SickKids first hospital in North America to replace a pulmonary valve without performing open-heart surgery

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SickKids is the first hospital in North America to use a catheter to replace a pulmonary valve, eliminating the need for open-heart surgery in patients with heart valve disease. This innovative procedure is a significant step for SickKids in reducing multiple open-heart surgeries, prolonged hospital stays and long recovery periods for children with congenital heart defects.

In October 2005, SickKids performed the first transcatheter pulmonary valve implant in a child who required the replacement of their pulmonary valve, which allows blood to flow from the heart to the lungs. The implant is a metal stent with a valve sewn inside. Through a small incision in the child’s leg, the stent is inserted through a vein into the heart using a catheter, a thin flexible tube, to replace the valve.

The non-invasive procedure, performed in the cardiac catheterization lab, takes 90 minutes. Patients are only required to stay in hospital overnight, rather than undergoing a six-hour open-heart surgery and a week’s hospitalization normally experienced after major cardiac surgery. Patients recover at home and are back to their regular routine after a couple of days.

“This procedure will transform the way we treat patients with heart valve disease and allow us to reduce the amount of highly invasive procedures that children normally endure,” says Dr. Lee Benson, who performed the transcatheter pulmonary valve implant and is head of the Cardiovascular Diagnostic and Interventional Unit at SickKids. “In future, adults may be able to undergo the same procedure and experience the same benefits.”

Congenital heart defects occur in one out of every 100 babies born each year and more than 20 per cent of defects involve the pulmonary valve. When defective, the pulmonary valve cannot properly regulate blood flow to the lungs and can cause breathing problems, fatigue, cyanosis and can lead to heart failure. Treatment often involves several highly invasive surgeries to replace the valve with artificial mechanical or tissue valves.

SickKids Heart Centre has the largest paediatric interventional catheterization program in Canada and is a leader in Ontario for innovative procedures to treat complex cardiac conditions in children. It conducts approximately 90 per cent of cardiac catheterization procedures for Ontario children, with 1,000 catheterizations performed last year.

Cardiac catheterization is a procedure in which a catheter is passed into the heart and its surrounding blood vessels through a small incision in the neck, arm or groin while a patient is under general anaesthesia. By inserting special catheters through a vein or artery, holes in the heart can be closed, narrowed valves and arteries can be opened, and abnormal electrical pathways that cause palpitations can be repaired. Most children can go home within 24 hours after the procedure with nothing more than a small bandage on their leg.

In 2007, SickKids is scheduled to open a new state-of-the-art Cardiac Diagnostic and Interventional Unit that will be used to diagnose and treat children with congenital heart disease. The 18,000 square-foot unit will include two catheterization labs, an integrated MRI, a post-anaesthetic recovery area and new systems for storing clinical and research information.