Minimally Invasive Surgery puts teen back in the game

Fourteen-year-old Rebecca Hemm of Moline, Ill., was born with pulmonary valve stenosis but, in many ways, she is one of the lucky ones. Babies born with heart problems often need life-saving surgery soon after they are born. Happily, she didn’t need open-heart surgery to replace the valve until she was 4 years old.

In 2011, Rebecca was among the first to receive a Melody Transcatheter Pulmonary Valve at University of Iowa Stead Family Children’s Hospital, the only site in Iowa to offer this minimally invasive option. The Melody Valve offers children and adults with a failing pulmonary valve conduit an option for treatment without additional open-heart surgery.

Rebecca’s cardiologist, Abhay Divekar, MD, clinical associate professor of pediatrics, says, "The Melody Valve is not a substitute for surgery, but it prevents or delays the next operation, and helps reduce the number of surgeries over a lifetime."

In the one- to two-hour procedure, which is performed in the cardiac catheterization suite, a cardiologist inserts a specially designed heart valve via a catheter into a vein in the leg and guides it to the heart. The valve is attached to a stent that expands with the help of a balloon to push the blocked pulmonary conduit open. The heart valve prevents blood from leaking back into the ventricle or pumping chamber.

Previously, these patients would have had a stent put in, but without a valve, blood often leaks back into the ventricle.

Patients are asleep for the procedure. Unlike open-heart surgery, with its week-long hospitalization, a patient usually goes home the next day.

Rebecca’s first surgery at age 4 to replace her pulmonary valve was performed in the Hemms’ hometown of Bern, Switzerland. "Even before her first surgery, she seemed fine," says her mother, Monika, recalling how relieved she and Rebecca’s father, Arthur, were. But by the time she was 4, "tests showed that blood wasn’t getting pumped through to her lungs."

Rebecca came through the initial operation very well, but the prospect of another open-heart surgery was a concern. "It’s so hard to watch your own child go through major surgery," says Monika.

When the family moved to the United States in 2007, her parents brought her to the outreach clinic in Genesis Heart Institute in Davenport to be followed by UI Stead Family Children’s Hospital pediatric cardiologists.

Rebecca didn’t need any additional procedures until 2010, when UI doctors were performed balloon angioplasty to break up calcification on the valve.

By fall 2011, when it was clear that it was time to operate on her valve again, the Melody Valve was offered as an option for the first time. Monika Hemm says she’s glad her daughter received the minimally invasive procedure. Rebecca went home the next day and was back at school two days after that. "It was a very good experience," says Monika.

"The whole thing went very quickly and was such a change from her surgery in 2003," says Monika. "This time, she was in the recovery room for about half an hour and came up to her room right after that. She got up out of bed that night and we took her home the next day."

Divekar adds, "Rebecca was a great candidate and we’re happy the procedure prevented and delayed the next operation."

In Rebecca’s case, instead of needing several surgeries over her lifetime, she might just need one or two.

Candidates for the Melody Valve must have a previously placed surgical conduit that contains a tube or valve. Patients can be adults or children but must weigh over 60 pounds.

Today, life is back to normal for the 8th-grader at John Deere Middle School in Moline, Ill., where Rebecca played tennis on her school team last fall and sings in the choir. She enjoys spending time with her older sister, Cynthia, and younger sister, Tina.