Heart surgery

Omaha’s Happy Procedure Helps Her Avoid Open Heart Surgery |


Stephanie Goans is probably one of the few people in Nebraska to be grateful for the pandemic.

Right before COVID-19 shuts everything down in March 2020, she was scheduled to undergo open heart surgery to install a pulmonary valve that would replace a faulty valve that surgeons removed when she was eight months old.

The procedure was postponed by the pandemic and later by Goans’ busy schedule as a single mother of two who works two jobs.






Dr. Jeff Delaney has an example of the Harmony Pulmonary Valve used in Stephanie Goans’ heart surgery. Delaney is a pediatric and adult congenital interventional cardiologist practicing at Nebraska Medical Center and Children’s Hospital & Medical Center.




Meanwhile, the Food and Drug Administration has approved a new type of pulmonary valve that can be threaded into a vein and into the heart via a catheter.

Unlike an earlier version of the valve, the newer can be used in more people born with pulmonary valve problems, including those like Goans who had surgery as a child and did not receive a valve replacement. at the time.

On September 15, Goans, 37, became the first from Nebraska to receive the new Harmony transcatheter lung valve during a procedure at Nebraska Medical Center.

Omaha’s mom spent a night in the hospital and returned home the following afternoon. The following Monday, she picked up her son from school and went to her daughter’s softball game as usual.

Typically, an open heart valve procedure requires a minimum of three to five days in the hospital and six to eight weeks of recovery at home.

“If I had had open heart surgery, I would still be done with the recovery,” Goans said. “I can’t lie down that long. I really can not.

Goans was among four patients, including two children, who received the new valve over the course of two days at the medical center and at the Children’s Hospital & Medical Center, said Dr Jeff Delaney, a pediatric and adult congenital interventional cardiologist who practices in the two hospitals. .






Jeff Delaney

Delaney


“The four valves we did over those two days were successful procedures,” he said. “Everyone went home the next day. (We have had) very good results.

The first catheter-able pulmonary valve was approved in 2011, Delaney said. But this valve, called Melody, comes in limited sizes and requires a uniform landing zone inside the heart where the valve will be implanted. Thus, it can only be used to treat up to about 20% of people born with problems with their right heart and pulmonary valve.

Now, about 80% of those with an irregularly shaped opening where the valve could be located are eligible for the new valve. This includes people like Goans who have had previous surgery.

“This opens the door for a lot of patients,” Delaney said. He noted, however, that some patients may still not be qualified based on their anatomy or their need for other surgical fixes. Doctors examined seven patients and accepted four to receive the Harmony valve.

The Harmony offers another benefit as well, he said. Now that it’s in place and provides an even landing zone, medics could place a Melody valve inside Goans’ Harmony valve when it eventually loses its function.






Heart 1

A team is working to place the first Harmony valves at the Nebraska Medical Center. They are, from left to right, Lauren Young; Dr Doff McElhinney, supervising physician; Lauren Bishop; Dr Chris Curzon; Dr Jeff Delaney; and Dr Nick Markin, in the background.




“No biological valve lasts a lifetime,” said Delaney. “They tend to last around 10 to 15 years.”

The valve itself is made of tissue from a pig that is attached to a flexible metal frame that opens once it is delivered through the catheter. The valves are sized to fit each recipient by medical device manufacturer Medtronic, based on the patient’s cardiac CT scan.

The pulmonary valve normally acts as a one-way door between the right ventricle, the pumping chamber of the heart, and the lungs. Blood travels from the right ventricle through the pulmonary valve to the pulmonary artery and then to the lungs, where it takes in oxygen to deliver it to the rest of the body.

Goans said her pulmonary valve at the time of her childhood surgery was the size of a pinhole. The blood has just flowed. Doctors told her parents that she might need another surgery.

Nonetheless, Goans was active as a child in Logan, Iowa, playing soccer and participating in a drill team, flags, and cheerleaders. She then gave birth to daughter Annabelle, now 15, and Wyatt, 10.

But the right side of his heart has grown larger over the years. Goans said his chest felt full and breathing was like sucking air through a filtered straw. She was tired all the time.

Delaney said it’s not uncommon to remove blocked valves in young children. Valves are usually not replaced immediately because children pass them so quickly, and most patients can tolerate some blood leaking through the valve.






Stéphanie Goans and the children

Goans, left, received a new pulmonary valve delivered through a catheter. A single mother of Annabelle, right, and Wyatt, Goans said she didn’t have time to lie down for the six to eight weeks it would take for open heart surgery.




Another reason to wait, if possible: Doctors don’t want to do more heart surgeries on a patient than they need. Every open heart operation creates scar tissue, Delaney said, and every time the breast is opened afterwards, the risk of complications increases. Doctors in particular do not want to have a third or fourth open heart surgery by the time patients reach the age where they also have other medical conditions that add to their risk.

“In Stéphanie’s case, if she had surgery when she was a child and then had this valve without surgery, we can start over when she is 40 with a catheter. … My God, the risk that we saved him in his lifetime is remarkable, ”said Delaney.

Nebraska Medical Center and Children’s are the only centers in Nebraska to implant the valve. Delaney’s partners, Drs. Chris Curzon and Rachel Taylor will eventually be certified to implant the valve. The team participated in all follow-up testing after the approval of the old Melody valve. For this reason, they were also selected by Medtronic to be one of 12 centers participating in the Harmony follow-up study.

Patients who receive the new valve, Delaney said, will be added to a registry, allowing researchers to study long-term valve function.

The new valve also adds to the growing share of less invasive cardiac catheter procedures available. Thirty years ago, the majority of catheter procedures were done to diagnose disease, Delaney said. Most of the treatments were performed in the operating room. Now that has reversed, with around 25% of cases involving diagnostic procedures.

Goans returned for a check-up in October. Her cardiologist told her that it looked like her heart had already shrunk. She will have another test in three to six months that will include how well her heart is handling stress. This will help her understand how hard she can push in the gym.

The biggest improvement, she said, was in her breathing, a change she noticed hours after surgery. She now wakes up rested after a night’s sleep rather than always exhausted.

“I was so happy they didn’t have to open up to me,” Goans said. “COVID is fearful, but in reality it was a blessing to me that my surgery was postponed. “