Monday, January 9, 2012

Cardiology collaborations

We often talk about how the Sheikh Zayed Institute's location on the top floors of Children's National Medical Center's main building in Washington, DC, is an unprecedented opportunity for doctors, researchers, and engineers to collaborate. Frequently, subspecialty clinicians, from otolaryngologists to neurologists, come upstairs to present their individual field's challenges.

We were recently visited by Charles Berul, MD, Division Chief of Cardiology at Children's National. Children's National Heart Institute is one of the premiere programs in the world when it comes to treating congenital heart disease. Dr. Berul shared with the bioengineering team some of his own research into developing better treatments for his unique pediatric population as well as the areas of opportunity for developing innovative new treatments for pediatric cardiology.

One of the common themes we hear is that current devices aren't developed specifically for children. There is little incentive for companies to undertake all the rigorous efforts of device development for children, no matter the surgical or clinical need, because very few children are sick enough to need these treatments compared with the adult population who require such solutions. In cardiology, this can mean devices and surgical tools that are far too large for a baby's tiny heart, or it can mean a wire or lead that wears out too quickly due to the daily activities of a typical toddler.

Dr. Berul discussed a catheter-based approach to normalizing heart arrythmias (irregular heartbeats) that employs an ablation technique. It has been quite successful in patients who have arrythmias due to scar tissue from previous heart surgeries. This is a huge problem for children who were treated for congenital heart disorders (CHD) at a young age and are now adults. Now that techniques have improved to surgically correct such anomalies for many children born with CHD, more people than ever before are living long into adulthood for the first time.

He noted that about 50 percent of people living with congenital heart disease suffer arrythmias about 10 years after surgery. The catheter ablation technique may resolve the arrythmia through a minimally invasive correction that prevents these people from needing additional open heart surgeries. Cardiac experts have been using some three dimensional imaging techniques to be as precise as possible when targeting a site in the heart for ablation in these delicate procedures, but Dr. Berul noted that some of the image fusion and HIFU projects at the Institute could break new ground and really help the cardiac team perform this procedure even more precisely. It is likely that the numbers of people who might require treatment for a CHD-related arrythmia will only increase in the coming years.

Additionally, Dr. Berul has worked for a long time to develop better ways to place pacemaker leads to accommodate children who can't have the pacemaker installed in the same way an adult would. He showed how his team developed a subcutaneous placement of the pacemaker leads, a placement that transfers the electrical current of the pacemaker just as well in little children as it would if the leads were implanted in the typical location, in close proximity to the heart. This could be used in children whose anomalies don't allow for traditional placement, or in children who are too small for that approach. He noted that today's pacemaker leads have a tendency to break or malfunction, and there is a need for a new design that can hold up better over the long term to avoid repeat procedures, especially in children.

These discussions are fascinating, both in terms of learning more about the current best practices in these subspecialty fields, and hearing the Institute team and the Children's National doctors thinking bigger, together, about how future collaborations could really improve care for children who need it.