Pioneering Pediatric Cardiac Testing and Treatment
Takeshi Tsuda, MD, performs advanced pediatric cardiology research into the factors leading to heart failure.
The Nemours Cardiac Center at the Nemours Children’s Hospital, Delaware, participates in multiple pediatric cardiac research studies, all with the goal of improving care for children with congenital heart disease and other cardiac-related conditions.
We conduct pediatric heart studies in collaboration with researchers at local hospitals and universities, the pharmaceutical and medical device industries, National Institutes of Health (NIH), and organizations such as the Congenital Heart Surgeons' Society and the Pediatric Heart Network.
Our research spans the entire breadth of pediatric cardiac research, from work on the genetic causes of heart malformations to evaluating the results of cardiovascular surgery and interventional cardiology procedures, to studies in preventive cardiology.
Pediatric Cardiology Research
Our research priorities are centered around four main areas:
Our physicians are working to advance the field’s understanding of congenital heart disease. We contribute to several multicenter registries which provide valuable information on outcomes and treatments such as cardiac catheterization interventions and cardiac surgery.
We conduct research to test the safety and effectiveness of new treatment options including devices and surgical procedures, and we have several studies identifying neuroprotective strategies for children requiring cardiac surgery and the best means to provide nutrition to infants after heart surgery. Our group is focused on improving long-term outcomes in all patients with congenital heart disease.
Our group is very active in heart failure/transplant research and participates in large multicenter registries for pediatric patients requiring mechanical circulatory support or heart transplantation. Physicians within the cardiac center are among the leaders in using these registries to improve our understanding of the role of ventricular assist devices and transplantation in treating children with heart failure.
In addition, our doctors are working to link large national datasets to dramatically increase the potential of previously collected data. We have been selected to participate as a clinical site for the PumpKIN Program clinical trials. PumpKIN (Pumps for Kids, Infants and Neonates) is supported by the National Heart, Lung, and Blood Institute (NHLBI) for the developing and testing new pediatric circulatory support devices. We are also involved in ongoing pediatric heart studies identifying risk factors in children and young adults for the subsequent development of heart failure in adults. We recently became the second center in the U.S. to be accredited by the Heart Failure Colloquium, which was designed to establish better practices for the care of children with heart failure.
In the lab, our efforts focus on understanding genetic factors influencing long-term neurodevelopmental outcomes following pediatric heart surgery, genetic causes of heart disease, studying proteins and biomarkers related to heart failure, and developing approaches to improve postsurgical outcomes using advanced biomaterials. We are studying computer modeling of complex congenital heart disease to provide better patient monitoring in the postoperative period.
The Nemours Cardiac Center is internationally recognized for our work in the area of preventive cardiology. We maintain a leadership role in national efforts in both obesity and preventive cardiology and are proud to work in active collaborations with other distinguished researchers and organizations. We are involved in pediatric cardiac research on lipids, high blood pressure, diabetes, inflammatory markers and the genetics of lipid disorders. We participate in several multicenter studies including CARDIA, TODAY, PDAY and Do-It. Findings from these research studies will be important in understanding early-end organ injury from cardiovascular risk factors.
Labs Engaged in Pediatric Cardiology Research
At Nemours and at the Nemours Cardiac Center in particular, pediatric heart research is a group effort. Our physicians deliver care and are actively involved in research that informs the care they give. We routinely use our cardiac diagnostic laboratories in conducting research protocols. This includes cardiac catheterization, echocardiography, electrophysiology, MRI, ECGs, Holter monitors, ambulatory blood pressure monitoring and exercise testing. We are also in frequent contact with the research scientists at Nemours, so our care is always at the forefront of medical knowledge and breakthroughs.
Our pediatric cardiac research is supported by a number of Nemours research labs:
The TERM Lab looks at applications for the replacement or regeneration of heart tissues for children affected by a range of genetic, congenital and acquired diseases. The TERM Lab uses advanced cell-biological, biochemical and tissue engineering techniques to investigate heart muscle and tissue breakdowns in patients with congenital cardiovascular disease (CCD).
Approximately 25,000 children a year receive some type of corrective surgery for congenital heart defects. Some even require transplants. We know from long clinical experience with children that the heart has a limited ability to repair itself. So our pediatric cardiology researchers are looking for ways to help the heart do that for more children with congenital conditions. We’ve found that isolated cardiac cells can regenerate aspects of the architecture of the heart. We think that it may be possible to take advantage of this to construct cardiac tissue equivalents in the lab. We hope that this cardiac tissue engineering will provide a source of implant material for pediatric heart surgeons to increase the number of patients that can be treated for a host of heart diseases.
The Biomedical Analysis Lab (BAL) is a core lab involved in a variety of both basic and clinical research projects. The lab applies a multidisciplinary approach to the exploration of various changes in the human body at the molecular and cellular levels. One area of focus is obesity-related biomarkers for cardiometabolic disease (CMD). The lab uses several contemporary techniques that are especially powerful in studying biomarkers and follow the changes in health and disease conditions in children. The studies the lab performs will lead to better understanding of the disease conditions and the development of more directed therapies.
Our research and clinical sites involved in cardiac care benefit from this facility in Wilmington, Del. The Biobank was established in 2009 to provide tissues and blood to researchers across all of our locations. The facility helps facilitate our translational research (turning science into practical applications to improve patient health) by providing a direct link from our physicians to our researchers. The Nemours Biobank also enhances our efforts to:
- identify biomarkers (molecules found in body fluids or tissues that are signs of a normal or abnormal process, or an abnormal condition or disease) for early disease diagnosis
- predict disease progression
- track treatment outcomes
- conduct genetic studies and pharmacogenetic research leading to personalized medicine approaches to patient care
This lab investigates the underlying mechanism of heart failure from a molecular standpoint by using animal models. Heart failure is a progressive, lethal disease with loss of intrinsic protective mechanisms, and disruption of ordinary communication among the cells is thought to be responsible for the pathological changes. Our main focus is on signal transduction pathways that induce pathological myocardial remodeling or myocardial fibrosis. We routinely employ hemodynamic, molecular biology, biochemical and cell biology techniques. We are also exploring translational approaches to study the human myocardium, with heart failure patients from collaborating institutions.
Our Pediatric Cardiology Researchers
The Nemours Cardiac Center benefits from the talents of some of the country's very best pediatric cardiologists, pediatric cardiac surgeons and researchers. In fact, we're ranked among the nation’s best in pediatric cardiology and cardiac surgery by U.S. News & World Report. In addition, our physicians participate or play a leadership role in a variety of national cardiology organizations and pediatric heart studies.
Christian Pizarro, MD is the director of the Nemours Cardiac Center and chief of cardiothoracic surgery at Nemours Children’s Hospital, Delaware. His pediatric cardiac research interests include the surgical management of single ventricle patients, neonatal cardiac surgery, valve repair, heart transplantation, tracheal reconstruction surgery and congenital heart surgery.
Dr. Pizarro is actively involved with the Congenital Heart Surgeons’ Society and the Pediatric Heart Network Single Ventricle Reconstruction Trial. He leads research programs in the cardiac center examining neurodevelopmental outcomes after cardiac surgery and the genetics of congenital heart disease.
A graduate of the University of Chile School of Medicine, Dr. Pizarro completed a residency in general surgery at Pennsylvania Hospital and a residency in cardiothoracic surgery at the Hospital of the University of Pennsylvania. He served his fellowships in pediatric cardiothoracic surgery at Great Ormond Street Hospital for Sick Children, London, and the Children's Hospital of Philadelphia.
Wolfgang A. K. Radtke, MD, a nationally and internationally recognized expert in interventional pediatric cardiac catheterization, has been at the Nemours Cardiac Center of the Nemours Children’s Hospital, Delaware since 2005. He is Professor of Pediatrics at the Jefferson Medical College and director of the Pediatric Cardiac Catheterization Laboratory of the Nemours Cardiac Center.
He is very active in the pediatric cardiology program development for the National Scientific Sessions of the American Heart Association. Dr. Radtke has been, and continues to be, active in experimental and clinical pediatric cardiac research and development of catheter-based treatments of congenital heart disease and related outcomes studies.
Bradley W. Robinson, MD has been a practicing pediatric cardiologist since 1992, and a member of the Nemours Cardiac Center since 2004. He is an Associate Professor of Pediatrics at Thomas Jefferson Medical School. He is also the director of the exercise lab at the Nemours Children’s Hospital, Delaware.
Dr. Robinson’s main pediatric cardiac research interests are the study of arrhythmias with exercise and the outcomes of patients with chromosomal abnormalities after surgery.
Erica Sood, PhD is a pediatric psychologist in the Nemours Cardiac Center and the Division of Behavioral Health at Nemours Children’s Hospital, Delaware and director of the Cardiac Learning and Early Development (LEAD) Program. She is an Assistant Professor of Pediatrics at Thomas Jefferson University Medical School. Dr. Sood is involved in several pediatric cardiac research studies examining neurodevelopmental outcomes and neuroprotective strategies for children with congenital heart disease who had cardiac surgery at a young age.
She also conducts research on the psychosocial functioning of children with congenital heart disease and strategies for improving access to behavioral health care for this patient population. She is an active member of the Pediatric Cardiology special interest group of the Society of Pediatric Psychology.
Takeshi Tsuda, MD, FAAP, FACC is a physician scientist investigating basic and translational research in heart failure. Dr. Tsuda directs the molecular cardiology research work performed within the Nemours Biomedical Research department. His research team performs in vivo hemodynamic studies in the mouse model (echocardiography and cardiac catheterization), molecular biology technique, protein assays and cell biology experiments.
His major research interest is extracellular matrix protein fibulin-2 and its regulatory effects in transforming growth factor (TGF)-b activation in cardiac remodeling or myocardial fibrosis. He developed a unique mouse model in which fibulin-2 is genetically ablated and in which TGF-b is overexpressed. His pediatric cardiac research group has established a new technique in measuring TGF-b in the tissues using bioassay. Now this new TGF-b bioassay has been applied for the measurement of TGF-b in human tissues. He also established a novel concept of “Integrated Wall Stress” in assessing contractile reserve of left ventricle by echocardiogram.
Dr. Tsuda is a Staff Cardiologist at Nemours Cardiac Center and Associate Professor of Pediatrics in Thomas Jefferson University, Jefferson Medical College.
Publications & Clinical Trials
Browse a listing of research publications from Nemours researchers related to cardiology. View Cardiac Publications »