Spring 2007

Big Advances for Small Heart Patients

Genes Reveal the Heart's Secrets | Solutions Without Surgery | Smaller Tools for Tiny Patients

"Congenital Defects: A Lifelong Affair of the Heart"

When she was born, Ashley Dumford had a hole in her heart. She was diagnosed at Cincinnati Children's with an atrial septal defect, a common congenital malformation. If left untreated, this hole in the wall between the heart's upper chambers could cause problems in adulthood. So at age 5, when the hole had not yet closed on its own, Ashley underwent open heart surgery to correct it.


Now at age 17, Ashley still comes to Cincinnati Children's for check-ups. If it's up to her, she'll continue to visit her cardiologist, Richard Meyer, MD, for as long as he will see her. "There are differences between congenital birth defects and heart diseases you get later in life," Ashley says. She and her mom, Betsy, both feel it's important that the same doctors who detect and treat these conditions in children monitor these patients as they grow.


The check-ups have proven valuable: When Ashley was 8, Dr. Meyer found she had a mitral valve prolapse, an abnormality of a valve in the heart. He continues to assess the valve's condition at yearly appointments.


According to the American Heart Association, about 35,000 babies are born each year with a congenital heart defect. Due to advances in treatment, many of those babies will live to adulthood. Ashley's mom says, "There can be complications in these patients that adult cardiologists are not used to seeing. I feel more comfortable having Ashley seen by Dr. Meyer because of that."


Ashley, a high school junior, has volunteered at the Ronald McDonald House since she was 8. She also participates in a leadership program and is currently heading a drive to collect personal care items for a nonprofit organization aiding kids placed in foster care. Although she was born with a heart defect, there's no doubt that Ashley Dumford has plenty of compassion.

When he tells a pregnant woman that an echocardiogram shows a heart defect in her unborn child, Richard Meyer, MD, knows by the stunned look on her face that she hasn't heard about recent advances in heart care for infants.

"Most times I have to reassure her that she will deliver the baby normally and that the defect is correctable," says Dr. Meyer, a pediatric cardiologist at Cincinnati Children's. Many parents don't know the amazing advances in pediatric cardiology over the past 15 years, especially in genetic research and noninvasive procedures to correct defects.

Genes Reveal the Heart's Secrets

By isolating the genes that cause heart abnormalities, doctors can identify defects, such as holes in the heart, that in the past were a major cause of death in newborns or young children. Even before children are born, doctors know what needs to be repaired at birth or soon after. Sometimes they perform corrective surgery even before the child is born.

"Because of advances over the last 30 or 40 years in correcting heart defects, we are now seeing children who have congenital heart defects growing into adulthood, marrying and having children," says Dr. Meyer. "By 2020 there will be 1.3 million in that group."

With some heart conditions, there is about a 50 percent chance that the parent could transmit the defect to each child. So it's important to track these patients' offspring if doctors are to correct heart problems.

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Solutions Without Surgery

Once problems are identified, doctors can correct many defects without surgery. For example, doctors can close a hole in one of the upper chambers of the heart with a noninvasive procedure rather than surgery. After an overnight hospital stay for observation, the child goes home the next day.

"We can save children the discomfort and long hospital stay they would have experienced in the past," he explains.

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Smaller Tools for Tiny Patients

A significant advance in recent years has been the "miniaturizing" of equipment, allowing cardiac surgeons to perform procedures on newborns.

"Since companies are making instruments and clamps smaller, we can do many procedures on newborns that in the past would have had to wait until children were 7 or 8 years old," says Dr. Meyer.

In the past, for instance, if a child was born with transposition of the great arteries, in which the great vessels of the heart are switched, it was not possible to treat these patients in infancy. Today, however, doctors can operate to correct this condition as early as the child's fourth day of life.

Even the youngest heart patients can benefit from cardiac catheterization as a result of technological advances. If their arteries are too narrow, surgeons insert a tiny, hollow tube into the artery, then expand a balloon to return the vessel to its proper size. To maintain that size after the procedure, they insert wire stents into the vessel. Such procedures, that allow
correction without invasive surgery, were impossible until recently because stents were too big.

"We have made great strides in caring for young heart patients," says Dr. Meyer. "What parents need to know is that if their child is diagnosed with a congenital heart defect, the prognosis is often good. Many children will lead productive lives and in the future probably have children of their own."

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