New replacement valve can help patients to avoid multiple open-heart surgeries

Congenital heart defects are the most common type of major birth defects in the U.S., affecting about 34,000 babies each year. Twenty percent of these patients are born with a malformation of the pulmonary valve, which is a flap-like opening on the right side of the heart that is responsible for regulating the blood flow to the lungs. Now, a new replacement valve being used at Rush University Medical Center can help patients with damaged heart valves delay or avoid multiple open-heart surgeries.

Rush is the first hospital in the region to offer the new, less invasive treatment option called the Melody Transcatheter Pulmonary valve, which has been used in Europe since 2000 and was recently approved by the FDA for use in the U.S.

Patients who are missing or have a narrowed pulmonary valve require multiple invasive, open-heart surgeries during their lifetime in order to implant a prosthetic conduit or tube to replace the missing or malformed pulmonary valve.

The conduits used to bridge the right ventricle to the pulmonary arteries may last only a decade, or in some cases, only a couple of years because the body outgrows the tubes and they become narrowed or leaky.

"With this new device, we are able to implant a heart valve using a small catheter inserted into a vein in the patient's leg without opening up the patient's chest," said Dr. Ziyad M. Hijazi, director of the Center for Congenital and Structural Heart Disease at Rush. "This procedure could revolutionize care for patients - saving them from multiple open heart surgeries and improving their quality of life."

Avoiding open-heart surgery is key to improving the quality of life of any patient with a congenital heart defect. Every time a patient has to undergo open-heart surgery, more and more scar tissue develops. The next time a surgeon has to go in to do the surgery it becomes riskier because there is so much scar tissue, which can make the surgery longer and more difficult. Also, there is considerable pain, morbidity and recovery time associated with open-heart surgery.

The Melody valve is a tissue valve that is sewn inside of a wire stent and crimped onto an angioplasty balloon on the end of the catheter. The catheter is inserted through a small incision in the leg and navigated through the blood vessels up into the heart. Once in place, the balloon is inflated and that deploys the valve.

The procedural success for the new valve replacement is over 95 percent and the vast majority of patients have minimal leakage and very minimal narrowing after the new valve is placed.

Alexander Williams, a 20-year-old congenital heart patient from Harvey, Ill., was the first patient to have a transcatheter valve replacement at Rush in July 2010.

"I had a few different conditions affecting my heart," said Williams.

Williams was born with transposition of the great arteries, which is a congenital heart defect in which the two major vessels that carry blood away from the heart -- the aorta and the pulmonary artery -- are switched. He also had pulmonary atresia, which is an extremely rare form of congenital heart disease in which the pulmonary valve does not form properly, and he also was diagnosed with a ventricular septal defect or a hole in the heart.

To correct the malformations, Williams had to undergo several open heart surgeries.

"When I found out I needed another valve replacement, I was so glad to hear that I could have an implantation that did not require me to undergo yet another open surgery," said Williams.

The procedure took only four-to-five hours and Williams was able to go home after a short, 24-hour stay in the ICU.

"This is a huge breakthrough," said Hijazi. "Patients can go home the next day and avoid the long recovery time and avoid the risk of surgery which requires opening up the patient's chest and stopping the patient's heart."