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Patent Foramen Ovale

  • Overview

    If your infant or child has been diagnosed with a patent foramen ovale (PFO), Children’s Hospital Boston can help you understand your child’s condition and cope with this relatively common congenital (present at birth) heart defect. Unlike many other heart defects, PFO in isolation (occurring by itself without other defects) usually causes no symptoms and doesn’t need treatment—making your child’s outlook for future health very positive.

    • A foramen ovale is a hole (flap) between the wall (atrial septum) that separates the heart’s right and left upper chambers (atria).
    • Before a baby is born, this flap is a naturally occurring opening, allowing blood to bypass the fetus’ lungs, which will not receive oxygen until the baby’s first cry at birth.
    • After birth, the foramen ovale seals in 75 percent of people. In the other 25 percent, the opening fails to seal and remains open (patent)—this persistently open hole is a patent foramen ovale. It is similar in location to ASD (atrial septal defect), but its effects on the body are extremely limited.
    • The exact cause of PFO is unknown, but it’s thought that heredity and genetics may play a role.
    • Unless a child has other associated heart defects, it is unlikely that symptoms or complications from PFO will ever occur.
    • Rarely, a baby with a PFO will develop a bluish skin tone (cyanosis), noted especially with straining (as in a bowel movement) or crying.
    • A PFO is often closed surgically if it’s associated with more complex heart defects, such as hypoplastic left heart syndrome, Ebstein’s anomaly or pulmonary atresia.

    How Children’s Hospital Boston approaches patent foramen ovale

    Our team in Children’s Heart Center understands that a diagnosis of a PFO can be distressing for parents. It’s unlikely that your child will need treatment for an isolated PFO. But if further understanding or therapy is suggested, you can have peace of mind knowing that our doctors treat some of the most complex pediatric heart conditions in the world, with overall success rates approaching 98 + percent—among the highest in the nation among large pediatric cardiac centers.

    Our clinicians will work closely with you to determine the right treatment plan for your child. We provide families with a wealth of information, resources, programs and support—before, during and after your child’s treatment. With our compassionate, family-centered approach to treatment and care, you and your child are in the best possible hands.

    Patent foramen ovale: Reviewed by Michael Landzberg, MD

    © Children’s Hospital Boston, 2011

    Children’s a world leader in pediatric research

    Consistently ranked among the top pediatric hospitals in the United States, Children’s ishome to the world’s most extensive pediatric hospital research enterprise; and we partner with elite health care and biotech organizations around the globe. But as specialists in innovative, family-centered care, our physicians never forget that your child is precious, and not just a patient.

    Read the stories of Children’s patients with heart disease …

    … hear words of wisdom from their parents, siblings and caregivers in our Experience Journal.

    Visit our Heart and Blood Vessels pages …

    … to learn how the heart works.

  • In-Depth

    It’s natural for you to be concerned right now about your child’s health—a diagnosis of patent foramen ovale (PFO) can be distressing. But you can rest assured that at Children’s Hospital Boston, your child is in expert hands.

    With more than 80 cardiac experts on our staff, Children’s operates the largest pediatric heart program in the nation. Every year, we treat thousands of children, adolescents and adults who are living with a broad spectrum of cardiac problems—ranging from congenital heart defects to blood vessel disorders, heart and lung disease and congestive heart failure.

    What is the foramen ovale? What is a patent foramen ovale?

    • A foramen ovale is a flap-like hole between the wall (atrial septum) that separates the heart’s right and left upper chambers (atria).
    • Before a baby is born, this hole is a naturally occurring opening allows blood to bypass the fetus’ lungs, which will not receive oxygen until the baby’s first cry at birth.
    • Because the fetus’s lungs do not yet function, it’s the mom’s umbilical cord that sends oxygen-rich blood across the foramen ovale and out to the fetus.
    • After birth, oxygen-enriched blood returns directly from the baby’s own lungs, and the foramen ovale seals in 75 percent of the population. In the other 25 percent, the opening fails to seal and remains open (patent)—this persistently open hole is a patent foramen ovale. It is similar in location to atrial septal defects (ASD) but it rarely results in disease on its own.

    Are there additional defects associated with a PFO?

    A PFO can be associated with more serious heart defects, such as hypoplastic left heart syndrome, Ebstein’s anomaly or pulmonary atresia. When repairing these defects, the surgeon will often close the PFO.

    What are the symptoms of a PFO? Why is it a concern?

    Unlike many other heart defects, a PFO in isolation (occurring by itself without other defects) usually causes no signs or symptoms and doesn’t need treatment. A PFO will usually become evident only if a child has another associated cardiac problem.

    Rarely, a baby with a PFO will develop a bluish skin tone (cyanosis) when he strains (as in a bowel movement) or cries. If a PFO causes a baby’s oxygen levels to be low because of right-to-left blood flow across it, the doctor may close the hole surgically.

    Untreated PFOs have been considered to have association with some other conditions in adults, including stroke, migraines and “the bends” and sleep apnea, but the PFO’s relationship to these conditions is not conclusive and is still being studied at Children’s and other research centers.

    How do you diagnose a PFO?

    Most babies, children and adults with a PFO show no symptoms, so if it’s discovered, it’s usually “accidentally” during an exam for another cardiac issue or symptom.

    Diagnostic testing for a PFO may include EKG (electrocardiogram) or one of several types of echocardiogram.

    One type of echocardiogram that gives particularly detailed views of a PFO is a transesophageal echo (TEE), which uses a small ultrasound probe placed into a child’s esophagus to closely evaluate the heart and blood vessels within his chest. This technique obtains a clearer image because sound waves don’t have to pass through skin, muscle or bone tissue.

    How do you treat a PFO?

    Most of the time, a baby or child with a PFO doesn’t need treatment at all. If a child needs surgery to treat an associated heart defect, the PFO may be closed at the time of the surgery.

    Closing a PFO surgically—usually by insertion of a device that “plugs” the PFO and is gradually enveloped by the body’s tissue—is useful under uncommon select circumstances that your physician may guide you about. For more, see Treatment & Care.

    Will my child be OK after surgery for a patent foramen ovale?

    The outlook varies from child to child, but heart surgeries at Children’s have success rates approaching 98 percent—among the highest in the nation among large pediatric cardiac centers. Between 2007 and 2010 atrial septal defect repairs such as those performed for patent foramen ovale had 100 percent success at Children’s.

    What causes a patent foramen ovale?

    The exact reason that a foramen ovale will remain open instead of closing naturally is unknown, but it’s thought that heredity and genetics may play a role.

    It’s important for parents to understand that you’ve done nothing to cause your baby’s PFO or any accompanying defects. Nothing you’ve ingested or have been exposed to environmentally has been definitively linked to having a baby with PFO.

    How common is a PFO?

    It’s fairly common. After birth, the foramen ovale closes in 75 percent of the population. In the other 25 percent, the opening fails to close and remains open (patent).

    Will my baby be OK in the future?

    Most people who have had congenital heart disease will have an ongoing relationship with their Children’s cardiologist. Your cardiologist may recommend that your child take aspirin or another blood-thinner because of PFO’s potential for association with stroke.

    The doctor will follow your child during maturation into childhood, the teen years and even adulthood. It’s uncommon for any restrictions to be placed on future activities for your child. We’ll watch for specific complications of PFO or related disease, and will advise on daily-life issues, such as exercise and activity levels, nutrition and precautions related to pregnancy, if such exist.

    If my child needs care and support for a PFO when he grows up, where can he find it?

    • The Boston Adult Congenital Heart and Pulmonary Hypertension Service (BACH) provides long-term inpatient and outpatient care and advanced therapeutic options for patients with congenital heart disease and pulmonary hypertension as they reach and progress through adulthood.
    • BACH is an international center for excellence, with physicians and services from Children’s, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. The center promotes and supports clinical and scientific research for the advancement of care of these patients, and is a leader in the education of providers caring for this unique population.
    • The Adult Congenital Heart Association (ACHA) is a national not-for-profit organization dedicated to improving the quality of life—and extending the life—of adults with congenital heart defects. The organization serves and supports many of the adults with congenital heart defects (thought to number as many as one million), their families and the medical community, as well as conducting research and providing advocacy, outreach and education.

    FAQ

    Q: Are there different types of patent foramen ovale?
    A:
    There aren’t different types of PFO, but there are different conditions under which it can occur:

    • in isolation (uncomplicated): If the PFO occurs by itself without other heart defects present, it will very likely not need to be treated.
    •  in association with other heart defects: A PFO can be present along with other more serious heart defects that need surgery, such as hypoplastic left heart syndrome, Ebstein’s anomaly or pulmonary atresia. The PFO is often closed at the same time that surgery takes place for these other defects.

    Q: If my child needs surgery for his PFO, will he be OK?
    A:
    The outlook varies from child to child, but heart surgeries at Children’s have

    • success rates approaching 98 percent—among the highest in the nation among large pediatric cardiac centers. Between 2007 and 2010 atrial septal defect repairs similar to those performed for patent foramen ovale had 100 percent success at Children’s.

    Q: If my child has a PFO, what should I ask my doctor?
    A:
    Some questions you may want to ask include:

    • Does my child’s heart have other defects associated with his PFO?
    • What tests will you perform to further diagnose my child?
    • Will my child need surgery?
    • Are there alternative therapies?
    • Will my child be OK if he has a PFO?
    • What are the long-term health risks?
    • Will there be restrictions on my child’s activities?
    • Is there associated risk for stroke or migraines?
    • Is there need to take blood-thinners?
    • Will there be long-term effects?
    • What can we do at home?

    Q: When is a PFO usually diagnosed, and how?
    A:
    Most babies, children and adults with a PFO show no symptoms, so if it’s discovered, it’s usually “accidentally” during an exam for another cardiac issue or symptom.

    Diagnostic testing for a PFO may include an EKG (electrocardiogram) or one of several types of echocardiogram.

    Q: What is Children’s’ experience treating congenital heart defects?
    A:
    Children’s surgeons treat some of the most complex pediatric heart conditions in the world, with overall success rates approaching 98 percent—among the highest in the nation among large pediatric cardiac centers. Each year, we treat hundreds of children, adolescents and even adults with a wide variety of heart defects and disorders.

    Our experts have pioneered some of medical science’s most advanced heart treatments, now in use around the globe. Children’s is among the only major pediatric heart centers in the world performing fetal heart interventions for certain congenital defects.

    Q: What heart research and innovations are coming from Children’s?
    A:
    A significant amount of Children’s groundbreaking cardiac research aims to refine and advance the open heart surgery and catheterization procedures that treat congenital heart defects in newborns and young children—including pulmonary atresia. Children’s Cardiac Surgery Research Laboratory is studying the mechanisms of heart disease and new treatments for children with congenital heart defects.

    Children’s Hospital has been part of the leadership and organization of randomized clinical trials assessing the role of PFO in disease, as well as the possible risks and benefits of treatment of PFO in diseases felt to be associated with PFO.

    Learn more about Children’s cardiac research initiatives and Children’s current projects in cardiology research.

    Causes

    The exact reason that a foramen ovale will remain open instead of closing naturally is unknown, but it’s thought that heredity and genetics may play a role.

    It’s important for parents to understand that you’ve done nothing to cause your baby’s PFO or any accompanying defects. Nothing you’ve ingested or have been exposed to environmentally has been definitively be linked to having a baby with PFO.

    Symptoms

    Unlike many other heart defects, a PFO in isolation (occurring by itself without other defects) usually causes no signs or symptoms and doesn’t need treatment. A PFO will usually become evident only if there’s another associated cardiac problem.

    Rarely, a baby with a PFO will develop a bluish skin tone (cyanosis) during straining (as in a bowel movement) or crying. If a PFO causes a baby’s oxygen levels to be low because of right-to-left blood flow across it, the doctor may close the hole surgically.

    Untreated PFOs have potential for association with some other conditions in adults, including stroke, migraines and “the bends” and sleep apnea, but the PFO’s relationship to these conditions is not conclusive and is still being studied at Children’s and other research centers.

    When to seek medical advice

    Call your health care provider immediately if your baby or child is having difficulty breathing or is breathing rapidly, has a bluish color or seems to tire too easily.

    Questions to ask your doctor

    After your child is diagnosed with PFO, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

    • Some questions you may want to ask include:
    • Does my child’s heart have other defects associated with his PFO?
    • What tests will you perform to further diagnose my child?
    • Will my child need surgery?
    • Are there alternative therapies?
    • Will my child be OK if he has a PFO?
    • What are the long-term health risks?
    • Will there be restrictions on my child’s activities?
    • Is there associated risk for stroke or migraines?
    • Is there need to take blood-thinners?
    • Will there be long-term effects?
    • What can we do at home?

    Who’s at risk

    Congenital heart defects usually occur sporadically (by chance), with no clear reason for their development. So, it’s difficult to predict who’s at risk. Familial cases have been reported, but no genetic link has been confirmed.

    A PFO is often present in association with more complex heart defects, such as hypoplastic left heart syndrome, Ebstein’s anomaly or pulmonary atresia.

    Precautions and complications

    Be sure to tell your child’s doctors about the presence of PFO if your child ever needs IV fluids for another condition, since it’s possible that the PFO could become problematic if air or dirt were to contaminate the IV line and enter the veins. The fact that a PFO is present might change some aspects of what a surgeon does in preparation for, or during an operation.
     

    Untreated PFOs have potential for association with some other conditions in adults, including stroke, migraines, “the bends” and sleep apnea, but the PFO’s relationship to these conditions is not conclusive and is still being studied at Children’s and other research centers. As your child grows, it’s important to sustain a relationship with your cardiologist.

    Long-term outlook

    The outlook varies from child to child, but heart surgeries at Children’s have success rates approaching 98+ percent—among the highest in the nation among large pediatric cardiac centers. Between 2007 and 2010 atrial septal defect repairs similar to those performed for patent foramen ovale had 100 percent success at Children’s.

    Nevertheless, your child will need monitoring and possibly medication, since he may be at some risk for stroke.

    For teens

    If you’re a teen with a congenital heart defect, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you’ll also have to deal with medical appointments, some delay of your natural wish for independence, feeling a little different and assuming a lot of personal responsibility for maintaining your own good health.

    It may help to remember that most teens with PFO do the same stuff as other teens, like going to school, doing chores and hanging out with friends. Most kids with a PFO don’t have restrictions on their activities, either.

    If your doctor has cleared you to do so, you can play sports and participate in even rigorous or high altitude activities without any problems. Plus, you’ll have a lot of backup: Doctors, counselors, physical therapists and other members of your treatment team are all there to support you.

    Even so, if you feel depressed or anxious through this important time in your transition to adulthood, speak to your doctor, counselor or parent—they’re all on your team, and they want to help.

    For adults

    Aging in general tends to bring out any underlying pathology in the heart or other major organs. So, if, as a person with a PFO, you start experiencing physical problems because of age-related changes, the doctor may take a closer look at the PFO just to rule it out as a contributing factor.

    If you were diagnosed with, or treated for, a PFO as a child, you’re probably being followed by your cardiologist, since complications can arise in adulthood. You may need monitoring and medication by your cardiologist, since you could be at some risk for stroke.

    Fortunately, Children’s can help adults with congenital heart defects. Many adults who were patients at Children’s as babies or children continue to be monitored by the clinicians who’ve followed them since childhood.

    In addition, our Boston Adult Congenital Heart and Pulmonary Hypertension Service (BACH) provides long-term inpatient and outpatient care and advanced therapeutic options for patients with congenital heart disease and pulmonary hypertension as they reach and progress through adulthood.

    BACH is an international center for excellence, with physicians and services from Children’s, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. The center promotes and supports clinical and scientific research for the advancement of care of these patients, and is a leader in the education of providers caring for this unique population.

    Prevention

    The exact reason that a foramen ovale remains open instead of closing naturally is unknown, but it’s thought that heredity and genetics may play a role.

    It’s important for parents to understand that you’ve done nothing to cause your baby’s PFO or any accompanying defects. Nothing you’ve ingested or have been exposed to environmentally has been definitively be linked to having a baby with PFO.

    PFO glossary

    • aorta: one of the heart’s two great arteries. In a normal heart, the aorta arises from the left ventricle and carries oxygen-rich blood out to the body.
    • atrial septal defect (ASD): a congenital (present at birth) heart defect in which there is an opening in the tissue wall (septum) that divides the two upper chambers of the heart (right and left atria). A patent foramen ovale (PFO) is a type of ASD.
    • cardiac/cardio-: pertaining to the heart
    • cardiac magnetic resonance imaging (MRI): a non-invasive diagnostic tool
    • cardiac surgery: a surgical procedure performed on the heart or one of the blood vessels connected to the heart
    • cardiac surgeon: a doctor who performs surgery on the heart. A pediatric cardiac surgeon performs surgery on the hearts of infants and children.
    • cardiologist: a doctor who diagnoses and treats heart problems non-surgically. A pediatric cardiologist treats infants, children and some adults with heart problems.
    • cyanosis (cyanotic): blue color of skin, lips and nailbeds caused by a reduction in the amount of oxygen-rich (red) blood circulating in baby’s bloodstream
    • congenital heart defect: heart defect present at birth. The heart usually starts to form in the first eight weeks of fetal development. It’s thought that most congenital heart defects develop during this period.
    • diagnosis: medical determination of illness or disease based on history, physical examinations and advanced technology diagnostic testing tools
    • echocardiogram (echo, cardiac ultrasound): a diagnostic tool that evaluates the structure and function of the heart using sound waves that produce a moving picture of your child’s heart and heart valves. The ultrasound can be used to understand flow in the different chambers and to estimate pressures.
    • electrocardiogram (ECG, EKG): a diagnostic tool that evaluates the electrical activity of your child’s heart. An EKG is usually the initial test for detecting a PFO.
    • in isolation: occurring by itself; used to mean a defect occurring without other associated defects
    • IV: intravenous, into the vein; one method of delivering medication
    • PFO (patent foramen ovale): a defect in the wall (septum) between the upper two heart chambers (the left and right atria)
    • signs and symptoms: the physical reasons why a child needs medical attention. Characteristics such as onset, quality, triggers and severity help diagnosticians to determine a disease, or to decide which testing is needed to determine the disease.

    For a more complete list of cardiovascular terms, visit our Cardiovascular Glossary.

    For in-depth visual information on several of the conditions, diagnostic tools and procedures described above, visit our cardiovascular Multimedia Library.

    Children's Heart Center

    The Heart Center at Children’s is the largest pediatric heart program in the United States. Our staff of more than 80 pediatric cardiac specialists cares for thousands of children and adults with congenital and acquired heart defects each year, from simple to complex cases. We have experience treating rare heart problems—with results that are among the best in the world.

  • Tests

    At Children’s Hospital Boston, we know that the first step in treating your child is forming an accurate, complete and timely diagnosis.

    The exam

    If your baby has a bluish skin tint, or if your young child is experiencing symptoms of a congenital heart defect, your pediatrician will refer you to a pediatric cardiologist (and/or neonatologist), who will perform a physical exam. Your child’s doctor will listen to your baby’s heart and lungs, measure the oxygen level in his blood (non-invasively) and make other observations that help to determine the diagnosis.

    Your child’s cardiologist will also investigate whether he has a heart murmur—a noise heard through the stethoscope that’s caused by the turbulence of blood flow. The location in the chest where the murmur is best heard, as well as the sound and character of the murmur itself, will give the cardiologist an initial idea of the kind of heart problem your baby may have.

    The tests

    Some combination (not necessarily all) of the following medical tests is also used to diagnose a PFO:

    • electrocardiogram (EKG): An EKG is used to evaluate the electrical activity of your child’s heart. An EKG is usually the initial test for detecting a PFO. It is performed by placing electrodes on the arms, legs and chest to record the electrical activity. The test takes five minutes or less and involves no pain or discomfort.
    • echocardiogram (cardiac ultrasound): An echocardiogram evaluates the structure and function of your child’s heart using electronically recorded sound waves that produce a moving picture of the heart and heart valves. If your baby has a PFO, the ultrasound will reveal the right-to-left shunting of blood across the hole. No discomfort is involved. It takes 30-60 minutes. Younger children may need to be sedated.

    Children’s proud history of heart care innovation

    In 1938, Children’s cardiac surgeon Robert Gross, MD, performed the world’s first successful surgery to correct a child’s heart defect. Since that time, we have gained recognition around the globe for our leadership in pediatric cardiology, and continue to make critical advances in the field. In 2011, U.S. News & World Report ranked Children’s cardiology and cardiac surgery programs at the top of the nation’s pediatric hospitals.

    We use the most sophisticated diagnostic and imaging procedures, including interventional catheterization

    and we offer dozens of specialized services in such areas as heart valve replacement, cardiac anesthesia, robotic surgery, and fetal cardiology.

  • Having identified your child's PFO, we at Boston Children's Hospital can begin the process of treating him. Our specialized training in pediatric cardiology means that we understand the unique challenges, circumstances and intricacies of working with young people who have heart conditions. In addition to our medical expertise, we provide patient-centered care that always recognizes your child as an individual—and we offer resources to meet the needs of your entire family.

    Treatment options

    Most often, a baby or child with a PFO doesn't need treatment at all. If your child needs surgery to treat an associated defect, the PFO may be closed at the time of the surgery.

    When is it necessary to close the patent foramen ovale surgically?

    Closing a PFO surgically—usually by insertion of a device that “plugs” the PFO and is gradually enveloped by the body's tissue—may be useful in limited select circumstances.

    • During every heartbeat, the PFO flap between the right and left atria pops open and allows blood to pass through.
    • The heart pumps, then fills; if the heart is thickened or develops changes in its filling pattern, it may require more pressure to fill certain chambers.
    • A greater pressure in the right sided atrium relative to the left sided atrium could cause the right side of the flap of the PFO to pop open allowing “blue” (oxygen-deprived) blood to leak to the left side of the body, resulting in:
    • cyanosis (bluish tinge to the skin)
    • orthodeoxia (decrease in oxygen within the arterial blood when sitting upright)
    • platypnea (shortness of breath when sitting upright)

    Surgical repair of a PFO

    Surgery to repair a PFO is a fairly simple procedure that takes only a couple of hours at most. Children often need at most an overnight stay at the hospital, and can go home the same or the next day.

    • A catheter is used to guide a special closing device to the PFO site (CardioSEAL is an example of a common type of device).
    • The device expands, forming a patch that covers the entirety of the hole.
    • The device remains in the heart permanently, eventually becoming enveloped by the body's own tissue.

    After your child's procedure, an anti-clotting medication is often prescribed for a number of months as a precautionary measure.Doctors will schedule routine follow-up visits to make sure the device has held its placement and is working well.

    Coping and support

    At Children's, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit our Center for Families for all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions if your child is diagnosed with a PFO. How will it affect my child long term? What do we do next? We can connect you with a number of resources to help you and your family through this difficult time, including:

    • patient education: Whether your child needs just an evaluation or surgery, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have. We'll also reach out to you by phone, continuing the care and support you received while your child was at Children's.
    • parent-to-parent: Want to talk with someone whose child has been treated for a PFO? We can often put you in touch with other families who've been through the same procedure that you and your child are facing, and who will share their experiences.
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
    • social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

    As your child reaches adulthood, you'll want him to know about our Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Service. Children's is a founding institution of BACH, an international center for excellence providing long-term inpatient and outpatient care and advanced therapeutic options as needed for congenital heart disease patients as they reach and progress through adulthood.

    Children's an interventional catheterization pioneer

    You'll be comforted to know that Children's pioneered interventional catheterization for many congenital heart defects and is a leader in the use of this procedure.


  • Research & Innovation

    Pediatric cardiologists and pediatric cardiovascular surgeons at Children’s Hospital Boston have pioneered the interventional catheterization techniques now used widely for many congenital heart defects.

    Research and clinical trials are in progress on all aspects of physiology, anatomy, quality of life and long-term outcomes for young adults and adults with congenial heart defects, including PFO. And a significant amount of groundbreaking cardiac research aims to refine and advance the open heart surgery and catheterization procedures that correct congenital heart defects in newborns and young children.

    Cardiac surgery research

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

    Some principal areas of active research are:

    • surgical robotics and ultrasound-guided intracardiac surgery: The department is pioneering the use of 3-D ultrasound and laparoscopic techniques to operate on the beating heart.
    • myocardial metabolism and myocardial hypertrophy and heart failure: Researchers are exploring new methods of myocardial preservation during heart surgery and the role of angiogenic growth factors in heart failure.
    • tissue engineering to stimulate the growth of new tissue to repair congenital defects, including valve abnormalities, right ventricular defects and arrhythmias

    Cardiology research

    Children’s 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—all of whom hold faculty appointments at Harvard Medical School—participate in clinical research activities, and many do laboratory research, as well.

    Learn more about Children’s cardiac research initiatives and Children’s current projects in cardiology research.

    Innovations: 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 in animals to remove blockages, repair faulty valves and close leaks.

    The other new instrument is a cardioportdevice that allows instruments to be safely introduced into the cardiac chambers with­out the usual risks of blood loss or an air embolism.

    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. Dr. Del Nido’s cardioport will soon be tested in clinical trials and will facilitate further development of similarly novel instruments for heart repair.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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