Each year, more than 1 million children are born worldwide with a congenital heart defect, the most common type of birth defect, according to the Children’s Heart Foundation and the National Institutes of Health. There is, therefore, a pressing need for innovations in pediatric cardiology to address the global burden of disease. Fortunately, pioneering new technologies are revolutionizing pediatric cardiology and leading to better patient outcomes.
I believe that the next five years will bring many advances in the field of congenital heart defects. One of these will be the miniaturization of percutaneous valve technologies. Increasing miniaturization is a crucial development as the current stent delivery systems are large and bulky, limiting options for treating younger children.
The recent advance of nonsurgical interventions, such as percutaneous pulmonary valve implantations, has helped reduce the number of times children and their families will have to face the risk and stress of open heart surgery. Typically, patients requiring surgery for defective pulmonary valves can expect up to four surgeries over their lifetime. Percutaneous pulmonary valve implantation can be done via a catheter inserted into a femoral vein, guided by X-ray. Once the valve (stent) is deployed in the correct position, it will function immediately.
Unfortunately, the procedure is not without limitations. One of these is that among the patients requiring repair of Tetralogy of Fallot, only those receiving a “conduit” and or a bioprosthetic valve between the right ventricle and the pulmonary artery (approximately 15 percent of patients) are suitable for percutaneous valve implantation. The remaining 85 percent, those with a “‘trans-annular patch,” are left with no other option than open-heart surgery.
My colleagues and I at Sidra Medical and Research Center in Doha, Qatar, and Weill Cornell Medical College in New York City are evaluating a new valve, which will be suitable for these patients. The new generation of valves will be inserted via smaller catheters, allowing us to offer treatments to younger and smaller patients who currently have few options. Although still investigational, we are pleased that these valves have shown very promising results in humans (European Journal of Cardio-Thoracic Surgery 2012; 41: 1192–1194; J Am Coll Cardiol 2011; 58: 2248–2256).
Another exciting innovation that will improve outcomes for patients with congenital heart disease is the use of 3D organ printing technology for heart surgery. 3D printers are increasingly being used in medicine, and cardiology is no exception. We can now construct models of the heart using images from a patient's MRI/CT scans and allow the surgeon/interventionalist to plan out the surgery/intervention based on the patient’s physiology, which leads to fewer errors.
The 3D models duplicate nearly every detail of the heart, including critical elements that can be missed in 2D echocardiograms, CT scans and MRIs. Although these traditional imaging devices can give physicians a good idea of patients' internal organs, few things can compare to assessing a life-size model of the heart prior to surgery.
It was 25 years ago that I decided to make congenital heart defects the focus of my career. In those 25 years I have seen great advances in the field, and that gives me hope for the future. Through pioneering the use of modern technology in new areas and promoting such uses to the cardiovascular community, clinical practice can be changed for the better (Catheter Cardiovasc Interv 2001; 52: 194–199). If we continue to drive innovation and push technology to the limits, ambitions such as eliminating open-heart surgeries in children and adults are possible.
Dr. Hijazi is the acting chief medical officer and the chairman of the Department of Pediatrics at Sidra Medical and Research Center in Doha, Qatar. He also is the medical director of the Sidra Cardiovascular Center of Excellence.