Project Heart issued a grant in December of 2018 to fund Dr. Jackie Shuplock and Dr. Ann Kavanaugh’s fetal research on d-Transposition of the Great Arteries (TGA). TGA is a common, yet serious, congenital heart defect occurring when the pulmonary artery and aorta are switched in position when entering the heart. This new multicenter project will shed light on why some infants with TGA are more stable and some are in very critical condition after birth. This TGA research is one step further in improving the treatment of CHD, and ultimately, one day finding a cure.
Currently, a measurement of “myocardial strain” is often taken during echocardiograms to identify heart dysfunction. This measurement is very useful and well studied in the adult and pediatric populations. However, very little research has been performed to assess how this tool could be helpful in predicting outcomes for the fetal population. What if we could study a baby’s heart in the womb and predict how healthy their heart will be after birth?
This is exactly what Shuplock and Kavanaugh’s TGA research is focusing on. In other words, technology using high quality fetal images is used to determine if the baby will be born with a critical case of TGA or be more stable after birth. Currently, ultrasound technology allows doctors to easily identify babies with TGA. However, the ability to prenatally identify those at highest risk for instability after birth has remained elusive. Prior research has suggested certain possible fetal factors could identify these high-risk babies. This research will attempt to determine exactly what these fetal factors are. They are using the equipment, bought with Project Heart’s grant, to obtain fetal imaging to determine these unstable cases.
“This study is very exciting because it is the first of its kind. We will be evaluating myocardial strain in the largest population of fetal patients with congenital heart disease performed to date. I believe this study will allow us to prove that myocardial strain will be just as effective in the prenatal population as in the adult and pediatric populations and will be an excellent tool to identify those babies at highest risk of developing heart dysfunction after birth,” Dr. Shuplock said.
Transposition of the great arteries (TGA) is one of the most common complex forms of congenital heart disease and requires surgical intervention in the newborn period for survival. Some newborns with TGA are at an especially high risk for rapid instability and death after birth, thought to be related to certain differences of their heart and/or lung characteristics. The “great arteries” in TGA refer to the aorta and the pulmonary artery, which carry blood away from the heart. In TGA, these vessels start at the wrong ventricle. They are “transposed” from their normal position, meaning that the aorta comes from the right ventricle and the pulmonary artery from the left ventricle. 1
Dr. Shuplock fully believes this TGA research can lead to more information in the world of CHD. Specifically, using research tools normally used after birth, in the prenatal realm as well. If these research findings come back showing benefits of myocardial strain in TGA patients, she anticipates future projects to focus on using the tool in other CHDs. We know this will lead to more knowledge for the future and are excited to be a part of the journey to find a cure for CHD. With the right technology and passionate doctors on the project, we are sure to get results.
Dr. Shuplock said, “I am very passionate about the field of fetal cardiology. In particular, finding better ways to identify babies with congenital heart disease, especially those babies at highest risk of poor outcomes. Currently, it is not always easy to identify those babies prenatally that are going to have the hardest time after birth. If we could better identify those babies, we could better tailor their treatment plans (thereby improving their outcomes) and better prepare the family and the medical staff for the likely course after birth.”