COVID-19 Update

At the Children’s Healthcare of Atlanta Heart Center, we’re committed to improving prevention and treatment of heart disease in children so that they can lead healthier lives. Our researchers are seeking innovative ways to improve the lives of children born with congenital heart disease (CHD) as they reach school age to prevent and treat the effects it has on children and teens.

We treat more than 40,000 heart patients each year and work closely with neighboring academic partners, including Emory University School of Medicine and Georgia Institute of Technology, to develop pediatric heart research. These research partnerships, combined with our experience in treating congenital heart defects in children of all ages, have allowed us to become a national leader in heart disease research.

The Emory University and Children’s Pediatric Research Unit is one of nine core sites in the Pediatric Heart Network (PHN). Created and funded by the National Heart, Lung and Blood Institute—part of the National Institutes of Health (NIH)—the PHN is a collaboration of clinical sites and a data coordinating center that conducts research studies in children with heart disease.

Learn more about the Pediatric Heart Network.

Heart Research

The Children’s Heart Research and Outcomes Center (HeRO) is a research partnership between Children’s, Emory University, and the Walter H. Coulter Department of Biomedical Engineering at the Georgia Tech College of Engineering and Emory University. HeRO seeks to reduce the morbidity of pediatric heart disease and leads the transformation of focused cardiac research into innovative therapies for young patients. Some of the primary focus areas of this research include regenerative and nanomedicine technologies, cardiac development, cardiac outcomes, cardiac devices and neurodevelopmental studies.

HeRO strives to create the next generation of pediatric-specific therapies through cutting-edge research using nanotechnology and stem cells, resulting in a better understanding of normal and abnormal cardiovascular development. Our researchers look at the whole picture and consider what will happen to these children from a neurodevelopmental standpoint as they age. By studying daily function and long-term outcomes, HeRO aims to have a better understanding of how to help children with heart disease regain normal function. This approach blends fundamental basic science with translational and clinical medicine to improve the quality of life for children with congenital heart disease.

At the Children’s Heart Center, we work closely with other pediatric heart centers across the country and use innovative technology to develop treatments for pediatric heart disease so that our patients can live healthy lives. Our pediatric heart research collaborations include:

Congenital Catheterization Research Collaborative (CCRC)
The Children’s Heart Center is home to the CCRC, which is a multicenter research consortium studying outcomes following catheterizations, and surgical and nonsurgical interventions. Nine other centers are involved. Since founding the CCRC in 2014, our team has received numerous awards and authored many publications.

Pediatric Heart Network
As one of 10 core sites in this NIH multicenter collaboration, we are working to define best practices for treating pediatric heart disease. We are leading a network investigation of collaborative learning to improve postoperative management.

Children’s Heart Research and Outcomes Center (HeRO)
HeRO is a dedicated research center focused on problems associated with pediatric heart diseases. The center promotes partnership of scientists with pediatric cardiologists and cardiothoracic (CT) surgeons at the Heart Center to align basic research with patient-oriented studies aiming to improve the lives of children with heart disease.

Cardiovascular Imaging Research Core (CIRC)
We provide noninvasive imaging services, including electrocardiogram (ECG), echocardiography, stress test, stress echocardiography and cardiac MRI, for cardiovascular research involving infants, children and adolescents. The CIRC has dedicated space, equipment and staff to provide quality cardiovascular imaging data that is systematically collected.

Cardiac imaging
We provide investigators across the country with advanced pediatric cardiovascular imaging services and research support. In collaboration with Georgia Tech, our CT surgeons use imaging to reconstruct a heart in 3D before surgery. This enables surgeons to better plan an operation based on the unique features of a patient’s heart.

Researchers studying the biology of the pediatric heart hope to help the next generation of children overcome heart disease. The following project is in development:

Electrical Stimulation of Pediatric Cardiac-Derived c-kit+ Progenitor Cells Improves Retention and Cardiac Function in Right Ventricular Heart Failure
Principal investigator: Joshua T. Maxwell, PhD

Cardiac stem cells, otherwise known as progenitor cells, have shown promise in treating several problematic and sometimes lethal conditions like heart failure. Our HeRO investigators have been among the leaders in strategies to utilize these cardiac progenitor cells to reverse heart failure or to prevent it.

Dr. Maxwell and his colleagues employed a novel technique to enhance the efficacy of these cardiac progenitor cells, or CPCs, in a study published in Stem Cells. Leveraging early work from animal models, Maxwell’s team demonstrated that electrical stimulation of cardiac derived c-kit progenitor cells, taken from the pediatric patient at the time of newborn heart surgery, could improve the cardiac function and retention of the cells.

In well-designed experiments, Dr. Maxwell and his colleagues demonstrated the mechanism by which electrical stimulation improves CPC function. The impact of electrical stimulation can be seen in important clinical parameters in this model, including improved contractility of the right ventricle and lessened dilation of the right ventricle as a response to injury. Electrical stimulation of the CPCs also reduced fibrosis in the heart.

This work will support ongoing basic translational and clinical work in our Heart Center. We are currently undertaking a first-in-human trial of c-kit cardiac progenitor cells in hypoplastic left heart syndrome. The work of Dr. Maxwell and his colleagues has immediate applicability to these clinical trials and may impact direct patient care in the future.

Heart researchers are conducting clinical trials to discover new treatments and techniques in several areas of children’s heart care.

Visit clinicaltrials.gov to find a Children’s clinical trial. Search for “Children’s Healthcare of Atlanta” and your child’s condition.

Placing Stem Cells Into the Hearts of Babies With Congenital Heart Disease

Principal investigator: Michael Davis, PhD, Director of the HeRO Center and Professor of Biomedical Engineering at Georgia Tech and Emory University

In this groundbreaking trial, surgeons at Children’s will implant patient-derived stem cells into the hearts of babies with hypoplastic left heart syndrome (HLHS) while they are undergoing surgical repair. The cells are collected during a baby’s first surgery within the first few days of life and then implanted into the heart three to five months later during the second of three HLHS surgeries. In the future, Dr. Davis and his research partners hope to gather quantitative data on the behavior of stem cells to create a large data repository of cell signals. By studying the signals, otherwise known as protein secretions of the cell, the team aims to determine how effective certain cells are in treating diseases.

COVID-19 and the heart

COVID-19 has significantly impacted children in Georgia, and researchers at Children’s are playing a critical role in understanding the cardiovascular impact of COVID-19. We are participating in two important national studies of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) through two NIH studies, Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM) and MUSIC, An Observational Cohort Study to Determine Late Outcomes and Immunological Responses After Infection With SARS-CoV-2 in Children With and Without Multisystem Inflammatory Syndrome (MIS-C).

An Observational Cohort Study to Determine Late Outcomes and Immunological Responses After Infection With SARS-CoV-2 in Children With and Without Multisystem Inflammatory Syndrome (MIS-C)

Principal investigator: William Mahle, MD, Pediatric Cardiologist

The study will enroll a minimum of 250 children with COVID-19 and/or MIS-C at more than 20 U.S. centers. MIS-C is a complication that follows a COVID-19 infection, which often impacts the heart. The study is designed to understand how the immune system responds to the COVID-19 infection and whether some aspects of the immune response contribute to the symptoms and complications. Much of the work analyzing the samples will be performed by Ignacio Sanz, MD, Chief of the Division of Rheumatology at Emory University, and Jeremy Boss, PhD, Chair of the Department of Microbiology at Emory University.

Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children (MIS-C) Study

Principal investigator: Matt Oster, MD, Pediatric Cardiologist

The goal of this research, conducted across 29 different sites as part of the Pediatric Heart Network, is to determine the spectrum and duration of coronary artery involvement, left ventricular (LV) systolic function, arrhythmias or conductions system disturbances within the first year from MIS-C illness onset, and to define the associated clinical and laboratory factors.

COVID-19-Related Multisystem Inflammatory Syndrome in Children (MIS-C) Affects Left Ventricular Function and Global Strain Compared With Kawasaki Disease 

Principal investigator: Mansi Gaitonde, MD

Clinical observations of the cardiac impact of MIS-C during the COVID-19 pandemic suggest more myocardial (heart muscle) involvement than typically occurs in Kawasaki disease (KD). Dr. Gaitonde and a team of researchers sought to formally evaluate this by performing a detailed cardiac functional analysis comparing contemporary MIS-C cases with a historical control group of KD cases. Left ventricular systolic function parameters were significantly reduced in MIS-C compared to KD, including ejection fraction, global longitudinal strain (GLS) and global circumferential strain. Of the MIS-C patients with depressed left ventricular function on admission, 75% had improvement in ejection fraction but still had reduced GLS values at hospital discharge. In summary, children with MIS-C appeared to have higher rates of myocardial dysfunction evidenced by reduced ejection fraction and reduced strain values compared to KD, and while the majority of MIS-C patients had recovery of ejection fraction, the strain values remained reduced beyond the acute infection. The implications of this in the long-term recovery period from MIS-C remain to be understood.

Anesthesiology

A Pilot Study of Thrombin Generation Changes in Neonates Undergoing Placement of a Blalock-Taussig Shunt

Principal investigator: Nina Ann Guzzetta, MD, Pediatric Cardiac Anesthesiologist

A Blalock-Taussig (BT) shunt is a device that redirects blood flow into pulmonary circulation, which moves deoxygenated blood away from the heart to the lungs and returns oxygen-rich blood back to the heart. It’s often placed in newborns with right-sided obstructive heart defects to improve blood flow. In the immediate hours after BT shunt surgery, it’s not uncommon for the newborn to experience complications due to blood clotting problems. This study explores the changes in thrombin generation, a critical part of clot formation, in newborns who undergo the surgery.

Catheterization lab

Comparison Between Surgical vs. Balloon Angioplasty vs. Intravascular Stent Placement for Recurrent or Native Coarctation of the Aorta

Principal investigator: Dennis Kim, MD, PhD, Pediatric Cardiologist

This study compares the safety and efficacy of three methods for treating coarctation, a narrowing of the aorta: surgical angioplasty, balloon angioplasty and stent placement. Angioplasty is a procedure that’s used to open arteries that are narrowed or blocked by plaque, a fatty buildup. It can be performed using a traditional open heart procedure or a catheter-based procedure—a minimally invasive technique that uses a thin, flexible tube inserted through a small incision and threaded to the blocked area. Balloon angioplasty has a small balloon on the tip of the catheter that’s inflated at the blockage to compress the plaque against the artery wall. A stent is a small, expandable tube that’s inserted into the artery during angioplasty to hold open the artery.

We’re widely recognized for our MRI studies of the heart and our heart echocardiography (ultrasound) program. Our dedicated core laboratory, the CIRC, is developing new strategies to evaluate the heart under conditions of stress or exercise.

Our researchers are working with colleagues at Georgia Tech to use imaging technology to create a 3D reconstruction of the heart. This will help us continue to improve the way we plan and carry out heart surgery in young patients.

Researchers are exploring areas in which heart disease and neurological development impact one another. Our findings will help us develop new therapies to improve the quality of life for children with heart disease—everything from medications and traditional psychological therapy techniques to at-home strategies to help families.

Learning and social interaction

Research shows that a large percentage of children with congenital heart disease face academic challenges, including attention problems and difficulties planning and executing important daily tasks, known as executive function. In addition, there’s emerging evidence that these children may have problems interacting with their peers, which can have a serious impact in adolescence and young adulthood. Peer interaction is an important part of a child’s emotional development, including self-esteem and identity.

By evaluating children at 1 year old and again at 2 years old, we’re better able to understand the causes of these problems and develop therapies to improve outcomes.

Infant brain injury

Our researchers are analyzing infant brain injury and exploring the causes of the inflammatory process with MRI and the latest translational tools. In preliminary results, we’ve found that more than 50% of newborns who require open heart surgery have injury to the white matter in their brain. We’re exploring how signals within the body, called cytokines, may contribute to this process. Researchers need to gather more information to understand the factors that contribute to early brain injury, but this research could help us prevent it more effectively.

More and more children with heart problems are living decades beyond what was expected in previous generations. But sometimes this success comes at a high price: neurological problems, lingering heart problems and damaged organs due to years of poor blood flow.

The Center for Cardiac Outcomes Research is exploring ways to meet the long-term needs of children with heart disease and their families.

Research goals are to:

  • Determine what improves the quality of life for most children with heart disease.
  • Prevent future complications related to a child’s heart condition.
  • Use electronic medical records to do research and improve long-term follow-up care for these children.

Researchers are involved in dozens of projects that include public health policy, clinical review and technical innovation. One current project is evaluating whether all newborns should receive screening that can detect previously missed heart defects—whether the rare chance that the screening catches a defect justifies the additional cost of the test. This is an example of how studies measure both what’s medically effective and what’s cost effective.

In addition, the research team is exploring clinical practices to determine whether there are trends of consistently good long-term outcomes or if treatment at a certain point of children’s development results in better outcomes when they’re adults.

From Buzzy—an electronic “bee” that takes away the pain of injections—to a heart valve that grows with a child, we look for new ways to make medical devices that make children more comfortable at the Children’s Heart Center.

Most medical equipment is designed and intended for adults, but children have different needs—both physical and emotional. In addition, because kids are always growing, these medical devices often lack flexibility. That means children have to go through multiple rounds of surgery to replace outgrown heart stents and valves, along with numerous other implants. These surgeries put them at needless risk for bleeding, infection and clots.

In partnership with Georgia Tech and Emory University, we created the Children's Healthcare of Atlanta Pediatric Technology Center to address the special needs of children. This program, funded with a $1.8 million grant from the U.S. Food and Drug Administration (FDA), is a joint effort among doctors, scientists and engineers to find ways to build equipment, implants and devices that are scaled and designed for kids.

Our first projects include developing a:

  • Smartphone attachment that allows real-time video consultation for ear infections.
  • Renal dialysis device to replace existing machines meant for adults.
  • Gel that delays the re-fusion of a child’s skull after surgery for craniosynostosis—a condition in which the stitches in an infant’s head prematurely fuse, causing abnormal head shape and facial features.

Researchers are also looking at a number of high- and low-tech healthcare solutions for kids, from a new eye chart that uses hand motions instead of the alphabet to a quick test for pneumonia that uses a modified whistle or kazoo.

Children’s investigators have been addressing key topics in heart failure and heart transplantation.

Use of Ventricular Assist Device (VAD) to Support Patients Before Transplantation

Dr. Butto presented important work at the 2020 American Heart Association meeting that looks at the best approach to transplant listing after VAD implant. Her analysis of a large dataset found that it may be best to wait several weeks after a VAD is implanted before proceeding with a heart transplant in children. The likely explanation for this benefit is that the child can rehabilitate and enhance his nutritional status before receiving the transplant.

Principal investigator: Arene Butto, MD, Pediatric Heart Failure Physician

Dr. Butto presented important work at the 2020 American Heart Association meeting that looks at the best approach to transplant listing after VAD implant. Her analysis of a large dataset found that it may be best to wait several weeks after a VAD is implanted before proceeding with a heart transplant in children. The likely explanation for this benefit is that the child can rehabilitate and enhance his nutritional status before receiving the transplant.

Studying Heart Failure in Children and Young Adults With Congenital Heart Disease Using the Pediatric Care Consortium

Principal investigator: Lazaros Kochilas, MD, Pediatric Cardiologist

Dr. Kochilas and his team leveraged the large database, Pediatric Cardiac Care Consortium, housed at Children’s and Emory University, to understand how heart failure impacts children and young adults with CHD.

Our areas of interest include:

  • Mechanical support of the failing heart
  • Heart failure management
  • Blood group incompatible transplants (donor and recipient don’t have compatible blood types)
  • Noninvasive markers of transplant rejection
  • Antibody-mediated rejection, which occurs when a transplant recipient’s own antibodies attack (reject) the new transplant
  • Re-transplantation