When you hear the words “heart trouble,” you’re probably more likely to think of an octogenarian than an infant. But every year some 35,000 babies in the United States are born with a heart defect that requires repair. And hundreds of other children have heart damage caused by illness. As devastating as such circumstances might be, families in the Upper Midwest can feel fortunate to have the University of Minnesota on their team. Home to the first successful open-heart surgery and starting point for the first wearable pacemaker and numerous other cardiac devices, the University continues to lead today in finding and applying new and better ways to mend ailing hearts.
For kids whose hearts have been harmed by illness, The Heart Center at University of Minnesota Amplatz Children’s Hospital is finding leadingedge solutions. Stevon Stibbons was a typical toddler until a viral infection last March caused his heart to stop functioning properly. Medications didn’t fix the problem, and doctors had to put him on an artificial pump to keep his blood oxygenated and circulating. But a device like that is only a short-term solution, and Stevon had a long-term problem.
Under a compassionate use exemption from the Food and Drug Administration, associate professor of cardiothoracic surgery and codirector of The Heart Center, James St. Louis, M.D., connected the device to Stevon’s heart to buy him time until a donor heart might become available.
In June, St. Louis decided to test whether the little boy’s heart might have recovered on its own. The first time he tried weaning Stevon off the Berlin Heart device, things went well for almost a week, but then Stevon’s heart needed help again. The second time, in September, Stevon’s heart took over.
And today? “He just runs and runs and runs,” mom Sheree Stibbons says. “He’s my miracle baby.”
St. Louis has since used the device to help three other children, including a newborn. “It’s really revolutionized how we’ve dealt with kids with failing myocardium,” he says. “We’ve had very good success with it.”
With the Berlin Heart as an option, the hope of making it to transplant—and perhaps even making it past the need for a transplant like Stevon—is brighter than ever.
The narrow path
In the case of congenital heart defects, the quest for better care has taken a narrow path. Sometimes when the heart and major blood vessels are developing in a baby’s body, a disrupted connection may remain between two parts of the heart, or a vein or artery may be too tiny to carry blood properly.
In the past, such situations have often meant not only opening the infant’s chest, but also temporarily stopping the heart and blood flow to the child’s developing brain—a procedure with a risk of brain damage and other side effects.
Today, however, physicians are able to do some lifesaving repairs by delivering patches or other devices through a catheter inserted into a blood vessel.
Although University doctors perform about 250 such catheter-guided procedures each year, they’re not an option for every child. For children facing more complicated conditions, University of Minnesota Amplatz Children’s Hospital two-and-ahalf years ago opened a special hybrid pediatric catheterization lab, the only one of its kind in the Upper Midwest. In this room, surgeons and interventional cardiologists—the doctors who perform the catheter-guided procedures—can work together to solve complex problems.
“By combining pediatric cardiothoracic techniques and pediatric interventional catheterization techniques, we can do many different types of repairs and palliative treatments and reach places normal surgical techniques and normal catheterization can’t reach,” says Daniel Gruenstein, M.D., an assistant professor in the University’s Department of Pediatrics and director of pediatric interventional cardiology.
“The fact that we are able to do very complex repairs on a beating heart actively circulating blood in a normal way, as opposed to artificially, is a huge advantage for our patients,” he continues, meaning less time on a ventilator and heart drugs and less time in intensive care after surgery.
The hybrid suite now serves about 10 patients per year, but Gruenstein expects that number to grow as the concept catches on.
“It’s widely recognized that this is the future,” he says. “We’re already years ahead.”
An expanding field
These are just a few of the many new approaches to healing young hearts. Doctors at the University are developing other minimally invasive devices and applications, too. And opportunities for applying hybrid procedures will expand dramatically when the children’s hospital moves into its new building—which includes a bigger, custom-designed hybrid facility—in 2011.
The good news? The University had been chosen as one of 11 sites in the country to participate in a clinical trial exploring an experimental device called the Berlin Heart EXCOR® Pediatric ventricular assist device, which is meant to keep kids’ hearts healthy until they can get a heart transplant.
“It’s an exciting time to be part of The Heart Center at the University of Minnesota,” Gruenstein says. “This is a terrific example of the good that can come and the advantages for children in Minnesota when new ideas, techniques, and technologies and an interested public get together to try something that’s positive for patients with complex diseases.”