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Personalising surgery for babies with a serious heart disease

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What did the project achieve?

“Our results reveal more about how different surgical techniques used to treat babies born with hypoplastic left heart syndrome (HLHS) can impact on the growth and function of their tiny hearts,” says Dr Pablo Lamata of King’s College London. “This valuable knowledge will help surgical teams to select the best approaches to use in the future – improving the chances of a successful outcome.”

Babies born with HLHS will need a series of life-saving operations during their first few years of life, but it is currently unclear which surgical techniques will work best for each child. In this study, the team was using recent advances in 3D imaging and computational anatomy to examine the structure and function of the heart in babies with the condition – to better understand the impact of different surgical techniques.

“We identified subtle differences in the structure and function of babies’ hearts – which depended on which of two different surgical techniques were used,” says Dr Lamata. “More research is now needed to understand how this affects long-term outcomes for these vulnerable patients.”

Babies born with HLHS often have an underdeveloped aorta, the main blood vessel of the circulatory system. They will usually need early surgeries to reconstruct the part of the vessel closest to the heart, which aims to improve blood flow.

“Our results show that this can increase the burden on the heart because the part of the aorta that has not been reconstructed is then not wide enough to accommodate all the blood that needs to be distributed around the body,” says Dr Lamata.

The lessons learned in this project are also helping the team to advance towards the use of sophisticated, non-invasive imaging tests for assessing children with aortic flow conditions like HLHS.

“Replacing current invasive procedures for monitoring the function of the aorta would reduce risks for children and enable much closer monitoring and better-informed decisions about their surgical treatment,” says Dr Lamata.

This research was completed on

Around one in every 5,000 babies is born with a serious heart defect called hypoplastic left heart syndrome (HLHS).1 They all need a series of lifesaving operations during the first few years of life. The severity of HLHS varies and it’s not clear which surgical technique works best in each situation, for each individual baby. Dr Pablo Lamata, of King’s College London, is developing better ways to predict how each baby will respond to surgery, so doctors can plan the best approach for them. Personalising treatment should improve babies’ chances of surviving and enjoying the best possible quality of life.

Action Medical Research and Great Ormond Street Hospital Children's Charity are jointly funding this research.

How are babies’ lives affected now?

Without treatment, babies with HLHS quickly become seriously ill. The left side of their heart is much smaller than usual and cannot pump enough blood to the body. Early symptoms include problems breathing, a weak pulse and blueish skin.

Less than four decades ago, babies with HLHS normally died within just weeks of birth. Improvements in surgery have given babies a much better chance of surviving and living a relatively normal life. Sadly, though, some babies still lose their lives and others have ongoing health problems.

“Babies with HLHS normally have three complex operations – the first when they’re less than two weeks old,” says Dr Lamata. “Planning these operations is difficult, because there’s little evidence as to exactly which surgical technique would work best for each child at each stage. Research into the pros and cons of each technique is needed urgently.”

 

How could this research help?

Dr Lamata’s team is analysing MRI scans of over 150 babies with HLHS, using specially created computer techniques, to generate a virtual 3D model – or avatar – of each baby’s heart and its major vessel, the aorta.

These personalised models show the shape of each baby’s heart and aorta, and the way blood flows, which reveals how well the baby’s heart is working.

“By comparing virtual 3D models of babies’ hearts before and after surgery, we hope to reveal the benefits and drawbacks of different surgical techniques,” says Dr Lamata. “We also hope to develop ways to predict how each surgical approach is likely to benefit individual babies over the long term.”

“Ultimately, we hope our work will give surgeons the tools they need to select the best treatment plan for each baby,” adds Dr Lamata. “This could improve babies’ chances of surviving and having the best possible quality of life during childhood and beyond.”

References

1. Khairy P et al. Univentricular heart. Circulation. 2007; 115(6): 800-12.

 

 

 

 

Project Leader Dr Pablo Lamata PhD Eng, MSc
Project Team Dr Tarique Hussain MBBChir MA PhDProfessor Reza Razavi MD FRCP FRCPCH FRCRDr GF Greil MD PhDDr Adelaide de Vecchi PhD EngMr Mohamed S Nassar FRCS PhD
Project Location Department of Biomedical Engineering, King's College London
Project Location Other Division of Imaging Sciences & Biomedical Engineering, King's College London
Project duration 2.5 years
Date awarded 22 July 2015
Project start date 1 September 2015
Project end date 28 February 2018
Grant amount £102,593
Grant code GN2401

 

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