Treatment of cardiac lesions without anaesthesic

Mar 23 2005

Navarre University Hospital has introduced a novel technique for the treatment of congenital heart defects and involving the percutaneous closure of the patent foramen ovale (PFO) with monitoring through intracavernous ecography.

PFO is a defect of the interauricular septum (partition or wall separating the two auricles) and that allows blood clots or thrombi to pass from the right auricle to the left. In most cases this opening closes after the baby is born but, on occasions, it stays open and, subsequently, clots can pass from the right auricle (venous) to the left (arterial) and give rise to a heart attack or to a transitory ischaemic attack. It is advisable, in those patients who have suffered a cerebral embolic stroke, the origin of which is suspected and shown to have arisen from this cause, that this opening or foramen be closed,otherwise the risk of another, more serious, embolism increases.

Although the treatment of septal defects at an auricular or ventricular level traditionally requires open surgery, for a number of years now POF and interauricular communication has been able to be treated percutaneously by means of a special device. This procedure is carried out at the Haemodynamics Unit with angiographic techniques.

This involves inserting a device within a catheter into the interior of the heart and which spreads out like an umbrella inside the right and left auricle. Once the right location has been identified, the device is released and the connecting cable is extracted by unscrewing from the outside. In this way, the system is implanted into the heart. The monitoring of the process at all times is carried out by transesophageal ecography, requiring the patient to be anaesthesised and the presence of an ecographer and anaestheticians.

The novelty incorporated by the Cardiology Intervention Unit is the undertaking of the monitoring procedure using intracardiac ultrasound equipment. This technique, developed in Spain at the Gregorio Marañón Hospital in Madrid and currently only used in two hospitals, significantly simplifies the medical treatment. Thus, a catheter introduced into the heart without need of an anaesthetic is used, significantly reducing the length of the operation (less than thirty minutes), as well as the risks and complications arising from the transesophageal ecography and the general anaesthetic. In this way, it is much more convenient for the patients, as they are conscious during the operation, and their recovery is quicker; in fact, they can be released the same day, thus giving rise to considerable savings in health costs.

There are a number of methods used in the percutaneous treatment of congenital cardiac defects. Specifically, a number of years ago, the Cardiological Intervention Unit incorporated the “Amplatzer” occluder system for closure of patent ductus (congenital communication between the aorta and the pulmonary artery). This involves a very simple procedure undertaken with angiographic techniques, i.e. no ecographer or anaestheticians are required.

Nevertheless, the most novel thing about this intercavity application is its treatment of the patent foramen ovale. It is estimated that up to 20% of the public have PFO, although not all need or are suitable for treatment. This is why we await some symptom as there are no studies indication which PFOs should be closed or not if there have been no previous symptoms. The cases has to be selected with precision, involving co-ordination between neurologists and cardiologists in order to confirm that a “contrasted” event has arisen with this level of PFO. In this sense, great attention ahs to paid to those at particular risk, such as divers, given that the presence of this defect can cause serious problems for practicing this activity.

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