Tag Archive for: congenital heart disease

Catherine Limperopoulos

Imaging reveals altered brain chemistry of babies with CHD

Researchers at Children’s National Hospital used magnetic resonance spectroscopy to find new biomarkers that reveal how congenital heart disease (CHD) changes an unborn baby’s brain chemistry, providing early clues that could someday guide treatment decisions for babies facing lifelong health challenges.

Published in the Journal of the American College of Cardiology, the findings detail the ways that heart defects disrupt metabolic processes in the developing brain, especially during the third trimester of pregnancy when babies grow exponentially.

“Over the past decade, our team has been at the forefront of developing safe and sophisticated ways to measure and monitor fetal brain health in the womb,” said Catherine Limperopoulos, Ph.D., director of the Center for Prenatal, Neonatal and Maternal Health Research at Children’s National. “By tapping into the power of advanced imaging, we were able to measure certain maturational components of the brain to find early biomarkers for newborns who are going to struggle immediately after birth.”

The fine print

In one of the largest cohorts of CHD patients assembled to date, researchers at Children’s National studied the developing brains of 221 healthy unborn babies and 112 with CHD using magnetic resonance spectroscopy, a noninvasive diagnostic test that can examine chemical changes in the brain. They found:

  • Those with CHD had higher levels of choline and lower levels of N-Acetyl aspartate-to-choline ratios compared to healthy babies, potentially representing disrupted brain development.
  • Babies with more complex CHD also had higher levels of cerebral lactate compared to babies with two ventricle CHD. Lactate, in particular, is a worrying signal of oxygen deprivation.

Specifically, elevated lactate levels were notably increased in babies with two types of heart defects: transposition of the great arteries, a birth defect in which the two main arteries carrying blood from the heart are switched in position, and single ventricle CHD, a birth defect causing one chamber to be smaller, underdeveloped or missing a valve. These critical heart defects generally require babies to undergo heart surgery not long after birth. The elevated lactate levels also were associated with an increased risk of death, highlighting the urgency needed for timely and effective interventions.

The research suggests that this type of imaging can provide a roadmap for further investigation and hope that medicine will someday be able to better plan for the care of these children immediately after their delivery. “With important clues about how a fetus is growing and developing, we can provide better care to help these children not only survive, but thrive, in the newborn period and beyond,” said Nickie Andescavage, M.D., Children’s National neonatologist and first author on the paper.

The big picture

CHD is the most common birth defect in the United States, affecting about 1% of all children born or roughly 40,000 babies each year. While these defects can be fatal, babies who survive are known to be at significantly higher risk of lifelong neurological deficits, including lower cognitive function, poor social interaction, inattention and impulsivity. The impact can also be felt in other organ systems because their hearts did not pump blood efficiently to support development.

Yet researchers are only beginning to pinpoint the biomarkers that can provide information about which babies are going to struggle most and require higher levels of care. The National Institutes of Health (NIH) and the District of Columbia Intellectual and Developmental Disabilities Research Center supported the research at Children’s National to improve this understanding.

“For many years we have known that the brains of children with severe heart problems do not always develop normally, but new research shows that abnormal function occurs already in the fetus,” said Kathleen N. Fenton, M.D., M.S., chief of the Advanced Technologies and Surgery Branch in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI). “Understanding how the development and function of the brain is already different before a baby with a heart defect is born will help us to intervene with personal treatment as early as possible, perhaps even prenatally, and improve outcomes.”

Note: This research and content are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The NIH provided support for this research through NHLBI grant R01HL116585 and the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant P50HD105328.

chest x-ray showing placement of tiny pacemaker

First infants in the U.S. with specially modified pacemakers show excellent early outcomes

chest x-ray showing placement of tiny pacemaker

Chest/abdominal x-ray of neonate receiving a modified pediatric-sized implantable pulse generator, demonstrating epicardial suture-on bipolar lead and pulse generator in the upper abdominal pocket.

In 2022, five tiny, fragile newborns with life-threatening congenital heart disease affecting their heart rhythms were the first in the United States to receive a novel modified pacemaker generator to stabilize their heart rhythms within days of birth.

An article in the journal Heart Rhythm assesses the outcomes to date for the infants who received pacemakers that were modified to work better in the smallest children who need them. The authors, including first author Charles Berul, M.D., chief of Cardiology at Children’s National Hospital, share that after following for between 6 and 9 months, “early post-operative performance of this device has been excellent.”

The big picture

Even the tiniest pacemakers and defibrillators on the market today aren’t small enough for infants and young children with heart rhythm abnormalities. So, for several years, Dr. Berul and colleagues at several other institutions have collaborated to adapt existing pacemakers, including the Medtronic Micra leadless pacing system, for use in tiny, critically ill newborns.

The specially modified pediatric-sized implantable pulse generator, called the Pediatric IPG, includes a Medtronic Micra sub-assembly that connects to an epicardial lead. While this makes the leadless pacemaker into one that uses leads, the resulting IPG is significantly smaller than any commercially available pacemaker previously on the market in the U.S.

The five infants in this case profile each received the modified Pediatric IPG at four separate institutions, and each surgery to implant the device was performed by a different cardiac surgeon. Two of the five cases were cared for at Children’s National. Cardiac surgeons Can Yerebakan, M.D., Ph.D., and Manan Desai, M.D. each performed one procedure.

The Pediatric IPG was authorized for use by emergency use exemptions from the federal Food and Drug Administration and with review and approval by each hospital’s Institutional Review Board, based on successful laboratory and pre-clinical models with favorable, though limited, results.

The patient benefit

All five infants were diagnosed with congenital complete heart block and required urgent pacing immediately after birth. The authors write:

“Permanent pacing in adults and older children is a routine, relatively simple implantation procedure. In the smallest of children, however, the generator is typically placed in the abdomen and can still present challenges in tiny babies under 2.5kg due to its bulk and dimensions, with risks of wound dehiscence, generator erosion and other complications.”

The authors note that the smaller profile of the Pediatric IPG reduces and has the potential to eliminate some of these challenges.

What’s next: Better delivery

Innovating smaller devices, including adapting current technology like the Medtronic Micra for pediatric use, is a good start but won’t be enough to eliminate some of the challenges for these patients. When a newborn or young child needs any pacemaker or defibrillator, they face open chest surgery. Their arteries and veins are just too small for even the smallest size transvenous pacemaker catheter.

That’s why Dr. Berul and engineers in the Sheikh Zayed Institute for Pediatric Surgical Innovation are working on a first-of-its-kind minimally invasive pericardial access tool. The team hypothesizes that this tool will allow for pacing and defibrillation therapy to be delivered through a single small port inserted through the skin that is about the size of a drinking straw.

You can read the full article Creative Concepts: Tiny Pacemakers for Tiny Babies in the journal Heart Rhythm.

infographic explaining tiny pacemaker

imaging of blood flow in the heart

4D flow explained: Advanced imaging measures critical blood flow characteristics of single ventricle hearts

Yue-Hin “Tom” Loke, M.D., pediatric cardiologist and director of the 3D Cardiac Visualization Laboratory at Children’s National Hospital, uses magnetic resonance imaging and software rendering to create novel 4D flow images of children with single ventricle congenital heart disease.

“My research measures the degree of vortex formation (and) the degree of energy loss in the atrium as potential measurements of heart health and uses these measurements as a potential gauge of the heart health of children born with single ventricle conditions including hypoplastic left heart syndrome,” he says. “This information can be used to guide the management of the care for children with congenital heart disease. This technology provides valuable insight into how well the heart is working, especially before the Fontan procedure.”

Learn more about the approach and how it impacts clinical care decisions in the Children’s National Heart Institute.

Dr. Donofrio performs an ultrasound

Tracking neurodevelopmental outcomes for kids with congenital heart disease

Extensive research has shown that children with congenital heart disease (CHD) who are born blue or who need cardiac surgery in their first year of life are at risk for developmental challenges and/or learning difficulties.

Mary Donofrio, M.D., co-director of the Cardiac Neurodevelopment Outcome (CANDO) program at Children’s National Hospital, says that we started the program — the only one of its kind in the Washington, D.C. region — to identify and manage delays in development and difficulties with learning, no matter when they arise.

“We start paying attention even before birth and then continue to evaluate neurodevelopment at key stages in a kid’s life to assure the best outcome. Our goal is for every kid born with CHD to be able to achieve their full potential, be active, make friends and succeed in school. Most important, we want each of our patients to grow up to be a happy and successful adult,” says Dr. Donofrio.

Learn more about CANDO at Children’s National Hospital and our role in developing best practices for neurodevelopmental and psychosocial services as part of the international multi-specialty Cardiac Neurodevelopmental Outcome Collaborative.

animation showing MRI cardiac imaging

Advanced MRI hopes to improve outcomes for Fontan cardiac patients

animation showing MRI cardiac imaging

Chief of Cardiac Surgery Yves d’Udekem, M.D., calls this “fourth-dimensional imaging” that identifies if blood flows swiftly, smoothly, or is subjected to swirls or turbulences that impede the effectiveness of the flow.

Cardiac imaging specialists and cardiac surgeons at Children’s National Hospital are applying advanced magnetic resonance imaging visualization techniques to understand the intricacies of blood flow within the heart chambers of children with single ventricle heart defects like hypoplastic left heart syndrome (HLHS).

The data allows surgeons to make critical corrections to the atrioventricular valve — the valve between the atrium and ventricle of the heart — before a child undergoes the single ventricle procedure known as the Fontan.

Yves d’Udekem, M.D., chief of Cardiac Surgery at Children’s National, says that eliminating leakage of the atrioventricular valve before a child undergoes the Fontan may improve a child’s quality of life after Fontan and reduce the likelihood of heart failure, transplant or death long term.

The big picture

Patients with only one functioning pumping chamber, or ventricle, have been on the same treatment trajectory for decades. However, critical international efforts to collect and analyze long-term outcomes for patients with Fontan circulations have led surgeons like d’Udekem to rethink what quality of life and a positive outcome means for these patients. This includes patients in the Australia and New Zealand Fontan Registry founded by d’Udekem while at Royal Children’s Hospital in Australia.

Research based on data in the patient registries shows that atrioventricular valve leakage plays a critical role in the outcomes for patients with single ventricle defects. For children with Fontan circulation, significant leakage of this valve leads to worse outcomes.

Moving the field forward

Treatment decisions for children with single ventricle heart defects are often made based on commonly used heart imaging to determine the effect of valve leakage based on two limited, key variables: the size and the squeeze of the heart. However, this is a late effect and may not reflect the true impact on children with single ventricle hearts.

The team at Children’s National — including d’Udekem and Yue-Hin Loke, M.D., cardiac MRI specialist and director of the 3D Cardiac Visualization Laboratory — use cardiac MRI to measure the flow between heart chambers. Special software can measure abnormal flow and energy losses inside the heart, drawing on principles of physics and engineering.

“Dr. Loke not only gathers three-dimensional imaging of the heart through every heartbeat, he also gathers brand new types of colored imaging of blood flow itself, showing how effectively it is propelled by the heart,” says d’Udekem. “This ‘fourth-dimensional imaging’ identifies whether the blood flows swiftly, smoothly or whether it is subjected to swirls or turbulences that impede the effectiveness of the flow.”

Children’s National leads the way

Harnessing the visualization technology and analysis for clinical care of patients with single ventricle defects is relatively new in the United States, but it has become a vital part of the routine, clinical pre-Fontan evaluations at Children’s National.

Few locations in the United States have the mechanisms and expertise to study abnormal flow patterns in children with single ventricle defects. Children’s National collaborates with engineers to help parse the information into clear-cut takeaways for the clinical teams to use in their treatment planning.

Also, while other centers have access to this technology, not many centers have cardiac surgeons like d’Udekem who have an active interest in applying the key learnings from this data as quickly as possible to improve outcomes for patients.

Loke describes the collaboration at Children’s National as a “unique crossroads of clinical need and clinical interest to help these kids in very bold ways.”

What’s next

d’Udekem and Loke are engaged in a comprehensive project that analyzes the impact of atrioventricular valve leakage to ensure that the flow inside the heart is optimized before a Fontan procedure.

The research will map the efficiency of blood flow between the atrium and ventricle before surgery and after a surgical correction is made. The goal is to test the hypothesis that better atrioventricular circulation before Fontan can make a big difference for patients’ long-term quality of life and overall health.

PeriPath surgery

NIH awards $1.8 million to trial pacemaker delivery system for children

PeriPath pacemaker

The PeriPath access port makes it possible for pacing and defibrillating leads to be placed in the smallest children through holes the size of a straw.

A $1.8 million Small Business Innovation Research (SBIR) grant from the National Institutes of Health (NIH) is funding the first clinical trial of a novel device called PeriPath. The device makes it possible for pacing and defibrillating leads (or wires) to be placed in the smallest children through holes the size of a straw, eliminating thoracotomy or sternotomy procedures for children who are too small for transvenous implantation.

Even the tiniest pacemakers and defibrillators on the market today aren’t small enough for infants and young children with heart rhythm abnormalities. Innovating smaller devices, including adapting current technology like the Medtronic Micra for pediatric use, is a good start but won’t be enough to eliminate some of the challenges for these patients. When a newborn or young child needs any pacemaker or defibrillator, they face open chest surgery. Their arteries and veins are just too small for even the smallest size transvenous pacemaker catheter.

The research goal

Charles Berul, M.D., division chief of Cardiology and co-director of the Children’s National Heart Institute, partnered with engineers in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Hospital to develop and test a first-of-its-kind minimally invasive pericardial access tool. The tool allows doctors to place pacing and defibrillation leads to the epicardial surface of the heart under direct visualization from an endoscope.

The team hypothesizes that this tool will allow for pacing and defibrillation therapy to be delivered through a single small port inserted through the skin that is about the size of a drinking straw.

Why it matters: Less pain, shorter and fewer surgeries

If successful, the device will eliminate the need for open chest surgery in patients who aren’t candidates for transvenous placement. The ability to place these leads percutaneously should:

  • Reduce pain and infection risk.
  • Decrease procedure times.
  • Minimize surgery complications that arise from open surgery.
  • Improve better visualization for pericardial punctures.
  • Allow other novel therapies such as epicardial ablation or, in the future, even drug/gene delivery into the pericardial space.

Any implanted pacemaker or defibrillator must be replaced every 5-10 years. A young child in critical need of such devices could face surgeries 10 or more times to replace the device and/or leads.

Pre-clinical testing shows early data that this percutaneous approach is as safe and effective as an open surgical technique, although it remains in early-stage evaluation.

What’s next

The NIH SBIR funding will allow the research team to assess long-term safety and efficacy and commercialize the PeriPath tool. Next steps are to:

  • Refine the design of PeriPath for production manufacturing, integrate testing protocols into a Quality Management System and conduct a pilot verification build. Success is defined as manufacturing production devices that pass 510(k) verification and validation testing.
  • Demonstrate substantial equivalence to predicate trocars through performance and handling validation testing using PeriPath to implant an epicardial lead in a pediatric simulator. If successful, the team will demonstrate equivalence and obtain investigational device exception (IDE).
  • In the latter part of the plan, to perform a first in human feasibility clinical study using PeriPath to implant a commercial pacemaker lead with institutional review board (IRB) approval in infants at Children’s National.

Bottom line

Dr. Berul says, “This research could have a transformative impact on current clinical practice by converting an open surgical approach to a minimally invasive percutaneous procedure.”

He also notes that while the study design focuses on the unique needs of infants and children with congenital heart disease – who are the primary focus of the device – the results of the trial may benefit thousands of adult patients who need pacemakers or defibrillators but who are not candidates for the transvenous placement.

Paper cutout of head with brainwaves

Lifesaving ICDs can cause anxiety, stress, PTSD for parents and kids

Paper cutout of head with brainwaves

Research shows that children with implantable cardioverter-defibrillators, and their parents, are at risk for anxiety, post-traumatic stress disorder and other psychological distress.

Recent advances in design and efficiency of implantable cardioverter-defibrillators (ICDs) have led to their increased use in younger patients, protecting more children with congenital heart disease from sudden cardiac arrest and sudden cardiac death, says a commentary in the journal Heart Rhythm. However, living longer with these devices and the day-to-day worry that they may have to deliver a lifesaving shock in the blink of an eye, may cause unusually high rates of anxiety, stress and other psychosocial distress for children with ICDs and their families.

Commentary authors Vicki Freedenberg, Ph.D., RN, electrophysiology nurse scientist, and Charles Berul, M.D., chief of cardiology, both from Children’s National Hospital, note that current available research shows both children with these ICDs and their parents are at risk for anxiety, post-traumatic stress disorder (PTSD) and other psychological distress. They highlight a new study published in the same journal that reports data related to prevalence and factors associated with PTSD in children with ICDs and their parents as a good start to better understanding these impacts.

Why it matters

Freedenberg and Berul say that the new study adds important information to an area without a lot of previous research. They also point out that understanding the long-term impacts of life with these devices is critical to ensuring the overall long-term health and wellbeing of both the children with these devices and their families.

What’s been the hold-up in the field?

The development of devices that work for younger children with congenital heart disease, including advances in ICDs and pacemakers, has increased in the last decade. In this time, studies of how these devices work for children have focused predominantly on clinical outcomes and questions related to clinical care.

As survival rates for children have increased, research needs to shift from the study of mortality and clinical outcomes toward understanding the full spectrum of how these devices impact daily life for these children and their families.

Moving the field forward

According to Freedenberg and Berul, the new study importantly includes both patient and parent perspectives, which is a first in this research area. They also offer recommendations for future studies, including the use of comparison groups to allow for generalization of findings. Researchers might also ask research questions to determine whether the device itself or the medical and non-medical factors that often occur simultaneously are more important to predicting mental health and wellbeing.

However, the commentary concludes with the most important takeaway: More research, with specific parameters focused on the impact of clinical interventions, is desperately needed to truly understand all the ways that children and their families are affected throughout life by the clinical care and support they receive.

Read the full commentary, Potential for shock leads to potential for stress, in the journal Heart Rhythm.

Baby on ventilator

JAMA study shows no benefit to nitric oxide in cardiopulmonary bypass for young children

Baby on ventilator

An international clinical trial showed that nitric oxide doesn’t help kids recover faster from cardiac surgery with cardiopulmonary bypass.

A study published in JAMA finds that the practice of introducing nitric oxide into the gas flow of the cardiopulmonary bypass oxygenator does not improve recovery or reduce the amount of time a child under age 2 needs to be on a ventilator after cardiac surgery.

Children’s National Cardiac Surgery Chief Yves d’Udekem, M.D., Ph.D., co-authored the international study, which is already leading to changes in how hospitals around the world care for children with congenital heart disease (CHD).

The results are from a double-blind, randomized controlled trial with more than 1,200 participants across six centers in Australia, New Zealand and the Netherlands. The research team found that children under age 2 who had cardiac surgery with cardiopulmonary bypass spent about the same number of days on ventilators after surgery, whether nitric oxide was used during surgery or not.

“These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery,” the authors conclude.

What this means

Previous smaller, single center studies had shown early indications that nitric oxide delivered during heart surgery could possibly improve recovery and shorten the need for respiratory support after surgery by reducing the occurrence of low cardiac output syndrome in children under age 2.

This large-scale international trial showed that this is not the case.

Why it matters

Based on these earlier studies, many hospitals in the United States and around the world who perform critical heart surgery on young children with congenital heart disease had already started to incorporate nitric oxide into cardiopulmonary bypass. This new, more robust data is helping hospitals reassess this practice. Many are stopping it altogether based on the findings.

This work is an important reminder of how valuable well-designed, large-scale, double-blind, randomized, controlled trials are to defining, improving and refining best practices in clinical care.

Also, trials of this size and significance in pediatrics generally, and CHD specifically, take a very long time to complete, if they are ever able to be completed at all. That’s because the number of children with these conditions is relatively small and spread out, even though CHD is the most common birth defect in the world. The authors say it is a major accomplishment to have completed a trial of this size and  in such a short time. Even better, the data gathered from this sample of patients from across international borders can be used to provide even more insights into how best to care for these children as they continue to grow and develop.

Mary Donofrio

Mary Donofrio, M.D., FAAP, FACC, FASE, named as The Van Metre Companies Professor of Fetal Cardiology

Mary Donofrio

Children’s National Hospital named Mary Donofrio, M.D., FAAP, FACC, FASE, as The Van Metre Companies Professor of Fetal Cardiology at Children’s National Hospital.

Children’s National Hospital named Mary Donofrio, M.D., FAAP, FACC, FASE, as The Van Metre Companies Professor of Fetal Cardiology at Children’s National Hospital.

Dr. Donofrio serves as Medical Director of the Prenatal Cardiology Program and Critical Care Delivery Program, Director of the Advanced Cardiac Imaging Fellowship and Co-Director of the Cardiac Neurodevelopmental Outcome Program at Children’s National. She is a Professor of Pediatrics at George Washington University and is the founding and current President of the Fetal Heart Society, a non-profit organization created to advance the field of fetal cardiovascular care and science through collaborative research, education and mentorship.

About the award

Dr. Donofrio joins a distinguished group of 42 Children’s National physicians and scientists who hold an endowed chair. Professorships at Children’s National support groundbreaking work on behalf of children and their families and foster new discoveries and innovations in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and donor’s forethought to advance and sustain knowledge.

Dr. Donofrio is an international expert in fetal cardiology. She specializes in the fetal diagnosis and assessment of cardiovascular disease and the in-utero and delivery room management of newborns with complex congenital heart disease (CHD). Dr. Donofrio created an evidenced-based risk-assessment protocol for delivery room management which is now the standard of care for newborns with CHD. Dr. Donofrio has been a co-investigator on several NIH sponsored studies assessing in utero factors that influence neurodevelopmental outcome in children with CHD and more recently a study designed to minimize brain injury during heart surgery using cardiopulmonary bypass. She has published more than 130 papers, including the American Heart Association Scientific Statement on the Diagnosis and Treatment of Fetal Cardiac Disease.

The Van Metre Companies, through their vision and generosity, are ensuring that Dr. Donofrio and future holders of this professorship will launch bold, new initiatives to rapidly advance the field of fetal cardiology, elevate our leadership and improve the lifetimes of children with special hearts.

About the donors

For the past 65 years, Van Metre Companies has remained one of the Greater Washington D.C. area’s most successful, private, multi-faceted real estate developers. Albert G. Van Metre, the founder of Van Metre Companies, established a tradition of philanthropy focused on local charities. As a homegrown business, perpetuating that legacy of local giving is both a responsibility and a source of pride. The Van Metre Companies Professor of Fetal Cardiology honors Albert G. Van Metre’s memory by continuing this tradition of commitment to the community they call home.

The Van Metre Companies hosts the Annual Van Metre 5K Run in support of Children’s National, a longstanding tradition that has raised nearly $3 million in the past 30 years. In 2010, Children’s National dedicated the Van Metre Companies Cardiovascular Surgery Operating Room, a state-of-the-art cardiovascular surgery suite which was funded through the Annual Van Metre 5K Run. They also established The Van Metre Companies Professorship in Cardiology held by Charles Berul, M.D., Chief of Cardiology and Co-director of Children’s National Heart Institute.

 

caspase molecule

Caspases may link brain cell degeneration and cardiac surgery

caspase molecule

The review summarizes both the known physiological roles of caspases as well as some of the well-characterized neurotoxic effects of anesthetics in pre-clinical models.

A review article in the journal Cell Press: Trends in Neuroscience outlines the wide variety of cellular signaling roles for caspase proteins — a type of cellular enzyme best known for its documented role in the natural process of cell death (apoptosis). The authors, including Nemanja Saric, Ph.D., Kazue Hashimoto-Torii, Ph.D., and Nobuyuki Ishibashi, M.D., all from Children’s National Research Institute, pay particular attention to what the scientific literature shows about caspases’ non-apoptotic roles in the neurons specifically. They also highlight research showing how, when activated during a cardiac surgery with anesthesia and cardiopulmonary bypass, these enzymes may contribute to the degeneration of brain cells seen in young children who undergo heart surgery for critical congenital heart defects (CHDs).

Why it matters

The review summarizes both the known physiological roles of caspases as well as some of the well-characterized neurotoxic effects of anesthetics in pre-clinical models.

The authors propose that these non-apoptotic activities of caspases may be behind some of the adverse effects on the developing brain related to cardiac surgery and anesthesia. Those adverse effects are known to increase risk of behavioral impairments in children with congenital heart disease who underwent cardiac surgery with both anesthesia and cardiopulmonary bypass at a very young age.

This work is the first to propose a possible link between developmental anesthesia neurotoxicity and caspase-dependent cellular responses.

The patient benefit

Better understanding of the time and dose-dependent effects of general anesthetics on the developing brain, particularly in children who have genetic predispositions to conditions such as CHDs, will help researchers understand their role (if any) in behavioral problems often encountered by these patients after surgery.

If found to be a contributing factor, perhaps new therapies to mitigate this caspase activity might be explored to alleviate some of these adverse effects on the developing brain.

What’s next?

The authors hope to stimulate more in-depth research into caspase signaling events, particularly related to how these signaling events change when an anesthetic is introduced. Deeper understanding of how anesthetics impact caspase activation in the developing brain will allow for better assessments of the risk for children who need major surgery early in life.

Children’s National leads the way

Children’s National Hospital leads studies funded by the U.S. Department of Defense to better understand how these other roles of caspases, which until now have not been well-documented, may contribute to brain cell degeneration when activated by prolonged anesthesia and cardiopulmonary bypass during cardiac surgery for congenital heart disease.

doctor listening to patients heart

Children’s National leads patient-centered study of adult congenital heart disease

doctor listening to patients heart

The team will work with the 14 research institutions across the United States to collect data and then examine rates of complications or associated illnesses, as well as how adult patients have accessed health care throughout their lives.

Investigators at Children’s National Hospital and the Louisiana Public Health Institute are leading a $4.9 million research effort to study how gaps in health care affect the health and well-being of adults with congenital heart disease (CHD), supported by the Patient-Centered Outcomes Research Institute (PCORI).

The research is led by Anitha John, M.D., Ph.D., medical director of the Washington Adult Congenital Heart Program at Children’s National Hospital and Thomas Carton, Ph.D., chief data officer at the Louisiana Public Health Institute, as well as two patient co-investigators, Ruth Phillippi and Scott Leezer. The study leads also include representatives from the Adult Congenital Heart Association and Anu Agarwal, M.D., who represents the University of California – San Francisco (UCSF).

“With the increasing number of adult patients with CHD, it is important for us to understand how current recommended practices influence patient outcomes,” says Dr. John. “This project will guide us on how to best care for our patients, not just through childhood, but across their entire lifespans. Most importantly, this project will involve direct outreach to patients, incorporating patient reported outcomes as a measure of long-term outcomes.”

Together, the team will work with the 14 research institutions across the United States to collect data and then examine rates of complications or associated illnesses, as well as how adult patients have accessed health care throughout their lives. The findings may help predict which patients are at greater risk of falling out of routine health care, and when these gaps in care are likely to occur across a patient’s lifespan. The study will also correlate findings with how patients are actually feeling in their everyday lives.

The 14 participating institutions are:

  • Ochsner Health
  • Children’s Hospital of Philadelphia
  • Icahn School of Medicine at Mount Sinai
  • University of California – San Francisco
  • Nationwide Children’s Hospital
  • Duke University Health System
  • NYU Grossman School of Medicine
  • Nicklaus Children’s Hospital
  • Children’s Hospital Colorado
  • University of Miami
  • Columbia University Irving Medical Center
  • Cincinnati Children’s Hospital Medical Center
  • Weill Cornell Medical College
  • University of Florida

“This unprecedented look at the health of adults living with congenital heart disease allows us to get a full spectrum view by combining clinical data with patient-reported health data,” says Dr. Carton.

The first patient-powered registry for adults with CHD — the Congenital Heart Initiative (CHI) is a key component of this research. Launched with seed funding from Children’s National and the Heart Research Alliance at UCSF, the CHI is led by Dr. John and her team at Children’s National in addition to a broad multi-stakeholder advisory board, including patients. The CHI was co-developed with input from patients, clinicians and researchers and continues to involve these voices in the advancement of the registry. Patients who are recruited for this research will participate via enrollment in the registry, which will allow researchers to ask patients directly about health, wellness and any specific barriers to care. Learn more about CHI’s progress in their first annual report.

“Patients, like myself, are charting a new course and we desire answers to significant questions, as do our providers, about impact of lifelong specialized care, along with improved understanding of the quality-of-life patients experience,” says Leezer. “This project represents a huge step forward towards obtaining answers for the adult CHD community.”

The study also draws on the vast health data resources of PCORnet®, the National Patient-Centered Clinical Research Institute, to conduct this study more efficiently. With health records for 66 million patients available for observational studies, the PCORI-funded PCORnet provides vast scale to power research on conditions affecting even small numbers of people.

“We are confident that this research will yield critical learnings that will empower the community, align resources and spur future innovation to better meet the specialized care needs of this emerging population,” says Mark Roeder, president and chief executive officer for the Adult Congenital Heart Association.

PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers and clinicians and other health care decision makers with the evidence-based information needed to make better-informed health care choices.

brain network illustration

Cardiopulmonary bypass may cause significant changes to developing brain and nerve cells

brain network illustration

Cardiopulmonary bypass, more commonly known as heart-and-lung bypass, has some unique impacts on the creation and growth of brain cells in the area of a child’s brain called the subventricular zone (SVZ), according to a study in the Annals of Neurology. The SVZ is a critical area for the growth and migration of neurons and nerve cells called neuroblasts, both of which ultimately contribute to the proper development of key brain structures and functions during the early years of life.

The findings, from a study conducted in the Cardiac Surgery Research Laboratory at Children’s National Hospital, provide new insight into the cellular impacts of the cardiopulmonary bypass machine on brain growth and development for newborn infants with congenital heart disease. They will have an important role in the refinement of strategies to help protect the fragile brains of children who require lifesaving cardiac surgery with cardiopulmonary bypass immediately after birth.

Specifically, the research team found that during cardiopulmonary bypass:

  • Creation of neurons (neurogenesis) in the neonatal and infant subventricular zone is altered.
  • Migration of nerve cells, called neuroblasts, to the frontal lobe is potentially disrupted.
  • Changes to the growth and movement of neurons in the SVZ are prolonged.
  • Cortical development and expansion is impaired.
  • Specific types of neurons found only in the brain and spinal cord, called interneurons, are also affected.

The study uses an innovative pre-clinical model of the developing brain that is more anatomically and physiologically similar to human neonates and infants than those used in prior studies and in most neurological laboratory-based research.

Cardiopulmonary bypass is one of several key factors thought to cause children with congenital heart disease to sometimes demonstrate delays in the development of cognitive and motor skills. These disabilities often persist into adolescence and adulthood and can ultimately represent long-term neurocognitive disabilities. It is also believed that genetic factors, abnormal blood flow to the brain while in utero or low cardiac output after surgical procedures on the heart may contribute to these challenges.

“Unraveling cellular and molecular events during surgery using this preclinical model will allow us to design therapeutic approaches that can be restorative or reparative to the neurogenic potential of the neuronal stem precursor cells found in the subventricular zone of the neonatal or infant brain,” says Nobuyuki Ishibashi. M.D., Foglia-Hills Professor of Pediatric Cardiac Research, director of the Cardiac Surgery Research Laboratory at Children’s National and senior author on the study. “In particular, previous studies in our laboratory have shown improvement in the neurogenic activities of these precursor cells when they are treated with mesenchymal stromal cells (MSCs).”

The findings from this study further support the work already underway in the NIH-funded MeDCaP clinical trial for neonates and infants undergoing cardiac surgery using the cardiopulmonary bypass machine. That trial uses the heart and lung machine itself to deliver MSCs directly into the main arteries that carry blood to the brain.

Drs. Wernovsky and Martin

Cardiac care leaders recognized for mentorship and innovation at AAP

Two Children’s National Hospital cardiac care leaders received prestigious recognition awards from the American Academy of Pediatrics (AAP) during that organization’s virtual National Conference and Exhibition in October 2021.

  • Gil Wernovsky, M.D., cardiac critical care specialist at Children’s National Hospital, received the 2021 Maria Serratto Master Educator Award from AAP Section on Pediatric Cardiology and Cardiac Surgery, celebrating his 30-plus-years as a clinician, educator, mentor and leader in the field.
  • Gerard Martin, M.D., FAAP, FACC, FAHA, C. Richard Beyda Professor of Cardiology, Children’s National Hospital, received the AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award, in recognition of his work to establish the use of pulse oximetry to screen newborn infants for critical congenital heart disease in the first 24 hours of life.

Dr. Wernovsky: 2021 Maria Serratto Master Educator Award, AAP Section on Pediatric Cardiology and Cardiac Surgery

Gil Wernovsky

Gil Wernovsky, M.D., received the 2021 Maria Serratto Master Educator Award from AAP Section on Pediatric Cardiology and Cardiac Surgery.

The Master Educator Award is presented each year to a pediatric cardiologist or cardiothoracic surgeon who exemplifies excellence as an educator, mentor and/or leader in the field.

A practicing cardiac critical care specialist with more than 30 years’ experience in pediatric cardiology, Dr. Wernovsky trained and mentored more than 300 fellows in pediatric cardiology, cardiac surgery, neonatology, critical care medicine and cardiac anesthesia, in addition to countless residents and fellows. He also organizes national and international symposia to share expertise around the world. During the COVID-19 public health emergency, for example, he co-founded the Congenital Heart Academy (CHA). The CHA provides content from an international faculty of cardiac care to more than 26,000 practitioners in 112 countries and includes a thriving YouTube channel.

Dr. Wernovsky is also a founding member of several international societies focused on bringing together clinicians, researchers and students across sub-specialties of pediatric cardiology and cardiac surgery for knowledge exchange and best practice sharing. These include: the Pediatric Cardiac Intensive Care Society, World Society for Pediatric and Congenital Heart Surgery, the International Society of Pediatric Mechanical Circulatory Support and the Cardiac Neurodevelopmental Outcome Collaborative.

Dr. Wernovsky received the award on October 10 at the virtual Scientific Sessions of the 2021 American Academy of Pediatrics National Conference and Exhibition.

Dr. Martin: AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award

Gerard Martin

Gerard Martin, M.D., FAAP, FACC, FAHA, C. Richard Beyda Professor of Cardiology, Children’s National Hospital, received the AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award.

The Section on Advances in Therapeutics and Technology (SOATT) educates physicians, stimulates research and development and consults on therapeutics and technology-related matters for the AAP. The Achievement Award recognizes someone who has shown leadership in applying innovative approaches to solve pressing problems.

Dr. Martin is the C. Richard Beyda Professor of Cardiology and has cared for children at Children’s National for more than 30 years. As an advocate for congenital heart disease efforts nationally and internationally, he played an integral role in the development of an innovative use of existing hospital technology—the pulse oximeter—to detect critical congenital heart disease in newborn babies.

Today, Dr. Martin and colleagues across the United States and around the world have worked to make this screening method a standard of care for newborns everywhere. It is a part of the Health Resources and Services Administration (HRSA) Recommended Uniform Screening Panel and has become law in every state. They continue to conduct research to refine the recommendations and hone-in on the most effective ways to harness these tools.

Dr. Martin was selected for this award in 2020. He accepted it and offered remarks during the 2021 virtual AAP National Conference and Exhibition on Monday, October 11, 2021.

cardiology timeline

History of cardiac care for children in Washington, D.C.

An article published in the journal Cardiology in the Young provides a comprehensive timeline mapping the growth trajectory of cardiology and cardiac surgery at one of the nation’s oldest children’s hospitals — Children’s National Hospital in Washington, D.C.

Cardiology and cardiac surgery at Children’s National have grown exponentially in the nearly 80 years since the first heart-related surgery was recorded in 1942. Today, aligned with the growth trajectory of the hospital as it has evolved to become one of the top-ranked pediatric institutions in the country, the Children’s National Heart Institute has also evolved. In the last year, this included welcoming new Cardiac Surgery Chief, Yves d’Udekem, M.D., Ph.D.

The authors, Gerard Martin, M.D., M.A.C.C., C.R. Beyda Professor of Cardiology, and Richard Jonas, M.D., emeritus chief of Cardiac Surgery, both from Children’s National Hospital, note that this history of care has laid the groundwork for the Heart Institute to continue growing and caring for more neonates, infants, children and adults with congenital heart disease in the entire mid-Atlantic region and around the world.

cara timeline mapping the growth of cardiac care for neonates, children and adults at Children’s National Hospital

The article features a timeline mapping the growth of cardiac care for neonates, children and adults at Children’s National Hospital.

flow chart of pulse ox study

Newborn screening for critical congenital heart disease serves as vital safety net

One of the nation’s longest-running newborn screening programs for critical congenital heart disease (CCHD) finds that screening continues to serve as a necessary tool to help identify every child with CCHD — even in states where the majority of babies are diagnosed before birth.

The screening program study findings were published in Pediatrics. The data is some of the first to provide long-term evidence for using pulse oximetry to screen newborns for critical congenital heart disease 24 hours after birth. This screening test was added to the Department of Health and Human Services Recommended Uniform Screening Panel in 2011 and is now required in all 50 states.

“This study reinforces why pulse oximetry screening for CCHD is an important tool in our arsenal to identify and treat critical congenital heart disease, and other conditions that affect the flow of oxygen throughout the body, as soon as possible,” says Bryanna Schwarz, M.D., a cardiology fellow at Children’s National Hospital and lead author. “We know that prompt, early detection and swift intervention is crucial to positive long-term outcomes for these kids.”

The team looked at the data and outcomes for all babies born throughout eight years at Holy Cross Hospital in suburban Maryland, one of the first community birthing hospitals in the country to routinely perform the screening. Over the eight-year period, 64,780 newborns were screened at the site. Of those:

  • Thirty-one failed the screening, and every baby who failed was found to have congenital heart disease or another important medical condition.
  • Twelve of the failures (38.7%) were babies with critical congenital heart disease who were not previously identified by prenatal detection.
  • Nine others (29%) had a non-critical congenital heart condition.
  • Ten additional babies (32%) had a non-cardiac condition.

The authors note that the 12 newborns with CCHD identified through pulse oximetry screening are noteworthy because they represent critical congenital heart disease cases that are not found before birth in the state of Maryland, where rates of prenatal diagnosis are relatively high. The finding indicates that screening after birth continues to play a critical role in ensuring every baby with critical congenital heart disease is identified and treated as quickly as possible.

“Holy Cross Health and Children’s National have had a decades-long relationship, as we mutually care for women and infants throughout the region. With Children’s National having the U.S. News & World Report #1 ranking Neonatology service in the nation and Holy Cross Hospital being among the top 10 hospitals for the number of babies delivered each year, we are honored to be leading together the great work that is being done to serve our health care community,” says Ann Burke, M.D., vice president of Medical Affairs at Holy Cross Hospital. “We are committed to continuing to do our part to care for women and infants, as well as contribute to the national landscape for neonatal care. We are delighted in the outcomes we have seen and look forward to continued advancement.”

In this study, infants who did not have critical congenital heart disease were considered “false positives” for CCHD. Still, every one of them was found to have another underlying condition, including non-critical congenital heart disease or non-cardiac conditions (such as sepsis and pneumonia) that would also require monitoring and treatment.

The researchers also ran a projection of recently recommended updates to the screening protocol, which include removing a second re-screen after a newborn fails the initial test, to look at whether removing the second rescreen to verify results would decrease accuracy. While the false positive rate did increase slightly from .03% to .04%, eliminating a second re-screen allowed the newborns who were identified to receive crucial care sooner without having to wait an additional hour for one more test to verify their condition.

“It’s time to stop asking if pulse oximetry is a necessary tool to detect critical heart disease in babies,” says Gerard Martin, M.D., M.A.C.C., senior author of the study and C.R. Beyda Professor of Cardiology at Children’s National Hospital. “Our focus now should be on making evidence-based refinements to the screening protocol based on collected data to ensure the process is simple, can be performed consistently and provides as accurate results as possible.”

Crowded makeshift buildings of a shantytown

Calling greater attention to sub-Saharan Africa’s pressing challenges in pediatric cardiac care

Crowded makeshift buildings of a shantytown

Sub-Saharan Africa has only 0.19 pediatric cardiac surgeons per million children — nowhere near enough surgeons to care for all the pediatric congenital heart disease and acquired heart disease present in the people who live there.

A literature review in the journal Current Opinion in Cardiology draws further attention to the pressing needs for better pediatric cardiac care in regions of the world where the population continues to grow, but the development of specialty care for children continues to lag. The article focuses specifically on sub-Saharan Africa.

“If 40% of live births occur in Africa by 2050 as the projections suggest, congenital heart disease may well become the most important contributor to infant mortality rate in sub-Saharan Africa in the next three decades,” stated the authors, including Annette Ansong, M.D., who recently joined Children’s National Hospital as medical director of outpatient cardiology.

As highlighted previously by other authors within the Global Health Initiative at Children’s National and through the work of the American Heart Association, the region’s needs are already significant in  tackling the impacts of existing congenital heart disease and rheumatic heart disease. Rheumatic heart disease is a devastating long-term outcome of rheumatic fever caused by untreated streptococcus infections.

Annette Ansong

“If 40% of live births occur in Africa by 2050 as the projections suggest, congenital heart disease may well become the most important contributor to infant mortality rate in sub-Saharan Africa in the next three decades,” stated the authors, including Annette Ansong, M.D., who recently joined Children’s National Hospital as medical director of outpatient cardiology.

Dr. Ansong and colleagues reiterate the point that today, “whereas one cardiac center caters to approximately 120,000 people in North America, 33 million people in sub-Saharan Africa must depend on one center for care.” They also note that this region of Africa has only 0.19 pediatric cardiac surgeons per million children compared with more than 58 times as many in North America.

Changing the trajectory of pediatric cardiac care in sub-Saharan Africa will take motivation on several fronts, the authors write. Dedication to early detection and intervention (medical or surgical), an emphasis on building an in-country pipeline of human resources and skills’ sets are needed to tackle the increasing numbers of children requiring this specialty care. Political will and better financial resources can also support the training and development of centers that specialize in these capabilities.

pregnant hispanic woman

Significant health disparities in detection of critical congenital heart disease

pregnant hispanic woman

Mothers who are Hispanic or who come from rural or low socioeconomic status neighborhoods are less likely to have their child’s critical heart condition diagnosed before birth, according to a new study in the journal Circulation.

Mothers who are Hispanic or who come from rural or low socioeconomic status neighborhoods are less likely to have their child’s critical heart condition diagnosed before birth, according to a new study in the journal Circulation.

This is the largest and most geographically diverse study of these challenges to date. The study compared patient data of more than 1,800 children from the United State and Canada diagnosed with two of the most common, and the most serious, critical congenital heart defects: hypoplastic left heart syndrome (HLHS), when the left side of the heart is not developed completely, and transposition of the great arteries (TGA), when the two main arteries that carry blood away from the heart are reversed.

“The earlier we diagnose a heart defect, especially a serious one such as HLHS or TGA, the sooner we can make a plan for how to safely deliver the infant and reduce the impacts of that heart defect on the rest of the body,” says Anita Krishnan, M.D., first author and cardiologist at Children’s National Hospital. “Early detection and diagnosis of these conditions is crucial to ensuring the best possible outcome for the child, especially in protecting the brain.”

Even when infants’ heart defects were detected before birth, babies from neighborhoods with lower socioeconomic status were detected later in gestation than others.

“The COVID-19 pandemic has brought the idea of significant disparities in health care to the forefront of our national attention,” says Dr. Krishnan. “Even though many health care providers have seen these inequities firsthand in their own clinical experience, it was still surprising to see the strength of the association between socioeconomic position and the care available to mothers.”

In both the United States and Canada, expectant mothers are first screened as part of routine prenatal care in the first trimester for early signs of congenital heart defects and other genetic disorders via blood screen and ultrasound. In the second trimester, a comprehensive ultrasound evaluation for structural anomalies is routine. If any issues are detected, the mother is referred for a fetal echocardiogram and counseling.

The authors suggest that decreased linkages between neighborhoods and people identified in the study and subspecialists could contribute to the disparities found in the study.

“Prenatal detection rates may improve if we are able to leverage outreach and telehealth to strengthen the relationships between these specialties and the groups we identified in the study,” Dr. Krishnan says.

The study included a total of 1,862 patients, including 1,171 patients with HLHS (91.8% prenatally diagnosed) and 691 with TGA (58% prenatally diagnosed). The study group included prenatally diagnosed fetuses with HLHS or TGA and postnatally diagnosed infants less than two months old with HLHS or TGA. Data was collected from institutions participating in the Fetal Heart Society, a non-profit 501(c) multicenter research collaborative with a mission to advance the field of fetal cardiovascular care and science. Mary Donofrio, M.D., director of Prenatal Cardiology at Children’s National, is society president and served as a senior author on this study.

Read the AHA’s press release: Prenatal detection of heart defects lower in rural, poor areas and among Hispanic women.

little girl at the dentist

Limit antibiotic use before dental procedures to high-risk heart patients, says AHA

little girl at the dentist

A new scientific statement from the American Heart Association (AHA) says that good oral hygiene and regular dental care are the most important ways to reduce the risk of a heart infection called infective endocarditis (IE) caused by bacteria in the mouth.

A new scientific statement from the American Heart Association (AHA) says that good oral hygiene and regular dental care are the most important ways to reduce the risk of a heart infection called infective endocarditis (IE) caused by bacteria in the mouth. The statement was published in Circulation, the AHA’s flagship journal.

This statement addresses the impact of the major changes made in the 2007 AHA infective endocarditis (IE) guidelines that limited antibiotic prophylaxis (AP) prior to dental procedures to cardiac conditions at highest risk of complications from endocarditis by focusing on the following:

  • What was the acceptance of and compliance with the 2007 recommendations?
  • Was there an increased incidence of viridians group streptococci (VGS) infective endocarditis (IE)?
  • Were the recommendations from the guideline valid and should they be revised?

While the statement speaks to all types of heart disease, one area of particular interest in congenital heart disease was highlighted by statement co-author Craig Sable, M.D., F.A.H.A., associate division chief of Cardiology at Children’s National Hospital.

He noted that the statement specifies that children and adult congenital heart patients undergoing pulmonary valve replacement can be at higher risk for IE. The most significant risk factor for IE is the material the valve is made from, regardless of whether it is placed by surgery or catheterization.

Read more about this statement from the AHA

Watch AHA’s video explaining the statement, which features Dr. Sable.

chest x-ray showing pacemaker

Medical device pitch competition focuses on pediatric electrophysiology devices for CHD

chest x-ray showing pacemaker

While the last decade brought great advances in technologies that improve the care of adult arrhythmias, pediatric patients have been left behind, with only five devices approved for use in children in the same period.

Congenital heart disease (CHD) affects six out of 1,000 babies born in the U.S. each year and is often complicated by arrhythmias, a condition where the heart beats too rapidly, too slowly or irregularly due to a misfiring of the body’s electrical impulses. While the last decade brought great advances in technologies that improve the care of adult arrhythmias, pediatric patients have been left behind, with only five devices approved for use in children in the same period. As a result, pediatric specialists are often using off-label or improvised devices to treat pediatric arrhythmias, including the smallest newborns.

Recognizing this unmet need, the National Capital Consortium for Pediatric Device Innovation (NCC-PDI), in collaboration with MedTech Innovator, is accepting applications through April 12, 2021, for its annual “Make Your Medical Device Pitch for Kids!” competition. This year’s competition focuses on innovations in pediatric devices that treat CHD, with an emphasis on electrophysiology devices such as pacemaker systems, ablation catheters, wearable monitoring devices and related technologies that address arrhythmias in children.

“NCC-PDI was created, with the support of the Food and Drug Administration (FDA), to seek out and address significant unmet needs in pediatric medical devices,” says Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National Hospital and principal investigator of NCC-PDI. “We have learned from the experts that pediatric-specific technologies for treating arrhythmias would be a game changer in the care of their patients, so we are focusing our competition and grant awards on this opportunity.”

Kolaleh-Eskandanian

“We have learned from the experts that pediatric-specific technologies for treating arrhythmias would be a game changer in the care of their patients, so we are focusing our competition and grant awards on this opportunity,” says Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National Hospital and principal investigator of NCC-PDI.

Using a virtual format, semi-finalists chosen from all submissions will make their first pitch on May 12, 2021. Up to 10 finalists selected from this event earn participation in a special pediatric-focused track of the MedTech Innovator accelerator program, the largest medtech accelerator in the world, beginning in June 2021. These innovators then participate in the pediatric competition finals in September 2021 where judges will award up to $150,000 in FDA-sponsored grants to the devices selected as most impactful and commercially viable.

How significant is the need for pediatric devices to address arrhythmias? In a recent survey of members conducted by the Pediatric and Congenital Electrophysiology Society (PACES), the vast majority (96%) said they believe there is a deficiency in devices available to serve the needs of pediatric patients. Conducted with the U.S.FDA, the survey also asked respondents to identify the biggest unmet need, which physicians identified as cardiovascular implantable electronic devices that are smaller, have better battery life and have pediatric-specific algorithms. Specifically, a leadless pacemaker designed for pediatric care was consistently on the most-wanted list.

NCC-PDI is one of five members in the FDA’s Pediatric Device Consortia Grant Program created to support the development and commercialization of medical devices for children, which lags significantly behind the advancement of adult medical devices. NCC-PDI is led by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Hospital and the A. James Clark School of Engineering at the University of Maryland with support from partners MedTech Innovator, BioHealth Innovation and design firm Archimedic.

Eskandanian says that enhancing access to resources for pediatric innovators is also one of the aims of the Children’s National Research & Innovation Campus, a first-of-its-kind focused on pediatric health care innovation, with the first phase currently open on the former Walter Reed Army Medical Center campus in Washington, D.C. With its proximity to federal research institutions and agencies, universities, academic research centers, as well as on-site incubator Johnson and Johnson Innovation – JLABS, the campus provides a rich ecosystem of public and private partners which, like the NCC-PDI network, will help bolster pediatric innovation and commercialization.

 

Dr. Martin interacts with a patient

Gerard Martin, M.D., F.A.C.C, recognized with American College of Cardiology top honor

Dr. Martin interacts with a patient

Gerard Martin, M.D., F.A.C.C., has been awarded the 2021 Master of the ACC Award by the American College of Cardiology in honor of contributions to the cardiovascular profession.

Gerard Martin, M.D., F.A.C.C., has been awarded the 2021 Master of the ACC Award by the American College of Cardiology in honor of contributions to the cardiovascular profession. Dr. Martin will be recognized for these achievements along with all 2021 Distinguished Award winners during Convocation at the hybrid 70th Annual Scientific Session & Expo taking place May 15-17, 2021 in Atlanta and virtually.

“Dr. Martin has made lasting contributions to the field of cardiovascular medicine through his dedication to improving cardiovascular health and enhancing patient care,” said ACC President Athena Poppas, MD, F.A.C.C. “It is an honor to be able to recognize Dr. Martin with the Master of the ACC Award and celebrate his tremendous achievements in the cardiovascular field.”

The Master of the ACC (MACC) Award recognizes and honors fellows of the American College of Cardiology who have consistently contributed to the goals and programs of the college and who have provided leadership in important college activities. MACC designees have been members of the college for at least 15 years and have served with distinction and provided leadership on various college programs and committees. Only four distinguished members of the American College of Cardiology are selected for this honor each year.

Dr. Martin is a cardiologist at Children’s National Hospital, where he has been in practice since 1986. He founded the Children’s National Heart Institute in 2004 and was named the C. Richard Beyda Professor of Cardiology in 2007. He has published over 150 peer-reviewed manuscripts, book chapters and invited publications and has presented abstracts at over 125 meetings. Dr. Martin is an invited lecturer who has traveled to over 200 meetings, hospitals and universities within the U.S. and around the world.

Dr. Martin is an advocate for congenital heart disease (CHD) efforts nationally and internationally. He played integral roles in the development and dissemination of critical congenital heart disease screening in using pulse oximetry — a practice that is now standard for all newborns across the United States. He also has volunteered on countless medical missions to developing countries.

Dr. Martin is board-certified in pediatric cardiology, a fellow of the American Academy of Pediatrics and the American College of Cardiology and is also a member of the Society for Pediatric Research and the American Board of Pediatrics.

Nineteen Distinguished Awards will be presented at ACC.21 this year, each recognizing an individual who has made outstanding contributions to the field of cardiovascular medicine. Recipients are nominated by their peers and then selected by the American College of Cardiology Awards Committee.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.