New Jersey's First Hybrid Procedure to Correct Congenital Heart Defects Performed
at Children's Hospital of New Jersey

Pediatric cardiac specialists at Children’s Hospital of New Jersey at Newark Beth Israel Medical Center are the first in the state to perform an advanced hybrid procedure to correct two congenital heart defects in a newborn infant - ventricular septal defect (VSD) and severe long segment coarctation of the aorta. Hybrid procedures combine catheter-based and surgical techniques to treat increasingly complex congenital heart malformations while minimizing the risks of cardiopulmonary bypass.

The pediatric cardiac team at Children’s Hospital was the first in New Jersey to close a VSD with the new FDA-approved Amplatzer Muscular Ventricular Septal Defect Occluder in January 2008. The hybrid procedure performed earlier this month is yet another first in New Jersey, combining catheter and surgical techniques to close a large hole between the lower heart chambers (VSD) and relieve a critical obstruction in the major artery from the heart to the body (coarctation of the aorta).

After a normal pregnancy and the birth of her baby daughter, Virginia Matas of Bloomfield believed that she and her husband were bringing home a healthy infant. After a few days Ms. Matas noticed that Sadira’s appetite was decreasing, then the baby began having episodes of rapid breathing and sweating. “I know newborns can be fussy and work themselves up but, something just didn’t feel right,” said Ms. Matas explaining why she took Sadira to the Emergency Department on the sixth day. “I am still shocked when I think about how close we came to losing her.”

From the Emergency Department at Saint Barnabas Medical Center in Livingston, Sadira was transferred to Children’s Hospital of New Jersey, both affiliates of the Saint Barnabas Health Care System, where Rajiv Verma, MD, Director of Cardiac Catheterization and Interventional Cardiology, and Joanne Starr, MD, Surgical Director of the Children’s Heart Center, determined that she was a candidate for an innovative hybrid procedure that would patch the VSD and relieve the obstruction in the aorta.

 “Traditionally these two heart defects are addressed in one major open heart surgical procedure, or in two sequential procedures. The risks are often quite substantial,” explains Dr. Verma. With the new medical device, state-of-the-art imaging technology and surgical advances, both of Sadira’s heart defects were corrected in one trip to the operating room - and one was completed without even stopping her heart.

With the interdisciplinary pediatric cardiac team in the operating room, Dr. Starr opened Sadira’s tiny chest to reveal her heart. Then, with her heart still beating, Dr. Starr made a small puncture through the heart wall through which Dr. Verma threaded a soft guide wire and catheter. Guided by sophisticated transesophageal echocardiography that was monitored by Stanley Einzig, MD, PhD, Director of Pediatric and Fetal Echocardiography, Dr. Verma threaded the tiny wire mesh and polyester patch into position, deployed the device and extracted the catheter. The Amplatzer Muscular Ventricular Septal Defect Occluder is a permanent implant that becomes a part of the heart wall.

Next, Sadira was placed on cardiopulmonary bypass so Dr. Starr could proceed with delicate surgery to enlarge the diameter of the narrowed aorta that was restricting blood flow to the lower half of her body.

Sadira went home several days after the procedure and continues to do well. She will require regular follow-up to ensure that she does not develop a recurrent coarctation or additional heart problems. “We did not know this extraordinary care was available so close to home until we needed it,” said Ms. Matas.

The Children’s Heart Center consists of nationally and internationally respected pediatric cardiologists and cardiothoracic surgeons, as well as experienced cardiac intensivists, cardiothoracic anesthesiologists, clinical nurse specialists, social workers and child life specialists. The entire team is based at the Children’s Heart Center and is available 24 hours a day. The coordinated pediatric transport service brings critically ill children from across the state to Children’s Hospital of New Jersey for the most sophisticated care.

DATE: March 19, 2008

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