Youngest patient ever benefits from non-surgical heart valve replacement at Lucile Packard Children's Hospital
STANFORD, Calif. – Doctors at Lucile Packard Children’s Hospital at Stanford have replaced a heart valve in a 9-month-old girl without opening her chest or putting her on a heart-lung machine.
She’s the youngest child ever to undergo the novel procedure in which a pig’s heart valve is threaded on a balloon through a catheter and then along a wire down a large vein in the patient’s neck. When the valve reaches its destination – the entrance to the pulmonary artery – the balloon is inflated, pushing the valve into place.
Developed two years ago by a British physician, the procedure has never before been done on a child under age 7. It has been performed only once in the United States, and in that case on an adult.
“Quite a few children with congenital heart problems require valve replacement,” said Dan Bernstein, MD, co-director of the Children’s Heart Center at Packard Children’s Hospital and chief of pediatric cardiology. “But those valves develop leakage over time and children end up having multiple surgeries to replace them. This procedure will reduce the number of re-operations they need.”
Bernstein, who is also a professor of pediatrics (cardiology) at the Stanford School of Medicine, predicts the procedure will eventually become standard. “I could see doing this procedure on a dozen to two dozen kids each year, just at this center,” he said.
The baby who received the new valve had undergone open-heart surgery when she was 10 days old. She was facing either another surgery or a heart transplant when the hospital’s physicians offered the alternative of replacing the infant’s pulmonary valve in the catheterization lab.
The child’s parents knew this was the first time the procedure would be done on an infant, but they understood that results were good in older, bigger patients.
“I really wanted this procedure to be available on my little girl,” said the child’s father.
“They don’t need to cut and open her chest. She loses less blood with the catheter, and doesn’t need to stay in the ICU very long.”
Because the child in this operation was so small, physicians had to modify the British procedure in several ways. They used a pig valve rather than the cow valve used previously; they used only the valve and minimal surrounding natural tissue, and they had to abandon using a catheter to transport the valve through the heart, instead relying on a “lasso” to hold the valve securely to the balloon that carried the valve into place.
“People don’t understand the changes in plans that occur when you do a procedure for the first time,” said Jeffrey A. Feinstein, MD, MPH, assistant professor of pediatrics (cardiology) and one of the cardiologists who performed the procedure. “We’re lucky we have a team that is comfortable doing that and works well together.”
Feinstein, who is also associate director of the Pediatric and Congenital Cardiac Catheterization Laboratory at Packard Children’s Hospital, predicts the hospital will receive more referrals of patients who need a new valve but don’t have many other options. “We make it look easy, but physicians aren’t going to go out and do this right away,” he said. “We’re a long way from this being standard procedure.”
The child’s parents said that they are pleased with the outcome, noting that their daughter is breathing, eating and sleeping better, and isn’t irritable or fussy. Indeed, Bernstein calls it a dramatic success. “The patient has shown a marked improvement in heart function,” he said.
“When your child has a disease,” said the child’s father, “one of the parents’ responsibilities is to provide the best health care available to that baby. I’m confident that I’ve given my little girl the best medical care in the world.”
Stanton B. Perry, MD, clinical associate professor of pediatrics (cardiology) and director of the pediatric catheterization lab, collaborated with Feinstein on the procedure. V. Mohan Reddy, MD, associate professor of surgery and chief of pediatric cardiothoracic surgery, provided the surgical expertise required to fashion the stent/valve combination.
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