THE PROMISE REGENERATIVE MEDICINE AND STEM CELL THERAPY HOLDS FOR CONGENITAL HEART DEFECTS

Authored by Dr Swati Garekar, Senior Consultant-Pediatric Cardiology, Fortis Hospital Mulund

Congenital heart defects (CHD) are the most common birth defects and can adversely impact quality of life if left untreated. Diagnosis and treatment at the correct time is the right step towards an excellent outcome. Since the first successful open-heart surgery on September 2, 1952, done on a 3-year-old boy with a ventricular septal defect (VSD) at the University of Minnesota, significant advances have been achieved.

However, challenges remain with implantation of valves or conduits for replacing defective or missing parts of the heart. These replacements have several drawbacks such as the need for lifetime anticoagulants, risk of endocarditis, calcification over time, and size mismatch as the child grows.

Another challenge lies with complex heart defects that require staged surgeries; the long-term concern is the pumping ability of the heart’s ventricle. Can regenerative medicine and stem cell therapy help?

Regenerative medicine endeavors include tissue engineering — applying tissue-engineered conduits, valves, and patches, including chemically treated homografts and xenografts. The future hints at scaffolds acting as temporary structures that provide a ‘bed’ for native tissue growth, eventually absorbed by the body.

Stem cell therapy hopes to enable repair and regeneration of heart parts. Stem cells, derived from umbilical cord, bone marrow, or heart biopsy, can be injected into the coronaries or myocardium.

Numerous clinical trials are ongoing internationally, including the TICAP trial (trans coronary infusion of cardiac progenitor cells in single ventricle patients) and the PERSEUS trial for univentricular heart disease. These studies indicate safety, feasibility, and some improvement in ventricular function and growth.

India's regulations via ICMR provide guidelines for ethical stem cell research and evidence-based uses. While stem cell therapy is standard for blood cancers and applying CAR-T therapy for certain lymphomas is recent, usage in CHD remains limited to clinical trials, with none ongoing currently in India.

Pediatric Cardiology and Me

Written by Dr Swati Garekar, December 2021

It’s often said that truly fulfilled doctors sacrifice everything at work, even family life. I respectfully disagree.

I feel joyful going to work, eager to apply my skills to help children with congenital heart defects. The friendships with patients and their families, the trust they place in our team to heal their children, are my strength.

Each day brings the fulfillment of revealing the mysteries of the heart through echocardiography, counseling hopeful families, and helping patients recover and live vibrant lives — returning to school, sports, and joyful normal childhoods.

Yet, the job carries its hardships. Seeing a patient's condition worsen, delivering devastating news, and mourning losses are inevitably part of the work. These moments weigh heavily on all of us, yet we push forward, honoring those who didn’t survive by renewing our commitment to care.

Balancing roles — as doctor, mother, wife, daughter, and friend — is a constant juggling act. Still, I find joy and strength in this multifaceted life.

As the year ends, I am grateful for my team and the privilege to serve families with care. To those on similar journeys, may you find kindness, patience, and hope.

Season's greetings and blessings to all.

Dr Swati Garekar
American Board Certified (pediatric cardiology)
Consultant Pediatric Cardiologist, Fortis Hospital Mulund