2023-06-08 13:26:58
Life-saving surgery at the Bambino Gesù pediatric hospital in Rome on a young 21-year-old patient suffering from severe pulmonary stenosis, a serious malfunction of the pulmonary valve that regulates the exchange of blood and oxygen between the heart and lungs. The specialists of the Interventional Cardiology Unit evaluated the implantation of a new latest generation transcatheter device, already in use for some years in the United States but not yet authorized in Europe, for which the green light was required from the of the Ministry of Health for compassionate use. It’s the first time in Italy.
“It is a system (Alterra Adaptive Prestent) made up of two components – explain the doctors of the Bambino Gesù – The first is a self-expanding metal stent, which acts as a reducer of the diameter of the dilated right outflow. of ‘hourglass’ which provides the support base for the second component, a standard pulmonary valve.Thanks to this system it is possible to intervene endoscopically even in the case of dilation of the right outflow up to 42-44 millimeters, against 29 millimeters manageable with traditional transcatheter devices”.
“The pulmonary valve prostheses, moreover, being made of biological material, undergo a partial deterioration over time which requires their replacement. The ‘hourglass’ due to its metallic nature – the doctors remark – does not undergo the same process and allows a new valve to be hemodynamically inserted when necessary”. The patient is doing well and was discharged just 2 days after the procedure was performed. The full use of this new transcatheter device, when possible, will therefore make it possible to treat a wider range of patients with congenital heart disease who are now destined for the scalpel due to extensive dilatation of the right outflow.
“The possibility – says Gianfranco Butera, director of the Infant Jesus Interventional Cardiology Unit – of a procedure after which you can go home in 2-3 days, is an important result in terms of the experience of the patient who undergoes less physical and psychological stress than open heart surgery. And it also represents an advantage for the National Health Service due to the lower commitment of resources. Interventional cardiology is based on continuous technological evolution. Only to the Child Jesus will we be able to pass from a number of 25-30 patients a year to at least 45-50 Today, thanks to the authorization of the Ministry of Health, we are happy to have been able to respond to the need for treatment of one of our patients for whom waiting would have represented too high a risk.”
Why the choice of this new latest generation transcatheter device? “The girl’s condition, unable to sustain open heart surgery, made it necessary to resort to compassion. In a healthy heart, the pulmonary valve – located between the right ventricle and the pulmonary artery – opens for allow the blood to proceed towards the lungs to oxygenate and then closes, to prevent it from going back along the right outflow channel – explains the Child Jesus – In patients with some congenital heart disease (most cases of pulmonary stenosis or tetralogy of Fallot) this hinge function is compromised, resulting in a phenomenon of pulmonary regurgitation, a partial reflux of blood which can normally be resolved with the placement of pulmonary valve prostheses by means of open heart surgery or, when possible, endoscopically. In this way, the correct function of the heart is re-established”.
“Endoscopic implantation – preferable due to the lower physical and psychological stress caused to the patient – can be hindered or prevented by the irregular morphology of the right outflow, which can present excessive dilatation due to previous surgical interventions or other factors This is the case of the 21-year-old patient who was followed up at the Bambino Gesù from an early age for severe pulmonary stenosis: neither open-heart surgery nor that of traditional transcatheter valves were feasible for her”, conclude the specialists of the pediatric hospital of the Vatican.
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