Anomalous pulmonary venous return (TAPVR or PAPVR)
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.
And a significant amount of the groundbreaking cardiac research currently being conducted at Children’s aims to refine and advance the open heart surgery and catheterization procedures that correct congenital heart defects in newborns and young children—including anomalous pulmonary venous return.
Cardiac surgery research
Members of Children’s Cardiac Surgery Research Laboratory—a multidisciplinary team of basic and applied research investigators who hold faculty appointments at Harvard Medical School—are studying the mechanisms of heart disease and new treatments for children with congenital heart defects.
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
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—who hold faculty appointments at Harvard Medical School—participate in clinical research activities, and many do laboratory research, as well.
New Congenital Heart Valve Center
Clinical heart researchers at Children’s are creating a new heart valve center with a focus on valve repair rather than replacement. The new center has formed in response to the greater emphasis currently being placed on identifying and treating valve abnormalities in children and young adults with congenital heart disease.
Part of our approach to repairing AV canal is finding new ways to get more accurate imaging information ahead of time with techniques such as 3-dimensional (3D) echo and cardiac magnetic resonance imaging. Through use of such techniques, our surgeons can better understand the mechanism of valve dysfunction, and the appropriate repair to address that mechanism. Children’s studies in the new center will be ongoing.
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.
Del Nido’s newly-developed cardioport
will someday make possible faster, less invasive heart surgery.
|Children’s history of 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 then, we’ve gained recognition around the globe for our leadership in pediatric cardiology, and we continue to make critical advances in the field. In 2010, U.S. News & World Report named Children’s cardiology and cardiac surgery programs the best of any pediatric hospital in the country.|