Report of the Task Force on Research in Pediatric Cardiovascular Disease.

Since the 1940s, when major breakthroughs occurred in the surgical treatment of congenital malformations, great strides have been made in the treatment of cardiovascular disease in infants and children. Nonetheless, significant difficulties remain that hinder our ability to treat the very youngest and smallest patients with cardiovascular disease, including those still in utero. Heart disease in infants, children, and adolescents is still a large problem, with substantial burden and cost for both families and society. Although surgical and technological innovations have greatly advanced treatment of cardiovascular disease in adult patients, treatment of infants, children, and adolescents has not kept pace. The most obvious reason for this situation is that children are not simply smaller adults. If they were, the appropriate miniaturization of instruments and equipment, scaling down from adults to children, would be sufficient. However, when considering interventions for neonates, or even fetuses, one must remember that they exhibit marked physiological characteristics that distinguish them from adults, such as increased heart rate and immature tissue development. To stimulate clinical research and thereby enhance our ability to treat infants, children, and adolescents, the National Heart, Lung, and Blood Institute (NHLBI) has launched 2 major initiatives. First, in May of 2000, we issued a solicitation for the establishment of a Pediatric Heart Disease Clinical Research Network of interactive pediatric clinical research centers (http://grants.nih.gov/grants/guide/rfa-files/ RFA-HL-00-013.html). Its purpose is to promote efficient evaluation of innovative treatment methods and management strategies for children with structural congenital heart disease, inflammatory heart disease, heart muscle disease, and arrhythmias. We anticipate that one outcome of the Network will be to promote rapid dissemination of the findings from these clinical studies to the medical community. Seven clinical centers and a data-coordinating center were funded in September 2001, and it is expected that 2 protocols will be under way by the end of this calendar year. Second, in March of 2002, the NHLBI released a solicitation for Specialized Centers of Clinically Oriented Research (SCCOR) in Pediatric Heart Development and Disease, with the broad goal of fostering multidisciplinary research on clinically relevant questions, thereby enabling basic science findings to be more rapidly applied to clinical problems (http://grants1.nih.gov/grants/guide/rfa-files/RFA-HL-02027.html). It is worth noting that this new centers program builds on long-standing Institute efforts to address pediatric cardiovascular disease. A Specialized Center of Research (SCOR) in congenital heart disease was funded in 1990 as part of the NHLBI Ischemic Heart Disease SCOR Program. A SCOR solicitation dedicated to pediatric heart disease resulted in three 5-year awards in 1992, and the SCOR program was expanded to comprise 5 programs in 1997. As these activities were being planned and implemented, the NHLBI convened the Task Force on Research in Pediatric Cardiovascular Disease in January of 2001 to identify the most important research priorities and scientific opportunities over the next 5 years in basic science, clinical medicine, and epidemiology associated with pediatric cardiovascular disease. Its findings and recommendations are summarized below, and the full report can be found at http://www.nhlbi.nih.gov/resources/docs/pediatric_cvd.htm. The Institute is pleased to have this report to help guide its efforts in the fight against pediatric cardiovascular disease. We hope the community will give it full and thoughtful attention.