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Fixing holes in the heart, minus the open heart surgery

POSTED: February 11, 2008 5:02 a.m.

Cardiologist Dr. Christopher Leach recently performed a new procedure allowing the closing of a hole in a patient's heart without using open-heart surgery. Because the procedure is much less invasive than heart surgery, the patient is up and walking around in less than a day.

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The concept of angioplasty seems amazing. A doctor opens a clogged heart vessel by threading a catheter through an artery in the groin.

Now, imagine using the same technique to repair a hole in the heart — something that previously could only be done through open-heart surgery.

On Jan. 10, cardiologist Dr. Christopher Leach was the first to perform this procedure in Gainesville, inside one of the cardiac catheterization labs at Northeast Georgia Medical Center.

He corrected a condition known as atrial septal defect, using the catheter to insert a mesh plug over the hole in a patient’s heart.

"The device is made of a nickel-titanium alloy that retains its shape, and the lining of the heart actually grows over the mesh," said Leach.

Patients recover from the procedure very quickly, he said.

"We just use light sedation, and you’re up and walking around by evening," he said. "With surgery, you’d be doing it with a thoracotomy (cutting open the chest) and with general anesthesia. Most people have to stay in the hospital for several days."

Leach, who came to Gainesville in August, learned the technique while he was serving his residency and fellowship at Washington University in St. Louis. He said he has performed the procedure about 60 times.

"Theoretically, there are potential complications that would result in having an open procedure (requiring transfer to an operating room)," he said. "But we reviewed 400 cases and never found an instance when that happened."

He said catheter-based techniques will never replace open-heart surgery for complex problems such as multiple coronary blockages.

"But interventional cardiology is just now getting into structural problems within the heart, rather than inside the vessels," he said.

Atrial septal defect was an ideal candidate for this type of procedure. It’s an abnormal opening between the two upper chambers of the heart, causing fresh blood to flow from the left side of the heart back into the right side.

"The right side is not designed to handle that much volume," Leach said. "(This) is a defect that’s there from birth, and it can be benign if the hole is very small. Symptoms often don’t present until the patient is in their 30s or 40s. But it can (ultimately) result in heart failure."

Atrial septal defect can also cause atrial fibrillation, an irregular heart rhythm. And it can put the patient at risk for a stroke.

There are different types of atrial septal defect, and not every patient is a candidate for the new procedure. But Leach said about 70 percent of cases can be treated with the catheter technique.

Daniel Tarte, cath lab manager at Northeast Georgia Medical Center, believes this procedure will one day become the preferred method of treatment for Atrial septal defect and similar defects.

"It’s much less invasive (than surgery) and easier on the patient," he said.

Tarte said the procedure takes 90 minutes to two hours, compared to three or four hours for open-heart surgery. When atrial septal defect patients are told there is a nonsurgical option, he said, most are eager to try it.

"These patients tend to be younger than the patients with coronary artery disease. They’re usually in their 20s, 30s or 40s," Tarte said. "Most of them prefer not to have their chests cracked for this."

Leach said in the past, Georgia patients who needed the procedure were usually sent to Emory University’s hospital in Atlanta.

"Our patients here have been very excited about being able to do it here in Gainesville," he said.


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