Last updated at 3:39 AM on 1st November 2011
Thousands of Britons have open heart surgery each year for heart defects, such as valve problems or a hole in the heart.
Micki Garvey, 56, an adult education manager from Queen’s Park, London, underwent a less invasive procedure.
THE PATIENT
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| 'Mine was a particularly rare form, but it hadn't ever caused me any problems before,' said Micki Garvey of her hole in the heart |
Sitting in a meeting in November 2009, I suddenly had severe chest pains and couldn’t breathe properly.
Colleagues called an ambulance, which took me to hospital; they kept me in overnight while my breathing returned to normal.
It was terrifying for my son Tuli, then 16, because his father died in hospital a few years earlier.
The doctors weren’t sure what had caused the problem, but I knew I was born with an atrial septal defect — a hole in the heart — which was diagnosed when I was 19 and experienced chest pains.
Around a quarter of all people have a hole in their heart, but don’t know it. Mine was a particularly rare form, but it hadn’t ever caused me any problems before, and even after this second episode, doctors said I didn’t need anything done.
However, I was referred to Hammersmith Hospital in London, and in the months before my first appointment in July last year, I started feeling exhausted. My job is physically demanding, and I work over 50 hours a week: I’d always coped with it, until then.
At Hammersmith two weeks later the doctors did more tests and explained a hole can cause blood to travel straight from one side of the heart to the other, rather than through the lungs. It was likely to cause more problems as I got older, because of the extra strain on my heart.
I was also at risk of a stroke, because a blood clot could reach my brain instead of being filtered out in the lungs, and they said I really needed something done.
In August I had an operation where the surgeons fed a device like a tiny umbrella up through my veins to close up that hole.
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| Camera technology means surgeons can see the heart in 3D, and treat even larger holes with keyhole techniques |
Worse still, I’d now have to have open heart surgery, to fix a patch over the hole. It needed a recovery of up to three months as the breastbone which was broken for the operation healed, and risks including stroke, bleeding, infection and respiratory failure — and a one per cent risk of death.
But just before the operation I saw a surgeon at Hammersmith called Marco Solinas who told me about a new procedure where they could make just a 5cm incision in between my ribs and use a tiny camera to look at my heart in 3D colour, and fix the patch on. I’d recover in a few weeks, the risks were less, and I’d have much smaller scars.
I had the operation in September last year. I needed powerful painkillers for the first two weeks, but I was hobbling around after three days, and went home on the fifth day.
Five weeks after surgery, I was back at work part-time, since the scars under my right breast and under my arms were healing nicely.
I feel so much better — the exhaustion has gone, I’m back to my full-time job, and out of danger.
THE SURGEON
Marco Solinas is senior lecturer at Imperial College London and visiting consultant at Hammersmith Hospital. He says:
Any defect of the heart such as a hole or heart valve failure used to result in open heart surgery, which meant breaking the breastbone and an incision of up to 30cm.
Atrial septal defect is one of the most common congenital heart defects, affecting one in 1,500 newborns. For some reason the septum, the wall of tissue which divides the two upper chambers of the heart, fails to develop properly.
Normally, blood travels out the right side of the heart, through the lungs, which filter out any debris and clots, before it goes back to the heart on the left side.
However, with atrial septal defect, the hole allows blood to travel straight from the right to the left side, short-circuiting the lungs. Blood clots can get to the brain, giving patients a high stroke risk.
These abnormal holes can be up to 2cm wide and 6cm long, as big as a thumb. If we don’t treat them by the time patients are in their 30s or 40s, the abnormal blood flow through the hole can damage the lower chamber of the heart, which can enlarge and eventually cause heart failure.
Untreated patients have an average life expectancy of just 50.
Over the past two decades, we’ve developed minimally invasive techniques for this — cardiologists can slide an umbrella-like device up through the veins to close the hole. But this can fail, sometimes because the hole is too big, meaning we’ve had no choice but to do a full sternotomy — opening the breastbone to fix a patch on to the hole.
But the latest camera technology means we can see the heart in 3D, and treat even larger holes with keyhole techniques.
This is now being done at just a few UK centres, but could help thousands of patients — not only those with atrial septal defect, but also with valve problems (6,000 Britons have surgery for this every year), and also some forms of persistent atrial fibrillation — an irregular heartbeat.
The new technique is less traumatic and painful for patients, because we don’t need to break the breastbone. And patients have a far smaller scar which in women can be hidden under a breast.
They stay in hospital for just five or six days, instead of ten to 12, and can even go back to work in two to three weeks instead of up to three months when bone needs to heal.
The operation takes around three hours. With the patient under general anaesthetic, I make an incision in the right side of the groin and feed a flexible tube up to the heart and connect the patient to the heart-lung machine, which will pump oxygenated blood back into the body through another tube in the left side.
Then I make a 5cm incision in the right hand side of the chest between the ribs, and use an expander to part the ribs (without breaking them) and expose the heart. I make an incision in the heart wall and introduce a camera into the heart through a port or valve in the chest which will give us a 360-degree view of the heart on a monitor.
Using the camera images to guide me, I sew a special polymer patch slightly bigger than the defect over the hole — within two months, tissue will grow over this.
We make sure the heart is working properly again and disconnect it from the heart-lung machine. Chest drains are left in place for a day or so to take away any fluids.
While cardiac surgery is a wonderful thing because it saves so many lives, this new technique is exciting and so much better for patients because it leaves less scarring, carries fewer risks and has a far shorter recovery.
The operation costs around £12,000 privately or to the NHS.
http://www.dailymail.co.uk/health/article-2055871/How-sticking-camera-ribs-save-open-heart-surgery.html
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