Occlusion Device Fixes Hole in Heart

Surgeons have performed the world's first operation using a tiny umbrella-like device to mend a hole in the inner wall of a patient's heart.

The new technique could save the lives of many heart-attack patients who experience an acute myocardial rupture--where a hole appears in the ventricular septum dividing the right and the left heart chambers--and would otherwise die. The hole allows blood to flow from the high-pressure left chamber into the low-pressure right chamber, which can cause severe breathlessness and low blood pressure. There is also risk of multiple organ failure. Without immediate medical intervention, 95% of people with this condition suffer severe heart failure and die. Traditionally the only medical intervention, for those patients who are fit enough, has been open-heart surgery; but this carries a 50% mortality rate since the operation often leads to other holes appearing in the muscle.

The procedure was performed at King's College Hospital (London, UK) by cardiothoracic surgeon Dr. Olaf Wendler and interventional cardiologist Dr. Jonathan Hill. The patient was taken to an operating theater and put on a heart-lung machine to relieve pressure on his heart and circulate his blood during surgery. The surgeons first did a coronary bypass to restore the normal blood supply to the heart. Then, the occluder device, just over 10-mm long, was placed through a surgical incision in the right chamber. The surgeon was able to see the hole and guide the device through it. He then opened up two occluders on either side of the hole, which attached themselves to its edges.

"There was so little we could do for these patients. We thought the new device might work better than trying to patch it up,” said Dr. Wendler. "Open-heart surgery puts a big strain on the heart, and you are sewing a patch on to muscle that is very soft and has deteriorated. With this, the umbrella seals up the hole and doesn't put the muscle under new strain.”

The occlusion device used in this procedure has never before been used to treat an acute myocardial rupture during open surgery. Historically, it been used to treat children who are born with heart defects or patients with longer term (chronic) holes in the inner wall of the heart.



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