A cardiologist at an Israeli hospital performed what the hospital is calling a “first in the world” heart procedure this week by plugging a bleeding hole in the artery of a 29-year-old patient using a device that is usually used to unblock arteries.
The procedure was performed by Prof. Victor Guetta, director of the Invasive and Interventional Cardiology Unit, and his team at the Sheba Medical Center in Ramat Gan after the patient walked into the hospital with an aneurysm in the left ventricle region of his heart that had ruptured and was bleeding into his chest cavity.
An aneurysm occurs when part of the wall of an artery weakens, allowing it to balloon out or widen abnormally. If it remains unruptured, doctors and patients need to closely monitor the condition. Some conditions may require surgery to reinforce the artery wall with a stent. However, if the aneurysm ruptures, the patient could develop sudden symptoms like pain, rapid heart rate, shock and low blood pressure. The condition is life-threatening and requires immediate attention.
The patient in question had already undergone several heart procedures for chronic cardiological problems. In the last two months he had been suffering from shortness of breath and when he got to hospital, after undergoing tests, the medical staff informed him that he had a rip in the heart ventricle that was leaking blood.
The standard option for treating the patient would have been open heart surgery, a procedure that is invasive, takes a number of hours and entails the risk of chest wound infections, a heart attack or stroke, blood clots, and lung and kidney failure. Recovery is slow, with patients emerging from anesthesia with two or three tubes in their chest to drain the fluids around the heart, and a hospital stay of a week to 10 days.
Guetta, however, thought there could be a better way, and the patient agreed to let him try it, though it had never been done before. The team of doctors accessed the heart using a standard catheterization procedure, inserting a straw-sized tube into a large blood vessel and making their way to the heart. Once there, they plugged the hole using an Amplatzer Ventricular Septal Defect (VSD) occluder, which is a self-expanding, double-disc device made from wire mesh.
The device is often used in standard cardiac catheterization procedures, like angioplasty, to open blocked arteries, but had never before been used to plug an arterial hole.
“This unique procedure has never been done before anywhere else. I was able to plug the patient’s hole or bleeding area using this device,” said Guetta in an emailed statement. “Within two days of the procedure, the patient went home. And his prognosis is good.”
Prof. Chaim Lotan, director of the Heart Institute at Hadassah Medical Center, said he “congratulates his fellow colleagues on a beautiful case.” He noted that the procedure is already used to close holes in other parts of the heart — to deal with ventricular or arterial septal defects, for example — but had never been used as it was in the case of the 29-year old patient.
It was a rare case of a patient who had undergone many other heart procedures and thus treatment necessitated taking an alternative path, he said. In any other case the best treatment would have been to fix the hole through surgery, he added. “They solved it in an elegant way.”