Lifewatch: Heart surgery

Reported by Claire Hosmann - email
Posted by Debra Worley - email

(WECT) - Every year, 17,000 children are born in the United States with a hole between chambers in their heart.

The hole forces their hearts to work overtime, creating a life-threatening situation.  Doctors are now patching the holes without even opening the chest.

15-year-old Anja Fortier has always had a funny feeling.

"You know when you get nervous and you get butterflies in your stomach? It kind of felt like that," explained Anja.

But the butterflies were actually in her heart.  She was born with an atrial septal defect - a hole between her heart's two upper chambers.  The hole has put her at risk for serious heart problems.

Fixing a problem like Anja's used to mean open heart surgery.  Now, she's having a far less invasive procedure that closes the hole with a prosthetic patch.

"We have a metal framework that sits around both sides of the defect to keep the tissue in place," said Dr. Robert Vincent.

The procedure takes less than an hour and is guided by real-time imaging while doctors send a catheter through the femoral vein.

A thin tube guides the patch into the heart.  Once it's in place over the hole, it's visible on the ultrasound.

Over time, tissue grows over it, sealing it into place permanently.

"It's really awesome to be able to come in on the day of the procedure, have it done and go home either that day or the next day without any surgery, without any incision and any stitches," said Dr. Vincent.

Patients who undergo the heart repair procedure are usually able to go home the same day.

Doctors say the results are just as effective as the traditional open heart repair surgery.

For more information, please contact:
Children's Healthcare of Atlanta
(404) 250-KIDS [5437]

BACKGROUND: Atrial septal defect (ASD) is a type of congenital heart defect where a hole exists in the septum, the wall between the heart's left and right chambers. Roughly eight out of 1,000 babies are born with a form or congenital heart disease. Six to eight percent of those babies have an ASD. The hole allows blood to flow between the left and right atria. One in four individuals with ASD have small defects that close up on their own during infancy or childhood. When a large defect is present, a large amount of arterial, or oxygen-rich blood, can leak from the heart's left side to right side. The blood is then pumped back to the lungs, despite it already being rich in oxygen.

Therefore, the oxygenated blood displaces oxygen-deficient blood. The condition rarely causes symptoms, which is why many people with ASDs don't realize they have it. The increased blood flow from the right side of the heart to the lungs causes a heart murmur, or swishing sound, which is often the first indicator of the defect. A chest X-ray, electrocardiogram or echocardiogram can help a physician diagnose the condition. Over time, ASDs can damage the heart and lungs. It may lead to heart failure or high blood pressure in the lungs, shortening a patient's life span.

THE SURGICAL APPROACH: After an ASD is diagnosed, a cardiologist will decide whether treatment is necessary. The standard treatment for closing defects has traditionally been open heart surgery, which has been performed for more than 35 years. "It is a very effective procedure," Robert Vincent, M.D., a pediatric oncologist at Children's Healthcare of Atlanta, told Ivanhoe. "It was one of the first operations that was ever done to correct congenital heart defects, and it is very safe." The procedure involves opening the chest so a surgeon can stitch the hole closed or place a patch over it. Eventually, heart tissue will grow over the patch or stitches. Patients can usually leave the hospital three or four days after surgery, but one downfall is the large scar that remains on the chest. As an alternative to the invasive surgery many teens can be treated with cardiac catheterization, where a catheter, or thin, flexible tube, is inserted through the groin into a blood vessel and threaded up to the heart. A cardiologist then inserts a device shaped like a "dumbbell," made of two mesh discs connected by a short mesh waist. The waist fills the hole and the two discs keep it in place. The procedure leaves no scar.

A new catheter delivery procedure was recently approved by the FDA to close atrial septal defects. Instead of the mesh "dumbbell," the procedure uses a prosthesis made of biocompatible material that allows tissue to grow in the device to seal the defect. The GORE HELEX Septal Occluder is made of ePTFE patch material that is supported by a single wire frame. Over several weeks or months, cells penetrate the ePTFE patch. The implant has been available in Europe, Latin America and Australia. It has already been used in thousands of successful implants. Even though this new option exists, open heart surgery may still have to be performed when defects are not in a position that can be closed with a catheter, Dr. Vincent said.