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Celebrating Heartwarming Advances in Pediatric Cardiology | Overview

American Heart Month is a great time to celebrate recent advances made in pediatric cardiology, including new methods in PDA closures and improvements in the placement of pulmonary valves in older children and adults. Such developments are enabling babies and children to live longer, healthier lives and in many cases, avoiding - or reducing - the need for open heart surgeries. 

Dr. Joseph Giamelli and Dr. Markus Erb are both on the cutting edge in pediatric cardiology at Boston Children's Health Physicians. They, along with the entire Boston Children's Health Physicians' pediatric cardiology team, have been putting a few of the newest advances to work to benefit some of their most vulnerable patients. 

A new device to close PDAs in preemies

As many as half or more babies born prematurely have persistence of a patent ductus arteriosus (PDA). The ductus arteriosus is an opening that exists in fetal life between two blood vessels coming from the heart. Normally, the opening closes on its own shortly after birth but in some babies, this doesn't occur and the PDA remains open. Left untreated, a PDA can lead to a host of complications since the condition increases blood flow to the lungs and takes blood from other parts of the body, causing the heart, lungs, and other organs to work harder and less effectively. In some cases, babies can require high-risk heart surgery to correct the problem. In 2019, the FDA approved the Amplatzer Piccolo Occluder by Abbott, which now offers a safer option to treat a PDA in even the smallest preemies. This device, which is made of a titanium-nickel alloy called Nitinol, is smaller than a pea. That makes it appropriate for newborns as young a three days old and weighing as little as 700 grams (approximately 1.5 pounds), according to Dr. Giamelli. It's placed in the ductus using a catheter and this permanently closes the opening. This minimally invasive option is easy for many preemies to tolerate, he adds.  

He points out that a similar procedure using a catheter through the aorta and the pulmonary artery has long been available to place a larger device for older babies and children. However, the new Piccolo device has some important differences. This new device is much smaller, which means the procedure can be performed much earlier, and its placement avoids the risk of obstructing the artistes.   

The whole process of placing the new device takes 15 minutes or less to complete and avoids the complications that can occur with surgery in the most vulnerable babies. 

"Babies who undergo this procedure progress faster, feed better, and have no scar," Dr. Giamelli says. 

In the past year, four or five babies at BCHP have successfully undergone this procedure. Once their PDA is closed, no further interventions are needed. 

New pulmonary valve replacement reduces the need for surgeries  

In patients with congenital heart defects, it's common to require open-heart surgery for pulmonary valve replacements and these procedures need to be repeated periodically. 

"There are two valves coming from the heart: one to the aorta (body) and one to the pulmonary artery (lungs)," says Dr. Erb. But in a segment of the population, the valve is too small or is even missing, requiring surgery to insert a replacement valve. 

"The size of the replacement valve at age two isn't large enough and won't last an entire lifetime," he points out. Most valves last about 10 years before needed to be replaced again. 

But the creation of the FDA-approved Melody™ Transcatheter Pulmonary Valve by Medtronic now provides a way for patients to prolong the time before undergoing another open-heart surgery. While it won't completely avoid the need for surgery eventually, it can put off the the need - at least for a while, Dr. Erb stresses. Using a catheter, the process involves having the valve inserted from the groin veins, advances through the right heart and into the pulmonary artery. This avoids the need to open the chest, causes less pain, and ensures a must faster recovery for patients. "Any time you can prevent a child from needing open heart surgery [or reduce the number of surgeries needed], this can go a long way toward helping them have a long, healthy life," he says. 

In the past six months, three Melody replacement valves have been used on patients in the Boston Children's Health Physicians network and a fourth such procedure is about to be performed, he adds. 

Thanks to these and other advances in pediatric cardiology, children with heart defects are enjoying longer and healthier lives with fewer complications. 

Learn about our Pediatric Cardiology Division.