November 07, 2003
Sealing Holes In The Heart
New Procedure Without General Anesthesia Sends Patients Home Within Hours
Davenport, IA - A new procedure introduced at Genesis Medical Center this week promises to send young patients with holes in their hearts home after only a few hours of observation. A condition that once required open-heart surgery now is performed without general anesthesia, lessening the discomfort and traditional risks associated with treatment.
"Over 40% of strokes in younger patients can be due to a hole in the heart that has been present since birth. This hole called Patent Foramen Ovale (PFO) or Atrial Septal Defect (ASD) allows small clots to migrate from the right to the left side of the heart and then to the brain leading to an obstruction of one of the brain arteries and subsequently a stroke," says cardiologist Nicolas W. Shammas, M.D., Cardiovascular Medicine, P.C. According to the American Heart Association, more than 700,000 persons in the United States each year experience a new or recurring stroke.
Historically, treatment of this condition has been with long-term anticoagulation drug therapy, using coumadin, or with open-heart surgery to close the hole. Lately, a new emerging therapy closes the hole in the heart with a non-surgical, or percutaneous, technique. "A catheter is typically placed across the hole of the heart from a small incision in the groin. Through this catheter, a closure device is deployed under guidance of an ultrasound that patches the hole." Dr Shammas says. This percutaneous technique has generally required general anesthesia until now.
In March of 2001 at Genesis Medical Center, Dr. Shammas, performed the first percutaneous procedure in the Quad Cities to close a hole in the heart of a 30-year old patient with a stroke. The procedure required general anesthesia and the placement of an ultrasound catheter in the esophagus of this patient to guide the deployment of the patch. Since then over 40 similar procedures have been performed at Genesis. "In general that procedure has been successful," says Dr. Shammas, "but researchers have been actively looking for ways to improve performance and lower risks. General anesthesia is not without risk and if it can be eliminated, that simplifies things considerably."
Under the supervision of Ziyad M. Hijazi, M.D., section chief of pediatric cardiology at the University of Chicago Children's Hospital, Dr. Shammas performed procedures on three patients today using a new intravascular ultrasound device and a new closure patch without general anesthesia. This is the first time the new imaging device has been offered in the Quad Cities. Developed by Siemens, AccuNav division, physicians are able to visualize the heart without inserting a probe into the patient's esophagus, which commonly requires the use of general anesthesia to minimize discomfort. This ultrasound catheter is inserted through a vein in the groin under local anesthetic and is directed to the right chamber of the heart. It allows visualization of the heart structures and can guide accurate deployment of the patch into the hole.
In addition to the new ultrasound device, a relatively new patch was used to close the hole in the heart. The AMPLATZER© Occluder, developed by AGA Medical Corp., has been recently approved by the FDA to patch atrial septal defect. This tiny umbrella-like device can be implanted into the channel of the defect by way of a catheter. After implantation, heart tissue grows and envelops the device, allowing the channel to close. "Although no comparative studies exist between the CardioSeal Occluder device I've been using for the last two years and today's device, several experts generally agree this new device will offer better stability in patching bigger holes, and possibly safer and better long term results," says Dr. Shammas.
Heart specialists perform more procedures at Genesis Medical Center than anywhere in the Quad Cities. Last year, specialists performed 374 open-heart procedures, 4,148 heart catheterizations and 2,268 angioplasty procedures. Genesis Medical Center recently spent more than $7.5 million to upgrade and expand heart care capabilities including new catheterization labs with all digital imaging systems and surgical suites capable of handling robotic technology. For more information, call Genesis On Call at 800-383-2575 or visit our Web site: www.genesishealth.com.
