Issue link: https://tmcpulse.uberflip.com/i/635316
t m c » p u l s e | j a n / f e b 2 0 1 6 19 "The theory is sound, and I do believe it will play a major role in the field in the future," Fraser said. "We know structural problems with the heart evolve as gestation progresses and that there are certain conditions that can be rescued. In other words, as the heart is developing, the condition is actually getting worse. The theory is, if you could intervene during fetal life, you might mitigate some of the subsequent con- sequences. We're still in the proving stage of these theories and the techniques are evolving, so what this translates into is still continuing to unfold, but there have definitely been cases where we have intervened successfully." No one doubts that fetal intervention will likely play a major role in treating congenital heart disease in the future. Couple that with new mechanical assist devices tailored for small hearts but engineered to last a lifetime, bioma- terial scaffolds designed to guide growth of new tissue, and a host of other technologies only now just being developed, and the field could look completely different than it does today. "I do think some of this will be revolutionary in the next 10 to 12 years," Douglas said. "We're kind of at an inflection point right now with biologically compatible materials, but when these replace the inert patches we're using now— when we repair blood vessels and heart valves with materials that will eventually incorporate into living tissue—I predict we'll see better long- term post-surgical outcomes that could make a substantial difference." Straight out of the best kind of science fiction, the future for treating congenital heart conditions is bold and innovative. Unfortunately, none of it will fix the millions of perfectly healthy hearts that will grow up and fail every year. Heart disease—the kind you acquire from poor diet, lack of exercise, smoking and other risk factors—is the No. 1 killer in the world. According to the American Heart Association, it accounts for 17.3 million deaths each year around the globe; the CDC says that's one in four deaths in the U.S. This number is expected to rise universally. According to Penny, it will be the next big global pandemic in developing countries as well, eclipsing even HIV. "We know that the seeds for acquired cor- onary artery disease in adults are actually laid down when they are children," Penny said. We know that the seeds for acquired coronary artery disease in adults are actually laid down when they are children. Our goal is to identify patients with these risk factors so that we can inter- vene early enough and hopefully reduce their risk of developing heart disease in the future. — DANIEL PENNY, M.D., PH.D. Chief of Cardiology at Texas Children's and Professor of Pediatrics-Cardiology at Baylor "Our goal is to identify patients with these risk factors so that we can intervene early enough and hopefully reduce their risk of developing heart disease in the future." Both Texas Children's Hospital and Children's Memorial Hermann Hospital have robust preventative cardiology programs focused on addressing the issue. It's a move that will certainly help, but even with Texas Children's being the largest pediatric hospital in the nation and Memorial Hermann Health System's omnipresence in the Houston land- scape, their programs will only go so far. In the end, the responsibility lays bare, ready to be picked up by parents, school districts, lobby- ists, even children themselves. "It's pervasive and unarguable," Fraser said. "Approximately one out of 100 children are born with congenital heart disease, but those other 99 face a lifetime risk of acquired heart disease, and we're doing it to ourselves. There are all these things we can do preemptively to have a healthier population and we're ignoring it. Ultimately, there's only so much you can do with knives and medicine." (Credit: A. Kramer/Texas Children's Hospital)