Kids With Heart NACHD

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New Blood-Resistant Glue Mends Broken Hearts Without Sutures

January 27, 2014

How do you mend a broken heart? You’re operating on a heart and it’s got a tear in it. How do you seal it?

Sutures? Staples? These are the traditional answers, but they aren’t good ones. Both involve piercing tissue and creating holes, which is bad news for an organ that’s constantly moving, and vigorously pumping blood. Holes lead to clots. They also bleed.

And if you specialise in doing heart surgeries on babies, as Pedro del Nido from Children’s Hospital does, you can add small size and delicate tissues to those other challenges. “The holy grail for heart surgeons, especially for those who work on babies, is to attach things without damaging the normal underlying tissue,” he says.

A glue, then. The trouble is that a heart adhesive must be strong enough to hold despite the heart’s constant beating, but flexible enough to allow those same beats to happen. It has to work in wet conditions—something that most glues aren’t designed to do. It needs to repel water so it doesn’t dissolve. It must thicken slowly or blood will wash it away. It can’t thicken immediately because you want to be able to position and adjust it. It has to be biodegradable.

The Precarious State of the Liver After a Fontan Operation: Summary of a Multidisciplinary Symposium

January 1, 2014

Abstract

As the cohort of survivors with the single-ventricle type of congenital heart disease grows, it becomes increasingly evident that the state of chronically elevated venous pressure and decreased cardiac output inherent in the Fontan circulation provides the substrate for a progressive decline in functional status. One organ at great risk is the liver. Wedged between two capillary beds, with the pulmonary venous bed downstream, which typically has no pulsatile energy added in the absence of a functional right ventricle, and the splanchnic bed upstream, which may have compromised inflow due to inherent cardiac output restriction characteristic of the Fontan circulation, the liver exists in a precarious state.