Posted on Jan 31,2018
For Audrina, who has successfully survived two open-heart surgeries and multiple cardiac procedures to repair a congenital heart defect, technological advances are a wonderful thing.
When it comes to medical technology, it actually is a lifetime.
When she needed another heart procedure to replace her pulmonary valve, Audrina, now 7, benefited from the advancements in patient-centered care in the Johns Hopkins All Children’s Heart Institute, which offers a simpler, safer and less invasive surgery: the Melody valve. That is key for Audrina, who will need to have the valve replaced every few years as she grows.
“The Melody valve allows replacement of a pulmonary valve through a vein in the groin—the femoral vein—or neck—the jugular—as opposed to another open-heart surgery,” explains Gary Stapleton, M.D., Audrina’s cardiologist.
Stapleton is the division chief of pediatric cardiology and medical director of the cardiac catheterization lab at Johns Hopkins All Children’s. He works closely on complex interventions such as the one performed on Audrina with pediatric interventional cardiologist Carrie Herbert, M.D., who has participated in roughly 20 of these procedures during her training. Herbert joined Johns Hopkins All Children’s in 2015 after completing her training in pediatric and interventional cardiology.
“Having Dr. Herbert join us out of training only enhanced our knowledge and expertise in newer and safer procedures,” Stapleton explains.
The procedure is much less invasive and usually only requires 23 hours of in-hospital observation as opposed to surgery, which typically requires a one-week stay in the cardiovascular intensive care unit (CVICU). The patients can also return to their normal activities within a week of the procedure as opposed to surgery, which requires up to eight weeks.
“Audrina has already had two open-heart surgeries, so by doing this procedure we were able to avoid a third open-heart surgery in the first six years of her life. With each open-heart surgery, there is increased risk of bleeding or damage to the heart due to significant scar tissue that builds up in the chest,” Stapleton explains.
Audrina’s parents were understandably thrilled to see the risk reduced.
“Because Dr. Stapleton and the Heart Institute added this innovative technology, it meant we didn’t have to go out of state to have this procedure done,” Audrina’s mom, Rachel, explains. “She is so active. She is living a normal life with ballet, gymnastics, tumbling…and it’s all because of the doctors here at Johns Hopkins All Children’s.”
“Audrina’s Melody valve is functioning beautifully with no residual stenosis or valve leak,” Stapleton reports. “The size of her right ventricle is now nearly normal. She has returned to all of her normal activities and her mother reports she is very lively.”
“We are constantly striving to find ways to perform procedures that are less invasive, safer, and require less time for recovery in our patients,” Herbert adds. “Adding new procedures like the Melody valve enhances our ability to do this, and keeps us on the forefront of being able to offer innovative procedures for our patients.”
Meanwhile, Audrina’s parents take comfort that she is receiving innovative, expert care every step of the way.
“I don’t think people realize how lucky we are to have such a wonderful hospital right here from minor things to major,” Rachel says.
About the Melody Valve Procedure
The surgery usually takes one to two hours with the patient under anesthesia:
- A catheter holding the valve is inserted, usually into a vein in the patient’s leg, and guided to the heart.
- When the Melody valve is in the right position, balloons are inflated to expand it into place so blood flows between the patient’s right ventricle and lungs.
- The catheter is removed.
- An X-ray technique known as fluoroscopy confirms that the valve functions properly.
- The access site is closed.