Tartu doctor transplants pulmonary valve

Aime Jõgi
Copy
Please note that the article is more than five years old and belongs to our archive. We do not update the content of the archives, so it may be necessary to consult newer sources.
Photo: Graafika: Kaido Linde

On March 6th, heart surgeon Toomas Hermlin performed a complicated procedure on two children, entering into patients’ hearts with balloon catheter via thigh vein, and from there on to pulmonary artery, providing it with a new valve.

For Estonia, the procedures were a fresh breakthrough. The operations were monitored by doctor Lars Söndergaard from Copenhagen University Hospital, who was satisfied with the surgery.

Both patients, young men aged 15 and 11, had been operated on earlier, as small children. The first of them was operated in Berlin while 3 years of age, the other in Tartu, at an even earlier age – and twice. The boys’ congenital heart troubles were serious and complicated. Both were characterised by constriction of pulmonary arteries and absence of valves.

The former operations were severe surgeries with external blood circulation, hearts having to be stopped during the decisive phase of the work. Already then, both boys’ hearts were transplanted homografts – blood vessels from donors with valves, sewn between right ventricular and pulmonary artery.

Up to now, the kids did well. However, they were not in their best strength and it was clear that repeated surgery was not to come too late.

«These children’s blood circulation from right ventricular to pulmonary artery was restricted and the transplant valve worked poorly,» said Toomas Hermlin. «Up to 50 per cent of blood directed to pulmonary artery spilt back.»

The transplant procedure of March 6th was accomplished via thigh vein, from where they proceeded to lower cavernous vein, then to right chamber of the heart and then on to the ventricular. Only then was it possible to enter pulmonary artery.

Such internal operations are performed with the help of fully digital angiograph, which is controlled by X-rays, helping to diagnose various cardiovascular diseases. The team of doctors watches the operation on a 56-inch screen. Blood vessels and heart chambers will, at decisive moments, be visible by injections of contrast medium, with iodine and impenetrable for X-rays, into heart cavities.

Toomas Hermlin explained that, at the start of the procedure, a special wire is placed into a branch of pulmonary artery, like a railway rail, upon which he, the surgeon, rides with his instruments. Also by that wire, the balloon catheter, covered by a long case, is taken to the needed location, with the valve to be implanted mounted on top of it.

Tense moments

Certain moments in operations always are of critical importance. Here, it was the ten seconds, during which the balloon at the top of the catheter was filled with a diluted solution of the contrast medium instances and, under pressure up to 10 atmospheres, the metal grid with valve was forced into its place. At that time, pulmonary artery received no blood and the patient’s blood pressure dropped so low that, for somebody who’s awake, it would have meant passing out.

«But as soon as the valve is in place, the balloon is quickly emptied and blood circulation is restored,» said Mr Hermlin.

In both cases, surgery took an hour and a half, plus preparatory work and giving the patient general anaesthesia. X-ray tube worked for 18 minutes in one and 20 minutes in the other case.

Toomas Hermlin, doctor at Tartu University Hospital’s radiology clinic, has for years worked with children’s congenial heart defects and sought for ways of curing them with minimum operating trauma.

The topic is complicated by Estonia’s smallness, wherefore the country lacks experts dealing with structural heart defects only. We are also lacking patients with complicated anatomy. And, the procedure is expensive, due to special instruments used and highly specific transplanted material – about €30,000.

Both lads left hospital the day after surgery, already. And, this week, they are enjoying spring holiday, full blast.

Comments
Copy
Top