Going Hybrid
Improving Safety and Outcomes for the Most Fragile Heart Patients
After a procedure in the hybrid catheterization laboratory, Russel Hirsch, MD, director of Cardiac Catheterization, reviews fluoroscopic
images in the lab's control booth. |
| 1950s Diagnostic catheterization emerges as the best method to confirm clinical findings before heart surgery. |
| 2007 Opening of the hybrid catheterization lab at Cincinnati Children's makes it possible to combine catheterization and surgery in one procedure, in one setting. |
At first, everything seemed fine when Maria was born, but within four hours, it was clear that something was terribly wrong. She was blue from lack of oxygen.
Maria was rushed from her birth hospital in Georgetown, Ohio, to Cincinnati Children's Hospital Medical Center, where a team of experts from The Heart Center found she had a major heart defect.
Maria's heart had only one ventricle. In a normal heart, the right ventricle pumps blood to the lungs, and the left ventricle pumps blood to the body. Maria had only one ventricle to do all the work, complicated by a narrow pulmonary artery that was constricting the flow of blood from her heart to her lungs.
Just days old, Maria was facing a series of three operations to reconstruct her heart. "It's very scary," says her mother, Robin Honeycutt. "I'm worried about her, but everyone is very reassuring, and what gives me hope is that the technology keeps getting better."
At Technology's Forefront
The first procedure was performed when Maria was 8 days old, in the new hybrid cardiac catheterization laboratory at Cincinnati Children's, a facility that is at the forefront of technology.
The lab combines the imaging technology interventional cardiologists need to perform complex heart catheterization procedures with the environment heart surgeons need to perform open heart surgery – hence the name hybrid lab, where both catheterization and surgery can be performed in one space.
Children who are candidates for hybrid procedures are often the smallest, most vulnerable patients, notes Russel Hirsch, MD, director of Cardiac Catheterization. These children may be at substantial risk when invasive procedures are necessary.
"Our new hybrid lab improves safety for these fragile children because hybrid procedures dramatically reduce the number of times we transport the patient and the number of times we give anesthesia," says Dr. Hirsch.
In the past, a child requiring both catheterization and surgery typically would be transported from the cardiac intensive care unit (CICU) to the cath lab, then back to the CICU, then to the operating room (OR), and then back to the cath lab for follow-up images of the heart.
These moves were necessary because the OR didn't have good imaging, and the cath lab wasn't set up for surgery, explains Dr. Hirsch. "Now we all have everything we need, in one location, for the best, safest patient care." A new communication network now links the cath lab with sites around the hospital so that digital angiograms and other vital data can be viewed in multiple locations.
"We can now communicate from the lab directly with colleagues in the CICU and the OR to obtain their opinions in real time," explains Dr. Hirsch. "If we decide another procedure is needed, even surgery, the team can be assembled right in the cath lab, without having to move the patient, administer anesthesia a second time or wait to schedule a second procedure. This communication network greatly adds to the safety of our patients."
Step One for Maria
For the first step in reconstructing Maria's heart, Dr. Hirsch and cardiothoracic surgeon Pirooz Eghtesady, MD, PhD, worked together in the hybrid cath lab. Dr. Eghtesady opened the baby's chest, and Dr. Hirsch placed a catheter directly into her aorta. He injected contrast material through the catheter and took pictures under fluoroscopy, which provides moving X-ray images, to obtain a clear picture of the anatomy of Maria's heart and the exact spot where the pulmonary artery was too narrow.
These images guided Dr. Eghtesady as he performed delicate surgery. Maria was placed on a heart-lung bypass machine while Dr. Eghtesady placed a patch on the narrow section of blood vessel. He then placed a shunt to create a new pathway from the aorta to the pulmonary arteries, so blood could reach Maria's lungs to be oxygenated. After surgery was complete, Dr. Hirsch performed a final angiogram to ensure that the shunt was widely open and the pulmonary arteries were unobstructed.
Four months later, Dr. Hirsch performed a follow-up exam in the cath lab. He found that Maria's pulmonary arteries were open, relaxed and growing well – prerequisites for the second phase of heart reconstruction.
At a preoperative checkup a few days before her second operation, Robin told Dr. Eghtesady that Maria now "weighs 12 pounds and eats like crazy."
She had passed the first hurdle and was ready to move on to the next step in a long process to rebuild her heart and offer her the best chance of a healthy life.
