with HLHS can’t pump enough oxygenated blood from their heart to the rest of their body and need surgery as soon as possible to survive. Treatment ultimately involves three corrective surgeries throughout the infant and toddler years.

The first surgery, known as the Norwood procedure, is the riskiest of the three. Ideally performed within the first week of life, the procedure re-routes the heart’s plumbing to ensure enough oxygenated blood is circulated while the child grows big enough for the second surgery. A device called a graft is used to connect the fully-functional right ventricle to the aorta, bypassing the stunted left ventricle, for proper blood flow. However, with each ventricular contraction, the graft gets squeezed, which can cause it to shift or lose its shape over time. Repeat interventions to adjust the graft are often needed.

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First six months of life are best for stimulating child heart growth

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In these sample sections of mouse heart, the color blue signifies scar tissue. Damage from scarring was minimized by early administration of the drug neuregulin.

Developing a child-centric approach to treating heart failure is no easy task. For one thing, the underlying causes of decreased cardiac function in children vastly differ from those in adults. While most adults with heart failure have suffered a heart attack, heart failure in children is more likely the result of congenital heart disease (CHD), or a structural defect present at birth that impairs heart function. And most therapies designed for adults haven’t proven equally effective in children.

Stimulating heart muscle cells to regenerate is one way cardiac researchers at Boston Children’s Hospital’s Translational Research Center hope to restore function to children’s ailing hearts. In this area, children actually have an advantage over adults: their young heart cells are better suited for regrowth.

Reporting in the April 1 Science Translational Medicine, Brian Polizzotti, PhD, and Bernhard Kuhn, MD, demonstrate that not only does the drug neuregulin trigger heart cell regeneration and improve overall heart function in newborn mice, but its effects are most potent for humans within the first six months of life.

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Catching—and avoiding—long-term rejection of heart transplants

As the close of American Heart Month draws near, let’s take a moment to learn what two teams of scientists are doing to help heart transplant patients keep their new hearts in the long run. (englishsnow/Flickr)

You’re a heart transplant patient. You’ve been on the waiting list for months, maybe years. Now, you’re being wheeled out of the operating room, a donated heart beating in your chest.

You’ve finished one journey, but are only just starting on a new one: keeping your body from rejecting your new heart.

Luckily for you, new methods under development could help tell early on when chronic rejection problems—the kind that arise five or 10 years after your transplant—start to loom. And even better, scientists are homing in on a new way to prevent chronic (and maybe short-term) rejection from happening in the first place.

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App-solute adherence: Using mobile technology to prevent transplant rejection

A new smartphone app could help teenagers remember to take their medications on time. Image courtesy of www.thatsnicephotography.co.uk

After an organ transplant, patients need to adjust to a lot of strict routines. This is hard, especially for teenagers who are trying to navigate adolescence. Some young patients say it’s difficult to remember when they need to take all their medications to prevent organ rejection, especially when they’re not feeling ill. Others complain that their parents’ constant harping to follow their care team’s instructions makes them want to do the exact opposite.

No matter the reason, thousands of teenagers are at risk of compromising their grafted organ.

Researchers at Boston Children’s Pediatric Transplant Center are developing a smartphone application that they hope will help adolescents understand the importance of taking care of themselves. But they realize that it’s not enough to take a clinical approach and it give an app makeover. In other words, to truly make an impact on teenagers, the app needs to be more than an electronic version of their parents.

“We really need to create ways to communicate with young patients that’s right for their age and treatment stage,” says Kristine McKenna, PhD, a psychologist with the Pediatric Transplant Center. “If you’re too patriarchal, or if you try to dumb things down too much, teens pick up on that and resent it. But if it’s too high-level they can become overwhelmed.”

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Defying orders to make heart surgery history

When the first fetal cardiac surgery was performed at Children’s Hospital Boston in 2001 – entering Jack Miller’s heart through his mother’s abdomen and opening blood flow – the world was stunned. But more than 60 years earlier, another operation was equally game-changing.

It was 1938, a time before heart-lung bypass, when ether and chloroform were only starting to be supplanted by more controllable anesthetics, when tinkering with the heart or even opening the chest were seen as dangerous and taboo.

Tinkering was what Robert E. Gross, chief surgical resident at The Children’s Hospital, liked to do. He was interested in a congenital heart condition known as patent ductus arteriosus, a passageway between the pulmonary artery and the aorta that’s supposed to close after birth — but doesn’t.

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Newly approved Berlin Heart helps patients waiting for a transplant

On the Berlin Heart, Alina Siman, 4, has regained her energy which will make her a better transplant candidate when a new organ becomes available

Four-year-old Alina Siman is being kept alive on a device that gained approval in the U.S. just two weeks ago. The Berlin Heart Group’s EXCOR, a ventricular assist device manufactured in Berlin, Germany, takes over the normal function of a heart by pumping blood directly to the pulmonary artery and into the lungs.

With FDA approval granted on December 16, the U.S. joins Europe and Canada in offering the device for children of all ages with end stage heart failure.

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Avoiding the needle: Engineering blood vessels to secrete drugs

Within days of injecting a cell mix into mice, numerous blood vessels form. Can these vessels be made to secrete drugs, without the need for IVs or injections?

People who rely on protein-based drugs often have to endure IV hookups or frequent injections, sometimes several times a week. And protein drugs – like Factor VIII and Factor IX for patients with hemophilia, alpha interferon for hepatitis C, interferon beta for multiple sclerosis — are very expensive.

What if they could be made by people’s own bodies?

Combining tissue engineering with gene therapy, researchers at Children’s Hospital Boston showed that it’s possible to get blood vessels, made from genetically engineered cells, to secrete drugs on demand directly into the bloodstream. They proved the concept recently in the journal Blood, reversing anemia in mice with engineered vessels secreting erythropoietin (EPO).

This technology could potentially deliver other protein drugs,

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MRI-powered medical robots are coming

It began as a proof-of-principle demonstrated with LEGOs – a surgical biopsy needle whose motor is driven solely by a clinical MRI scanner:

The above demo shows that an MRI machine’s magnetic field can be programmed to produce enough force to control a robotic instrument — an accomplishment with broad potential in medicine. In the demo, the scanner’s magnetic field swings a rotating arm, and a set of gears convert that motion into the motion of a biopsy needle, strong enough to puncture the tough outer tissue of an animal heart and then withdraw. All parts exposed to the magnetic field are metal-free and MRI-compatible.

While MRI-compatible robots have been built before, this was the first demo of a motor powered by MRI, says Pierre Dupont, chief of Pediatric Cardiac Bioengineering at Children’s Hospital Boston. His engineering team was one of five finalists for Best Paper Award — out of 790 papers presented — at last week’s International Conference on Intelligent Robots and Systems (IROS 2011).

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