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An Across-the-Lifespan Approach to Congenital Heart Disease

John Thomson (right) in the cath lab with Megan Gray (left) and Hannah Fraint (middle)

John Thomson (right) in the cath lab with Megan Gray (left) and Hannah Fraint (middle)

John Thomson and his colleagues are advancing non-invasive solutions for young patients with congenital heart conditions, dramatically changing their lifetime care.

Just a few months after interventional cardiologist John Thomson joined the Blalock-Taussig-Thomas Pediatric and Congenital Heart Center at the Johns Hopkins Children’s Center last summer, he and his team began offering a game-changing treatment for young patients with congenital heart disease.

Of the roughly 40,000 infants born each year with congenital heart disease, about 20 percent have an abnormality of their right ventricular outflow tract. “Until now, these patients needed to be treated with invasive procedures such as open-heart surgery. Or they would need to wait to have a pulmonary valve replacement later in life,” explains Thomson. The new treatment, which uses a novel transcatheter pulmonary valve (TPV) system, is a much less invasive option. It can be implanted percutaneously, using only a small incision, and is designed to expand into the right ventricular outflow tract while deploying a bioprosthetic pulmonary valve.

Approved by the U.S. Food and Drug Administration in March 2021, the system holds the potential “to dramatically change our lifetime management of these patients,” says Thomson, “and our catheterization lab at Johns Hopkins is currently the only center in Maryland approved by the company to offer this groundbreaking treatment.”

For Thomson, this new offering is just one more step forward in his career-long quest to provide alternative, noninvasive solutions for patients with congenital cardiac problems.

“In recent years within the field, we’ve seen real advances in keyhole procedures for children and infants that are effective and can offer an alternative to more traditional surgical approaches,” he says. He and his team in the catheterization lab — which includes attending physicians and pediatric cardiologist Hannah Fraint — utilize many of these techniques in performing stent procedures, duct closures and valve replacements, to name a few.

John Thomson

John Thomson

Thomson hails from England. He previously served as an interventional pediatric cardiologist at Yorkshire Heart Center at the Leeds General Infirmary, chief of the pediatric cardiology service, and as an associate professor in the faculty of medicine at the University of Leeds. His experience with England’s health care system offers a unique and valuable perspective on best practices for treating adult congenital heart disease.

“The most effective units follow patients with congenital heart disease from cradle to grave, because the vast majority of patients diagnosed with heart problems as infants will need follow-up for the rest of their lives,” says Thomson. While that across-the-lifespan strategy is typically used in England, the approach in the U.S., he says, “is often much more fragmented.”

Until relatively recently, patients with congenital heart disease at Johns Hopkins were either seen by pediatric cardiac specialists or adult cardiac specialists. That’s changed now with the Blalock-Taussig-Thomas center, which combines pediatric and adult cardiology in transitioning patients to adulthood. Then, patients are cared for by specialists specifically trained in the management of adults with congenital heart disease, such as cardiologist Ari Cedars.

“There’s a significant advantage to having pediatric and adult care all in one place — to having experts who can provide care for both congenital heart disease and adult-related problems, and who know the ways in which those two worlds will interact in the same patient,” says Thomson.

For example, general adult cardiologists typically have great depth of experience in treating coronary vascular disease and other heart problems that occur with aging but very limited training in congenital heart defects that exist since birth — and they are generally unfamiliar with the ways that early repairs deteriorate over time.

For his part, Thomson loves the extended relationships that come with his role. “We join families in their medical journey very early on, usually when patients are infants or even in utero. Then we get to know patients and their families so well, and they get to know us, as we care for them throughout the whole of their lives,” he says. “It’s very special and extremely satisfying.”


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