Pediatric heart repairs now mean less time in the hospital sometimes not even an overnight stay and medical-device advances give the doctors fixing those small hearts more options. That's good news for little people like Amanda Strachan, who at 18 months is a veteran of heart repair.
Amanda, daughter of Jayson and Kory Strachan, Heber City, has had multiple procedures to repair heart defects detected shortly after she and her twin, Matthew, were born prematurely Aug. 9, 2006. She had two atrial septal defects, holes in the wall between the upper chambers of her heart, and a valve defect, along with various other problems, including underdeveloped lungs. Matthew didn't have similar defects.
An atrial septal defect allows blood to flow from the left to the right side of the heart, which makes the heart and lungs overcompensate. Oxygen-rich blood from the left side goes back to the lungs to be unnecessarily re-oxygenated, a cycle that eventually enlarges and weakens the heart.
In April, the first hole was closed in what was to be a catheter procedure but turned into open-heart surgery because of the complexity of Amanda's heart structure. On Tuesday, the second hole was closed, but it, too, was more complex than expected.
Pediatric interventional cardiologist Dr. Collin Cowley took Amanda into the catheterization lab at Primary Children's Medical Center expecting to deploy a new device called a Gore Helex Septal Occluder, approved two weeks ago by the Food and Drug Administration. Although it's new, Primary cardiologists were involved in clinical trials and have broad experience with it. He found, though, he couldn't get the seal he wanted, and after a couple of tries, he used an Amplatzer Septal Occluder, instead.
"She had an extraordinarily difficult anatomy to deal with," Cowley said.
For one thing, she's very small. And atrial septal defects are not round holes in a piece of paper. They are located in the muscle between two chambers, made of semi-complex tissue into which other structures go in and out. Amanda's also was located "much further back and toward the bottom than normal. It was almost impossible, but we did it."
Even so, she's expected to go home today.
The difference in technology over the past seven years has been astonishing, both for marveling cardiologists and patients who can often go in, get the repair and head home by evening. What used to be an open-heart procedure, with the heart stopped and life preserved by a heart-lung-bypass machine, is now typically delivered in the cath lab. Instead of a large incision, a small hole is made in the groin and a catheter threaded up into the heart to deploy a device that plugs the hole.
"Most kids end up with not even really a bruise where the catheter goes in. The scab falls off in a week, and they're up and running. We don't have to stop the heart, cut through bone, cut the outside of the heart to get inside, which all offers lots and lots of potential damage. It's a nice step forward," Cowley said.
While the Helex device didn't work for Amanda, it has worked for other kids, he said. And it "first and foremost gives us choices."
The two devices are engineered entirely differently. The Amplatzer device is more rigid, with a wire mesh frame. The Helex device unfurls through the hole in the heart to allow two lightweight expanded polytetrafluoroethylene circles, one in each chamber, to seal together and close the hole. For the right anatomy, Cowley calls it a "beautiful device you can hardly see once it's in place."
There's a need for both types of devices, as Tuesday's surgery shows, he said. Physicians can use what will work best for a particular patient's body."It's nice to have options," he said, especially in the pediatric market, where many device manufacturers don't want to design tools, because there aren't as many patients as in an adult-device market.