UI cardiologists perform first-in-the-state procedure to save Iowa grandma’s heart
Using 3D models and virtual reality technology–pediatric cardiologists at University of Iowa Stead Family Children’s Hospital were able to complete a successful first-in-the-state, innovative heart procedure, helping a 67-year-old grandmother avoid open-heart surgery.
Surgery not an option
Maria Andrade, of Kalona, was diagnosed with sinus venosus atrial septal defect (SVASD) when she was evaluated by Osamah Aldoss, MD, a pediatric cardiologist and medical director of the cardiac catheterization laboratory, at the Adult Congenital Heart Disease clinic in September 2022. SVASD is a rare defect of the heart, which over time caused increased blood to the right side of her heart and flooded the lungs. Though the condition is a congenital heart defect–it was present at birth – Maria wasn’t fully affected by it until late 2022, when she noticed difficulty catching her breath while out on her daily walks.
“I could feel the palpitations in my heart, it would change the way I would breathe,” she says. “It was happening more and more frequently when I was walking, but also when I was working around the house.”
“With this condition, there is a hole between the two receiving chambers of the heart along with abnormal connection of a pulmonary vein and until recently it almost always needed a surgical repair to correct it” says Ravi Ashwath, MD, a pediatric cardiologist and medical director of Imaging at the hospital. “Not only is there the hole that requires surgery, but there is also an abnormal vein that comes back from the lung that needs to be routed to the correct chamber. It makes this a complicated procedure, so open-heart surgery has always been preferred.”
Because of her underlying health history–coronary heart disease, stroke, and cancer – surgery was a very risky option. Therefore, the team start exploring other methods to correct her defect in a less invasive way, says Aldoss.
Instead of open-heart surgery, they would repair Andrade’s SVASD using a transcatheter procedure in the catheterization lab, correcting the defect by going through blood vessels. This method required a lot of collaboration and planning, Aldoss says. This treatment was the first time to be performed in Iowa, and very few health care teams across the country have the experience.
Intercontinental collaboration
In November 2022 Ashwath and Aldoss reached out to the congenital cardiology team in the United Kingdom who had experience with this type of procedure.
“We collaborated on the imaging and knowing what we were looking at and were able to get a better idea of where this was going,” Aldoss says.
The teams–one at UI Stead Family Children’s Hospital and the other in the United Kingdom–worked together through virtual reality technology and with the use of the 3D heart to determine how best to approach the transcatheter procedure.
Ashwath, director of Non-Invasive Imaging and Cardiac MRI, did advanced imaging to more closely define where exactly the hole was located and the relationship of the abnormal vein. The imaging helped the team create a 3D model of Maria’s heart to help them better visualize the defect in physical form.
Aldoss and his catheterization team performed bench testing on the 3D model to evaluate the procedure and make sure the procedure is doable.
Maria’s procedure was done on Dec. 21, 2022, and she was able to go home the next day.
“When she first came to us she clearly had heart failure symptoms from this defect,” says Aldoss. “Now the heart doesn’t have to work nearly as hard, and she’s feeling much better.”
In addition to a longer hospital stay, open-heart surgery with comorbidities would have come with some restrictions for recovery, such as no heavy lifting for six weeks. For Maria, that would have been devastating.
“We had one grandson that I was taking care of and another on the way,” she says. “I’m so glad I was able to continue taking care of the babies.”
Now, she says, she’s back walking every day, taking care of her grandsons, and is able to move around her home freely without running out of breath.
“It’s incredible they were able to make me feel so much better without the surgery,” she says. “I’m very grateful for such a wonderful team.”
Maria is also grateful for another part of her care team – the hospital’s interpreting team. Maria is primarily Spanish-speaking so she relied on hospital interpreters to communicate with her surgical team.
“Everyone has been so wonderful here,” Maria says.
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