Featured Research

from universities, journals, and other organizations

Rebuilding a whole heart for children born with only half of one

Date:
November 6, 2012
Source:
Boston Children's Hospital
Summary:
Using a combination of surgical procedures developed over the last 11 years, surgeons have established a new approach for rebuilding the heart in children born with a severe heart defect called hypoplastic left heart syndrome (HLHS). This "staged left ventricle recruitment" strategy uses the existing standard single-ventricle treatment for HLHS and additional procedures to spur the body's capacity for healing and growth and encourage the small left ventricle in these children to grow and function.

Using a combination of surgical procedures developed over the last 11 years, surgeons at Boston Children's Hospital have established a new approach for rebuilding the heart in children born with a severe heart defect called hypoplastic left heart syndrome (HLHS). This "staged left ventricle recruitment" (SLVR) strategy uses the existing standard single-ventricle treatment for HLHS and additional procedures to spur the body's capacity for healing and growth and encourage the small left ventricle in these children to grow and function.

Members of Boston Children's Departments of Cardiac Surgery and Cardiology -- including Sitaram M. Emani, MD; Wayne Tworetzky, MD; James E. Lock, MD; and Pedro J. del Nido, MD -- reported their results to date with the SLVR strategy in the November 6 issue of the Journal of the American College of Cardiology.

HLHS is a rare but severe congenital heart defect in which the left ventricle, the chamber of the heart that pumps blood out into the body, does not develop properly. The majority of children born with HLHS undergo a series of three procedures, together known as single ventricle palliation (SVP), culminating in the Fontan procedure. Surgeons use the sequence to reconstruct a child's heart so that it can function with only a single working ventricle, but only about half of patients treated in this way survive to adulthood.

"Many of the children who reach adulthood eventually require a heart transplant because their Fontan circulation doesn't work effectively or causes additional complications," according to Emani, a pediatric cardiac surgeon who specializes in cardiovascular surgery for newborns and children with complex congenital heart disease.

In 2001, del Nido, Emani and their colleagues started considering ways to help children with HLHS avoid SVP as an end goal and improve long-term outcomes by reconstructing the heart so that it has two working ventricles.

"Children have an enormous growth and healing potential," Emani explained. "We realized that rather than give up on the left ventricle and commit a child to single ventricle circulation for life, we could leverage that growth potential in a staged approach that would promote growth in the left ventricle and gradually recruit it back into operation."

With the SLVR approach, a child undergoes initial single ventricle palliation with the Norwood procedure -- a procedure pioneered at Boston Children's in the 1980s -- in order to stabilize their circulation. Surgeons then perform additional procedures over time, such as mitral or aortic valve repair, removal of endocardial fibroelastic (EFE) tissue (tough tissue that can restrict the heart's pumping motion) and closure of atrial septal defects (gaps in the wall between the heart's left and right atriums).

Between each procedure, surgeons allow the child's heart to heal and strengthen, setting the stage for the next operation.

"The goal is to promote blood flow through the patient's left ventricle and thereby stimulate growth of the ventricle," Emani said. "If we can do that, we give the ventricle an opportunity to function."

Emani noted that the SLVR approach is highly customizable based on each individual child's unique heart anatomy. It also requires a high degree of collaboration and an open approach to cardiac care involving multiple medical and surgical subspecialties.

In their report, the authors document their experiences developing and refining the SLVR approach between 2001 and 2010. In that time, 34 children were treated using the approach, 12 of whom were successfully converted to complete, two-ventricle circulation. In the short term, survival rates among SLVR-treated patients have been slightly better than a comparable group of children who underwent SVP.

In addition, patients who underwent SLVR also displayed significant growth in the valves and chambers on the left side of the heart, even if surgeons could not get the left ventricle to function completely, demonstrating that the strategy can effectively rehabilitate the heart and successfully support its growth and function.

Compared to SVP, the SLVR approach has had equal if not better outcomes over the last decade. The approach's overall benefits are geared toward improved long-term outcomes and survival into adulthood.

The team notes that in the short term the SLVR approach is more invasive and intensive than the single ventricle approach. But they expect that the long-term benefits of SLVR -- especially in terms of reduced risks of future hospitalization, surgery and heart transplantation -- will far outweigh the initial costs.

"We believe the SLVR strategy could revolutionize the pediatric cardiology field's approach to treatment of HLHS," Emani says. "The general consensus has been that conversion to single ventricle circulation is the safest approach, but it has significant limitations when it comes to adult survival. While we are still refining the process, we think our two-ventricle approach will help children with HLHS not just survive but thrive into adulthood."


Story Source:

The above story is based on materials provided by Boston Children's Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. Sitaram M. Emani, Doff B. McElhinney, Wayne Tworetzky, Patrick O. Myers, Brian Schroeder, David Zurakowski, Frank A. Pigula, Gerald R. Marx, James E. Lock, Pedro J. del Nido. Staged Left Ventricular Recruitment After Single-Ventricle Palliation in Patients With Borderline Left Heart Hypoplasia. Journal of the American College of Cardiology, 2012; 60 (19): 1966 DOI: 10.1016/j.jacc.2012.07.041

Cite This Page:

Boston Children's Hospital. "Rebuilding a whole heart for children born with only half of one." ScienceDaily. ScienceDaily, 6 November 2012. <www.sciencedaily.com/releases/2012/11/121106114234.htm>.
Boston Children's Hospital. (2012, November 6). Rebuilding a whole heart for children born with only half of one. ScienceDaily. Retrieved October 21, 2014 from www.sciencedaily.com/releases/2012/11/121106114234.htm
Boston Children's Hospital. "Rebuilding a whole heart for children born with only half of one." ScienceDaily. www.sciencedaily.com/releases/2012/11/121106114234.htm (accessed October 21, 2014).

Share This



More Health & Medicine News

Tuesday, October 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

CDC Revamps Ebola Guidelines After Criticism

CDC Revamps Ebola Guidelines After Criticism

Newsy (Oct. 21, 2014) The Centers for Disease Control and Prevention have issued new protocols for healthcare workers interacting with Ebola patients. Video provided by Newsy
Powered by NewsLook.com
WHO: Ebola Vaccine Trials to Start a in January

WHO: Ebola Vaccine Trials to Start a in January

AP (Oct. 21, 2014) Tens of thousands of doses of experimental Ebola vaccines could be available for "real-world" testing in West Africa as soon as January as long as they are deemed safe in soon to start trials, the World Health Organization said Tuesday. (Oct. 21) Video provided by AP
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com
CDC Issues New Ebola Guidelines for Health Workers

CDC Issues New Ebola Guidelines for Health Workers

Reuters - US Online Video (Oct. 21, 2014) The U.S. Centers for Disease Control and Prevention has set up new guidelines for health workers taking care of patients infected with Ebola. Linda So reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins