Congestive heart failure

Children’s Hospital Boston is a world leader in opening new avenues of “translational research,” bringing laboratory advances to the bedside and doctor’s office as soon as possible. Senior medical staff members of the Department of Cardiology participate in clinical research activities, and many conduct laboratory research, as well.

Members of the Children’s Cardiac Surgery Research Laboratory—a multidisciplinary team of basic and applied research investigators who hold faculty appointments at Harvard Medical School—are studying the mechanisms of heart disease and new treatments for children with congenital heart defects and congestive heart failure.

Cardiac innovations

Reawakening the heart’s regenerative capacities

The problem: Kids with congenital heart defects often suffer from heart failure. And since heart muscle has little growth capacity after birth—nowhere near enough to fix a severe cardiac injury—a heart transplant is often the only treatment option.

Innovative solution: Researchers in Children’s Cardiovascular Program discovered a growth factor, called neuregulin1 (NRG1), that can reawaken the heart’s regenerative capacities, and may be able to strengthen the heart after a heart attack and in children and adults with heart failure.

NRG1, which is involved in the initial development of the heart and nervous system, spurred heart-muscle growth and recovery of cardiac function when injected systemically in rats. Preparations are underway to test the growth factor in humans. Doctors now envision a time when patients will receive monthly infusions to build up their hearts.

Creating new ways to perform surgery

Problem: When surgeons perform heart surgery on a baby, they need to open the infant’s chest and stop her heart—an inva­sive, lengthy procedure that can cause life-threatening complications. Pedro del Nido, MD, chief of Cardiac Surgery at Children’s, had to perform surgery on his tiny patients using this method, or come up with a way to improve it.

Innovative solution: Del Nido decided to develop a way to perform surgery on a still-beating heart. But he needed two things that didn’t exist: superior imaging tools that could show the structures inside the heart while it’s beating, and tiny instruments to perform the intricate surgery.

So he bor­rowed technology from the videogame industry and developed stereo-rendered 3-D ultrasound imaging that allows surgeons to see inside the beating heart as a hologram.

Del Nido also designed new instruments. One is a millimeter-sized tool that extends into the heart through needle-sized incisions. Using a joystick controller and real-time imaging, a surgeon can now navigate through the beating heart’s chambers to remove blockages, repair faulty valves and close leaks.

Results: Del Nido’s 3-D tool appears not only to provide superior imaging, but also to yield faster surgery times. Researchers using it to operate on pigs with congenital heart disease performed the procedure 44 per­cent faster than before. Learn more.

A life-saving bridge to transplant

Problem: Sometimes, children waiting for donor hearts are so sick that they must be placed on life support mechanisms that keep them immobilized and unresponsive.

Innovative solution: Children’s cardiologists and cardiovascular surgeons have researched, written about and implanted the Berlin Heart. This is a device that pumps blood from the heart to the body and/or to the lungs. Only the “delivery tubes” are implanted, and the rest of the device operates on a rolling cart outside of the body, so your child can move around.

Results: In 2008, we became one of only 10 pediatric institutions in the United States to receive unconditional approval from the FDA for ongoing Investigational Device Exemption (IDE). That means that even though the device has not yet secured full FDA approval, if your child needs a Berlin Heart, our experts are trusted to implant and maintain it.

Children’s scientific research program is one of the largest and most active of any pediatric hospital in the world. In particular, our cardiovascular and cardiac surgery researchers are yielding crucial insights into the causes and development of heart disease and disorders; paving ground for the most promising new treatments and interventions; and offering ideas and discoveries that could one day lead to cures. 

Learn more about the Cardiovascular Program at Children’s Hospital Boston.

© Children’s Hospital Boston, 2010