| A Batesville girl was the first patient to undergo a new, less-invasive procedure to repair a hole in her heart at Le Bonheur Children’s Medical Center in December.
Dr. Rush Waller, medical director of the LeBonheur Cath Lab, performed the first CardioSeal procedure on December 1 on Carrington Carter, 3, of Batesville. She was discharged the next day.
The procedure expands the hospital’s ability to mend a hole in a child’s heart without opening the chest or entering the operating room.
Le Bonheur began using CardioSEAL implants to repair ventricular septal defects (VSD) in select patients. A VSD is a hole between the lower chambers of the heart – the right ventricle and the left ventricle.
The CardioSeal implant is produced by NMT Medical, Inc. of Boston.
Before such devices became available, patients with VSDs required open-heart surgery. But doctors can now seal certain types of holes with a CardioSeal implant in the Cath Lab. Le Bonheur cardiologists have been closing atrial septal defects (ASDs) in the Cath Lab for years.
Le Bonheur doctors performed three procedures using the implant in the first two days of December – two were in the Cath Lab and one was a hybrid procedure in the operating room.
To deploy the device, the doctor gains access to the child’s heart via the femoral vein and artery.
Catheters are advanced from the groin or neck vein into the heart, and angiograms are taken to better visualize the heart and the defect. Transesophageal echocardiography is also used to guide the implantation of the device.
Once visualization is complete, the implant is attached and collapsed for placement into a special catheter, which is then advanced to the site of the hole. The doctor re-expands the implant so that part of it sits on each side of the hole, sandwiching the hole between the two sides of the implant.
The implant is then released from the catheter, the catheter is removed and the procedure is complete.
Although the CardioSeal has been approved since 2002, research published in the August, 2004 journal, Circulation, provides data supporting its effectiveness in children, said Dr. Waller.
Carrington was already a Le Bonheur patient, having received a pulmonary valve implant and partial closure of her VSD last year by pediatric cardiothoracic surgeon Christian Gilbert, M.D., in an open-heart procedure, said Tonya Carter, her mother.
Mrs. Carter said Carrington has recovered well. She enjoys gymnastics at Morgan Gymnastics and likes make-up.
Patients with complex cardiac problems are good candidates for the device because it allows repair of the defect while avoiding a major surgery, Dr. Waller said.
The new technology also makes possible hybrid procedures – in which interventional cardiology and cardiothoracic surgery are combined, said Dr. Jeff Myers, chief of pediatric cardiothoracic surgery at Le Bonheur.
A six-month-old patient received a CardioSeal implant at Le Bonheur in a hybrid procedure in December, he said. The patient had had a previous heart surgery for repair of an interrupted aortic arch.
Dr. Myers cut through the old incision in the front of the patient’s chest and cut through the breastbone to gain access to the heart. He made a small hole in the right ventricle over the child’s VSD and then Dr. Joel Lutterman, another interventional cardiologist, used echocardiography to place and deploy the device.
Once the VSD was closed, Dr. Myers removed a pulmonary artery band, which had been placed in the child’s previous surgery. With the closure of the VSD, the band was no longer needed.
The hybrid procedure eliminates the need to use the cardiopulmonary bypass machine and to stop the heart, Dr. Myers said. In addition, the patient only had to undergo one procedure for deployment of the device and removal of the artery band, Dr. Myers said.