Research Areas

Left Atrial Mechanics in the Normal Fetus

Using velocity vector imaging (VVI), we intend to define the normal mechanics of the left atrium in the human fetus. By defining normal wall mechanics in the left atrium, we will be able to explore the left atrial mechanics in congenital heart disease.
PI: James Strainic, MD

Computational Prediction of Outcomes of Fetal Heart Intervention

This is an international collaboration investigating finite element modeling of the fetal heart’s ability to predict fetal intervention outcomes. We propose to build patient-specific pre-interventional models of fetal hearts, and simulate post-interventional conditions to predict outcomes. Also, using computational modeling of coronary blood flow with electronic circuit analog, we hope to predict outcomes of PAS/IVS with abnormal coronary connections. These models can become a novel and more accurate approach to predict fetal heart intervention outcomes. A better approach towards outcome prediction can allow more accurate selection of patients, minimizing risks and maximizing benefits to the maximum number of patients.
PI: James Strainic, MD

Ductus Arteriosus Flow acceleration in Late Gestation

This is a single site study investigating the incidence of flow acceleration in the ductus arteriosus in the early 3rd trimester. We aim to investigate prenatal exposures, especially to Tylenol, and post-natal outcomes in maternal-fetal pairs who have elevated ductus arteriosus Doppler velocities.
PI: James Strainic, MD

Reproductive health education in adults with congenital heart disease

Single center study with aims to improve healthcare literacy regarding reproductive health in young women with congenital heart disease. Using an online platform, participants will be provided a presentation with information regarding birth control and preconception counseling.
PI: James Strainic, MD

Use of Rivaroxaban in Patients with Single Ventricle Congenital Heart Disease

Rivaroxaban is a direct oral anticoagulant whose use is well-studied in adults. It has recently become an option for pediatric clot prophylaxis and treatment. Pediatric congenital heart disease patients are at increased risk for thrombosis and commonly require treatment, but oral options have been very limited. Rivaroxaban offers a less burdensome alternative to current pediatric anticoagulant medications, but its use has not been well described in patients with congenital heart disease, especially those with single ventricle anatomy. The aim of this series is to track efficacy, safety, and outcomes of our clinical use of rivaroxaban in congenital heart disease patients.
Team: Silvestre Duran, MD; Sarah Plummer, MD; Martin Bocks, MD; Sanjay Ahuja, MD; Jodi Zalewski, CNP; Christina Gerber, PharmD; Shannon Bilsky, RN

Caring for High Risk Cyanotic Infants during a Global Pandemic: A Single Center Experience with COVID-19 and the use of Telemedicine for Interstage Home Monitoring

This is a single center case series on the use of Telemedicine during the COVID pandemic in the care of Single Ventricle and high risk cardiac patients. We analyzed the care of these patients and compared outcomes, adverse events, and unplanned procedures with the use of telemedicine and describe the first case of a single ventricle patient with acute COVID managed at home via telemedicine.
PI: Ernesto Mejia, MD; Sarah Plummer, MD

Stretched to the Limit: Comparing PTFE Covered Endovascular Stents through Serial Dilations

Bench research evaluating characteristics of PTFE covered intravascular stents. Stents were serially dilated and compared for recoil, foreshortening as well as balloon sizing to tear and fracture. The goal of this study was to further improve our use of endovascular covered stents in the care of children with congenital heart disease to account for somatic growth and serial stent implantation while assessing physical characteristics of stent fracture.
PI: John Lozier, MD; Ernesto Mejia, MD; Emily Kish, RN; Martin Bocks, MD

AngioAngles

John Lozier, MD has developed an easy-to-use tool to optimize fluoroscopic imaging in the Congenital Cardiac Cath Lab. Using the mathematics of vectors, a web app quickly and accurately calculates an unlimited number of perpendicular angles, helping operators obtain optimal cardiac images and reduce radiation and contrast exposure.
PI: John Lozier, MD

AngioAtlas: A Library of Angiograms of Congenital Heart Disease

AngioAtlas is a growing library of angiograms of congenital heart disease designed to improve learner understanding of congenital angiography. AngioAtlas was developed by Renelle George (during her Ped Card Fellowship at Rainbow) and Martin Bocks, MD, to aid learners in their ability to identify commonly observed pathologies both prior to and following surgical and catheter-based interventions. AngioAtlas provides viewers free access to all content and continues to take on interesting cases for dissemination to the pediatric cardiology community as a whole.
PI: Renelle George, MD; Martin Bocks, MD

Generation and Maturation of Autologous Tissue Grafts Created From Induced Pluripotent Stem Cells for the Treatment of Congenital Heart Disease.

Congenital heart disease is one of the most common forms of birth defects with an incidence of 1-2%. Many forms of congenital heart disease require surgical therapy to repair mechanical defects (closing holes, patching narrowed structures, or replacing valves). Therefore, the goal of this project is to generate human cardiac tissue with growth potential from patient-specific induced pluripotent stem cells and evaluate its ability to repair congenital heart defects.
PI: Eric Devaney, MD

Determine Sex Dependent Differences in Cardiac Myocyte Excitation-Contraction Coupling after Chronic Stimulation of Opioid Receptors during Normoxic and Hypoxic Conditions

In 2016, opioid overdoses accounted for more than 42,000 deaths, prompting the United States government to declare opioid misuse a public emergency. Sex differences in cardiac physiology have been well documented between males and females, although it is unknown if there are sex-dependent differences between opioid receptor activation and cardiovascular function. Consequently, using whole animal and cellular models we are discovering how male and females cardiovascular systems respond differently to opioid abuse.
PI: Eric Devaney, MD

Evaluate the Effects Ketone Bodies Have on Human Induced Pluripotent Stem Cell Derived Cardiac Myocyte Excitation-Contraction Coupling During Physiological and Pathological Conditions.

A growing consensus is that metabolic perturbations influence healthy cardiac development as well as underlie many cardiovascular diseases. Because of its association with diabetic ketoacidosis, the utilization of ketone bodies by the body has a negative stigma. However, new experimental and clinical evidence suggests ketone body utilization may be cardioprotective by decreasing both inflammation and oxidative stress. Consequently, the goal of this project is to understand how ketone bodies influence normal cardiac development and excitation contraction coupling in physiological and pathological conditions using human induced pluripotent stem derived cardiac myocytes as our model system.
PI: Eric Devaney, MD

3D Models Inform Presurgical Planning for VAD Placement

A multicenter international study to improve outcomes in patients with congenital heart disease and heart failure who are undergoing placement of ventricular assist device (VAD) as a bridge to transplant. Utilization of 3-D models of the heart has the potential to play a critical role in helping surgeons visualize the cardiac anatomy prior to surgical VAD implantation.
PI: Martin Bocks, MD

Exercise Testing in Post-COVID-19 Children

Evaluating cardiopulmonary mechanics in patients with mild symptoms post COVID-19 infection. Using a Bruce ramp protocol with metabolic cart, we will evaluate oxygen consumption, oxygen pulse, ventilatory equivalents of carbon dioxide, and pulmonary function tests in patients with recent positive COVID with ongoing mild symptoms.
PIs: James Strainic, MD; Justin Fiutem M.S., E.I.M. Credentialed, ACSM-EP

Friend or Foe? Post-Exercise Troponin Leak in Pediatric Patients

The goal of this study is to assess the known association of physiologic troponin leak in adults to the general pediatric population. Though chest pain in adults is almost always worrisome findings, in children, and especially adolescents, this complaint is rarely cardiac in origin. In this retrospective chart review of 10 years’ worth of pediatric ED visits for chest pain we plan to show that in the absence of worrisome exam findings and/or abnormal EKG, a mild troponin elevation after exercise can be physiologic and therefore not of clinical concern.
PI: Ernesto Mejia, MD; Walter Hoyt, MD

FFRCT Imaging to Detect Coronary Problem in Adult Patients with Transposition of the Great Arteries

Investigators at the UH Rainbow Babies & Children’s Adult Congenital Heart Program are testing the feasibility of using the HeartFlow FFRCT system to detect clinically significant coronary obstruction in patients following ASO compared to anatomic CT imaging alone. The optimal screening test for clinically significant coronary problems is controversial. The optimal test is non-invasive but can evaluate both anatomy and vascular function within the coronary system. The HeartFlow FFRCT system provides such information but was designed and approved for detecting coronary ischemia in patients with known or suspected coronary artery disease.
PI: Martin Bocks, MD

Patient Perspectives on Pediatric Cardiology Outpatient Telemedicine Visits During the COVID-19 Pandemic

The pediatric cardiology group is evaluating parent perspectives on telehealth visits during the COVID-19 pandemic. The goal is to assess concerns if any, these groups have related to telehealth visits and then to assess their perception of how successful the visit was in meeting their needs with respect to their cardiac concerns. We plan to use this data to inform ongoing decisions regarding continued use/further enhancement of telemedicine services.
PI: Nathaniel Robbins, MD

Smartphone-Based Application for Accurate and Efficient Patient Handoff

This quality improvement project adapted the use of a HIPAA compliant smartphone patient list application for use in pediatric Cardiology Fellowship program. The study went through the usual PDSA cycles and showed significant improvement in list accuracy and completion at time of sign-out, improved user satisfaction, and reduced after-hours time spent by trainees updating the list.
PI: Ernesto Mejia, MD; John Lozier, MD; Christopher Snyder, MD; Sara Plummer, MD