Joan Miró (17 years old) had a smile on her face when she learned, a few months ago, that she would be spared another open-heart surgery. With just a few days of life, he already underwent an operation to alleviate the congenital heart disease he suffers from (known as tetralogy of Fallot). Now, 17 years later, he had to face a second operation to change the pulmonary valve in his heart. But thanks to a new technique that has been used for the first time in Europe at the Vall d’Hebron hospital, the new valve was able to be implanted through a catheter, and the open heart surgery that would have been avoided meant, among other things, a large scar on his chest and a long recovery period. The day after the intervention, carried out in May, Joan left the hospital on her own.
The disease that this young man has is characterized by a narrowing of the exit from the heart to the lung (in the pulmonary valve and artery) which means that patients who suffer from it may have to undergo surgical treatment, even all from newborns As a result of these treatments, it is common for the pulmonary valve to stop working optimally and it is necessary, years later, to replace it.
The technology makes it easy for this device to be implanted by catheter, but a significant number of patients are not candidates for this operation due to the large dilation presented by the area that has been treated, which makes it impossible for the new valve, implanted via catheter , can be well anchored and stable. The new technique they have implemented in Vall d’Hebron, however, solves this problem. It does this by using a self-expanding stent (Alterra Adaptive Present) that works like an adapter, and thus overcomes the excess dilation.
Patients who, like Joan, suffer from this pathology experience pulmonary insufficiency. “This means that part of the blood that leaves the right side of the heart in the direction of the lungs returns to the heart,” explains Dr. Pedro Betrián, head of the pediatric hemodynamics unit at Vall d’Hebron who, with his team , Joan and a second patient (also 17 years old) intervened with this new technique, presented yesterday in society. “This means – he continues – that this organ has to manage a lot of blood volume, what it would receive under normal circumstances and what it returns, which causes the whole area to dilate”.
Joan, who will turn 18 in October and who attended the presentation ceremony, underwent this new procedure in May and was able to return home on his own two feet the day after the intervention. Even three weeks later, he appeared completely normal in the selection tests, which he ended up passing. He plans to start the Industrial Design degree in September.
He admits that he was “very happy” when he learned that a new open-heart operation could be spared. “I knew from a young age that at the age of 18 or so I would have to go through open heart surgery again. Such an intervention leaves a rather large scar and the recovery is long”, he says.
The difference regarding the recovery period between this new technique and open heart surgery “is very important”, emphasizes Betrián. “We do the whole procedure through a puncture in the femoral vein at the level of the groin. This allows the patient to walk home the day after the operation. If it is done with an open heart, he must be admitted for about ten days, adding the days of uci and plant”.
This new system will allow between 30% and 35% of patients with a pathology similar to Joan’s and who could not receive the new valve through a catheter (it is estimated that 50% of the total) can avoid open-heart intervention.
The Vall d’Hebron hospital was the first center in Europe to carry out this technique, which has been used for about five years in the United States. The center, as Betrián explained during the presentation, received a special permit for its use, and the fact is that the new mechanism does not yet have all the necessary permits approved in Europe.
Joan, after the intervention, leads a completely normal life. His pathology does not prevent him from doing anything. “His heart has a prosthesis, but it works perfectly normally”, argues Betrián. He can play sports, as he did before. Fortunately, his two sisters do not suffer from his congenital pathology.
