McNamara Keynote Explores the Future of Pediatric Interventional Cardiology

Technological advances allow babies born with congenital heart disease to grow, thrive and pursue dreams. The same could be said of the specialty that has contributed to the growth of these babies. Pediatric interventional cardiology has burst out of its infancy to explore a promising future that not only includes the care of babies, but also the adults who live with congenital heart disease.

“Decades ago, no one would have thought it would be possible to do the things we’re doing now in this field,” says John P. Cheatham, MD, FACC. He predicts continued advancement over the coming decades, through the work of creative and innovative people. During today’s Dan G. McNamara Keynote, Cheatham will reflect on the past and explore the future of pediatric interventional cardiology.

The specialty’s advances stretch back to the 1930s, when the first cardiac catheterization was performed in Germany. The roots of interventional pediatric catheterization took hold in the 1950s and 1960s with simple tools and procedures such as balloon atrial septostomy, says Cheatham, who is the George H. Dunlap Endowed Chair in Interventional Cardiology in The Heart Center at Nationwide Children’s Hospital and professor of Pediatrics and Internal Medicine, Cardiology, at The Ohio State University.

Cardiology Magazine Image"For the first time we deployed a device where we could use a catheter to close a large hole in the upper chambers of the heart ... This was the first use of a procedure that avoided open heart surgery." John P. Cheatham, MD, FACC

Building on that foundation, pediatric cardiologists learned to manage patent ductus arteriosus (PDA), first with intravenous infusions, and then the interventional team closed the PDA with the delivery of devices through the femoral vein. In 1974, they performed the first transcatheter treatment of an intracardiac (atrial septal) defect.

“For the first time we deployed a device where we could use a catheter to close a large hole in the upper chambers of the heart,” Cheatham says. “This was the first use of a procedure that avoided open heart surgery.”

What followed was the placement of stents and eventually the delivery of a heart valve on a stent in a pediatric patient in 2000. Two years later, the first transcatheter placement of a heart valve was performed in an adult.

“A new era in interventional pediatric cardiology had begun that allowed us to replace valves in a cath lab rather than using open heart surgery,” Cheatham says. This new era included more available devices and the ability to close holes inside the heart, open narrowed vessels and implant valves.

Hybrid cardiac procedures that were part surgery and part catheter-based followed. “The development of hybrid therapies demonstrates the cooperation — rather than competition — in the congenital world between interventional cardiologists and surgeons,” says Cheatham. “We’re all on the same team.”

What’s next? Tissue-engineered heart valves that can grow with the patients is the next frontier to conquer, Cheatham says. This research includes fetal therapy that could manage heart defects so a baby is born in a stable state.

Gene replacement therapy for diseases such as muscular dystrophy is another focus. “Sometimes the defective gene is replaced by vascular entry and our field is developing catheter techniques to deliver the gene,” Cheatham says. Although it’s not a cardiac defect, it’s rewarding to help in a way that could alter a patient’s life, he adds.

Advances in the treatment of congenital heart disease have led to about 90 percent of these babies surviving to adulthood. Today, more adults than children in the U.S. have congenital heart disease. Among these advances is the work of bright, innovative interventional pediatric cardiologists. “I’m proud to have been selected to give this Keynote, especially because Dr. McNamara was my mentor, and to share their work and look at what still lies ahead,” says Cheatham.

The Dan G. McNamara Keynote will take place today from 10:45 a.m. – 12:15 p.m. in Room 208 C.

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session

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