Research at Johns Hopkins Medicine Within the Johns Hopkins Heart Institute are a number of world-renowned research centers. The Broccoli Center for the study of Aortic Diseases, for example, is one of the few centers in the country focused entirely on the study of aortic diseases. Among its staff is the world’s leading expert on Marfan’s Syndrome. The hospital's ARVD Clinic is engaged in groundbreaking research on the problem of arrhythmogenic right ventricular dysplasia, a heart irregularity that often strikes young men, causing heart palpitations, fainting spells or even sudden death. Its research includes not only the development of new tests for detecting the often-overlooked problem, but new ways of treating it as well. Other research mixes basic science and medicine. The Institute of Molecular Cardiobiology studies the basic physical, chemical and genetic properties of heart cells to search for new ways of treating the diseases that strike it. Research there has already led to such breakthroughs as the development of a new class of heart medications. Known as xanthine oxidase inhibitors, they help boost the force of the heartbeat without increasing its need for energy. They may ultimately offer a revolutionary new treatment for patients suffering from heart failure. Other work on basic heart function at the Institute has not only revealed how the heart protects itself against severe injury during stress, but also offered a means of identifying those at risk for sudden cardiac death. Complementing these programs is the Non-Invasive Imaging Service. Its echocardiographic or EKG laboratory features 12 top-of-the-line echocardiographic systems, three of which are devoted exclusively to research. Also under development are special laboratories for Cardiac MRI studies, Vascular Imaging, and Cardiovascular CT or CAT-scans. Doctors in the Electrophysiology Service not only continue to refine pacemaker technology; they are also looking for ways to permanently fix arrhythmias through a technique known as laser ablation. Other research explores the causes of atrial fibrillation and fainting or syncope. The Non-Invasive Imaging Service is engaged in research to help refine the use of MRI’s and ultrasound in detecting heart disease. Researchers at the Ciccarone Preventive Cardiology Center come from a broad variety of fields and study such things as hypertension, diabetes, atherosclerosis, and the clustering of heart disease in families. Their goal is not just to help cardiac patients recover, but to help prevent the disease in the future. Cardiac Surgery Research Lab at Johns Hopkins Cardiac surgical research at the Johns Hopkins Hospital has a long and productive history. Since its inception in 1942 by Alfred Blalock, M.D., and Vivien Thomas, investigators in the Cardiac Surgery Research Laboratory have set the standards for surgical research today. Topics researched in the Cardiac Surgery Research Lab include: solutions to congenital cardiac defects, i.e. tetralogy of Fallot (blue baby) early advances in cardiopulmonary bypass using the heart-lung machine to facilitate open heart surgery early prosthetic valve development with related coating and bonding studies technique perfection for measuring myocardial gas tension use of various solutions for cardioplegia early development of the intra-aortic balloon pump comparisons of anti-rejection medications in heart and heart-lung transplantation organ preservation techniques effects of leukocyte filtration on cardiopulmonary bypass techniques for safely extending hypothermic circulatory arrest and minimizing neurological injury ways to prevent spinal cord injury from abdominal aorta  surgery using gene therapy to preserve the life of vein grafts looking at heterotopic heart transplants to decrease the work load of the failing heart drug therapies to prevent ischemia and reperfusion injury Specific research projects currently underway in the Johns Hopkins Cardiac Surgery Research Lab include: Excitotocity in Circulatory Arrest-Induced Brain Injury This project has been fully funded by the National Institutes of Health (NIH) over the past five years and has been approved by the NIH as of 12/01/00 for a special honorary Javits award for a period of four to seven years. This project was initially based on the premise that nitric oxide (NO) and glutamate levels increase in the system after circulatory arrest and cause brain injury. Progress to date has confirmed that a significant increase in the levels of NO and glutamate occur and, indeed, cause brain damage. Ongoing experiments involve further investigation of the mechanism of injury and using pharmacological pretreatments to eliminate brain injury normally seen following hypothermic circulatory arrest. In addition, novel MRI imaging techniques of the brain are being used to non-invasively assess brain injury or preservation as a result of the pharmacologic treatments. In Vivo Mesenchymal Stem Cell Grafting in Cardiac Muscle: Molecular and Physiologic Consequences In this study, adult mesenchymal stem cells are harvested from bone marrow and cultured for growth.  When adequate numbers of stem cells are present, these cells are injected into infarcted (dead) areas of a functioning heart to determine whether it will recover lost/non-functioning myocardium/heart muscle. Progress to date has shown that these stem cells differentiate into working muscle cells to maintain heart wall structure and improve regional function of the heart. Ongoing experiments encompassing larger areas of the heart may provide evidence of improved heart muscle survival following stem cell delivery. This study is supported by Osiris Corporation and The Cardiac Surgery Research Fund.  Heterotopic Heart Transplantation This project seeks to develop a working model of heterotopic cardiac transplantation with the heart being placed in the abdomen. Ultimately if this model is able to show the ability to support the circulation, it may have clinical application as:  1) An alternate to mechanical circulatory devices, or 2) An alternate to standard cardiac transplantation.  In the latter situation it will allow more patients to be transplanted since the heart will function as the auxiliary pump and will allow the use of “marginal” donor hearts. Progress to date has determined that the donor heart pumps effectively in the abdomen in an acute setting. We now seek to determine survival rate and the function of the transplanted heart. Our overall goal is to demonstrate that donor hearts otherwise unusable for standard transplantation, can be used successfully in abdominal heart transplants functioning as auxiliary circulatory support. Successful use of marginal donor hearts in this manner will maximize the existing donor pool to save more lives. This study is supported through the generosity of Robert and Pauline Garner. Retrograde Spinal Cord Perfusion Via the Inferior Vena Cava This study looks at spinal cord protection during thoracic aorta aneurysm surgery using retrograde blood flow, spinal cord cooling, and neuro-protective drug therapy. Progress to date has shown retrograde blood flow can perfuse and cool the spinal cord, however no neuro-protective effects were seen. Further drug therapy studies are ongoing. In addition, spinal cord microdialysis is being done to better characterize the nature of cord injury to provide insight into future protective mechanisms.  This study is supported by The Dana and Albert "Cubby" Broccoli Center for Aortic Diseases and the Mildred and Carmont Blitz Cardiac Research Fund. Molecular and Physiological Changes in the Heart Following Viral Delivery of Genetically Engineered PhospholambanThis project seeks to successfully deliver genetically manipulated calcium handling proteins into the working heart. Phospholamban is being delivered by attachment to virus particles directly injected into the heart muscle. The study is progressing to determine if delivery through the aorta during cardiopulmonary bypass will be more effective. Successful incorporation of this molecular alteration could potentially attenuate or eliminate heart failure. This study is funded through the University of California San Diego and The Irene Piccinini Investigator Endowment.