Physicians from SPbSPMU have applied a rare method of heart disease treatment
For the first time in the Northwest Federal District, endovascular surgeons performed a stenting of the right ventricular outflow tract on an infant.
A girl who had undergone this complicated procedure was born at the end of July in the Arkhangelsk region. A child was born prematurely: she weighed only 1290 grams. Doctors diagnosed the child with a group of cardiovascular abnormalities: the so-called Tetrology of Fallot.
This condition belongs to the list of cyanotic (in common — "blue") malformations. The patient suffers from hypoxemia — a lack of oxygen — which makes his skin and mucous membranes cyanotic.
The chances of surviving with this pathology without surgical intervention are not more than 50%.
— Normally, the ventricles of the heart and atriums should be isolated. And patients with Tetrology of Fallot have an interventricular septal defect — in other words, a hole through which blood not enriched with oxygen enters the aorta. In addition, there is stenosis (narrowing of the gap) in the right ventricle withdrawal section, which causes insufficient blood to enter the pulmonary artery, — explained Mikhail Komissarov, head of the X-ray Surgery Department of St. Petersburg State Medical University.
To date, there are effective methods for correcting this pathology. A radical surgical intervention is needed, during which cardiac surgeons close the septal defect with a patch. The most favourable age for long-term open-heart surgery is 3-6 months. In addition, the child must weigh at least 6 kg — otherwise the risk for the young patient will be too high.
This is why treatment usually takes place in two stages. The first step is to increase the flow of blood into the pulmonary artery so that the patient receives enough oxygen.
— A routine procedure in this situation is bypassing - a small tube is inserted into the pulmonary artery, which connects it to the beginning of the subclavian artery. In this way, a new arterial duct is formed. This is also a serious operation, although it does not involve connection to an artificial circulation machine. In our case, due to the small weight of the child, the consilium of doctors has chosen another method of treatment,— concluded Komissarov.
Firstly, the patient grew up to 2700 grams in the Perinatal Centre of the Arkhangelsk Regional Clinical Hospital and then was taken to St. Petersburg State Pediatric Medical University. Here, the girl was given a stenting of the right ventricle outlet.
— The catheter was led through the femoral vein to the pulmonary artery. Then the outlaw of the withdrawal section was enlarged with a cylinder and stents were installed. Stenting is a common procedure when it comes to coronary vessels, but is rarely done in this situation. Meanwhile, the first statistics show that this intervention is less invasive and safer for the patient,— added the head of the X-ray Surgery Department of St. Petersburg State Pediatric Medical University.
— With shunting, the mortality rate can reach 20-30%. A new alternative technology —stenting the right ventricular output department — significantly reduces risks. It is performed on children weighing from 1600 grams. This gives the child a chance to grow up so that they can undergo a radical correction,— said Andrei Nokhrin, Head of the Cardiosurgical Service of St. Petersburg State Pediatric Medical University. He also added that only a few dozens of such operations have been performed in Russia. In the North-West Federal District, this method was applied for the first time.
— We plan to put this technology on stream at the Pediatric University, — said Andrei Nokhrin.
Now the girl has already been discharged out of the hospital and stays at home. In four months, cardiac surgeons will perform a second operation: they will close the orifice in the intergastric septum and remove the stent.
A scientific article by Andrei Nokhrin and co-authors on the stage-by-stage treatment of the Tetrology of Fallot can be found by link