The nondescript yet mysterious fatty tissue that hangs like an apron from the stomach – called the omentum – holds great promise for thousands of children born with hypoplastic left heart syndrome(HLHS) or other severe cardiac defects, who might need a heart transplant within their first 10 years of life. In HLHS, the left side of the heart is underdeveloped, causing the right side to work much harder, which eventually leads to injury and heart failure. Using an animal model, researchers found that surgically attaching the omentum to the overburdened heart reduces signs of injury, allowing the heart to function normally. Their findings were published in the Annals of Thoracic Surgery.
“We were presently surprised to see that we can regenerate the heart with fatty tissue that is naturally present in the body,” says senior author Joseph Forbess, MD, MBA, Head of Cardiovascular-Thoracic Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Pediatric Surgery at Northwestern University Feinberg School of Medicine. “A simple, low-tech procedure potentially could prevent or at least delay the need for a heart transplant in children born with hypoplastic left heart syndrome, for example.”
The Centers for Disease Control and Prevention (CDC) estimates that each year about 960 babies in the United States are born with hypoplastic left heart syndrome. These babies require multiple surgeries that have dramatically increased survival, but still leave children vulnerable to developing heart failure and requiring a heart transplant. At Lurie Children’s Heart Center, about 40 percent of the inpatient census are now children with heart failure.
“Children with heart failure desperately need innovative approaches to prolong the life of their heart,” says Dr. Forbess. “With the omentum, we may have the answer, although we still don’t know how exactly it coaxes the heart to heal so impressively.”
Even in its original location, what the omentum actually does and how it works are poorly understood. It is known that this fatty tissue has extensive blood supply and immune cells. More recently, the omentum was found to be a source of pluripotent stem cells and numerous growth factors. It can physically limit the spread of infection and has been surgically moved to other parts of the body for that purpose. The omentum also has been used to promote healing and regeneration in traumatic and surgical wounds.
Dr. Forbess envisions that translocating the omentum early in life could protect the heart from subsequent injury in babies with hypoplastic left heart syndrome. The procedure could be performed during one of the regular surgeries these children undergo. But first, results need to be replicated in more animal models.
“If our results are confirmed in additional animal models, we could soon offer this promising approach in a clinical trial with children,” says Dr. Forbess.