Doctors Perform Non-Surgical Heart Procedures to Repair Holes in Young Hearts
Monday, July 26, 2004Robert Beekman, III, MD, director of the Division of Cardiology at Cincinnati Children's Hospital Medical Center, was a lead investigator for the use of a device known as the Amplatzer" Septal Occluder. The Amplatzer" is one of the most promising non-surgical devices for one of the most common causes of holes in the heart, known as atrial septal defect (ASD).
Most heart problems in children are the result of the heart developing improperly during the first two months in the womb. Those defects can be a hole in the wall between the heart's chambers, known as atrial or ventricular septal defects. ASD is a hole in the dividing walls (septum) of the upper chambers, or atria.
When an ASD is present, blood flows through the hole primarily from the left to right atrium. This movement increases the blood volume in the right atrium which means more blood flows through the lungs than would normally.
Depending on the size and the area of the septum involved, many ASDs may be closed by placement of an Amplatzer" during an interventional cardiac catheterization. This involves entering a vein in the leg with a small needle so that a small, flexible tube (catheter) can be guided into the heart and major vessels of the heart and lungs. The catheter then deploys an Amplatzer device to cover the ASD by attaching to the atrial septum.
"A band-aid is all that's left on the leg after the procedure is over," says Dr. Beekman. "And, closing holes in children's hearts using this technique is complication-free in over 99 percent of cases."
Dr. Beekman has performed over 200 procedures with the Amplatzer" device on children and adolescents around the country since its approval by the FDA in December 2001. Cincinnati Children's performs more than 550 cardiac catheterization procedures each year. In addition, over 400 cardiac surgeries are performed annually. In the last decade or two, Cincinnati Children's cardiology specialists have performed corrective operations earlier in life. Twenty to 25 percent of our heart operations are done on children under 1 month of age, and 60 to 70 percent are done on youngsters under 1 year.
"We've adopted the philosophy that heart problems should be fixed as soon as possible. That way, the blood vessels and the heart may have a better chance to recover and grow normally, and we can avoid long-term developmental and cardiopulmonary problems," explains Dr. Beekman.
Holes in the heart are often diagnosed in the first year of life but may not need to be closed until a few years later. Most often an ASD is suspected when a physician hears a heart murmur during a physical examination. Echocardiography is the primary method used to confirm the presence of an ASD. It may not only show the hole and its size, but also any enlargement of the right atrium and ventricle in response to the extra work they are doing. An electrocardiogram may show evidence of thickening of the heart muscle and a chest X-ray may show enlargement of the heart and increased blood flow to the lungs.
In most children, ASDs cause no symptoms. A very large defect may allow so much blood flow through it that it causes congestive heart failure symptoms such as shortness of breath, easy fatigability or poor growth.
If left untreated, ASD may cause problems in adulthood. These problems may include pulmonary hypertension (which is high blood pressure in the lungs), congestive heart failure (weakening of the heart muscle), atrial arrhythmias (which are abnormal rhythms or beating of the heart) and an increased risk of stroke.
The benefits of being able to close an ASD with an Amplatzer" device is that it can be put in place without stopping the patient's heart or utilizing cardiopulmonary bypass, it doesn't have the psychological trauma related to open-heart surgery and it doesn't create a scar across the chest the way open-heart surgery does.
After ASD closure in childhood, the heart size returns to normal over a period of four to six months. Following closure of an ASD, there should be no problems with physical activity and no restrictions although regular follow-up appointments should be made with a cardiologist.
For more information about ASD, the Amplatzer" device or other heart problems affecting children, visit the Cincinnati Children's Heart Center.
Attention TV News Reporters, Editors and Producers: On July 26 and July 28 from 1-1:30 pm (EST) an Amplatzer" VNR will be available at the satellite coordinates IA 5 / Transponder 19 (c) band and downlink 4080 (Vertical).
Contact Information
Amy Caruso, 513-636-5637,
amy.caruso@cchmc.org
