New heart surgery without cut to chest

INLSA

ON TOP OF THE WORLD: Gerhardus Prinsloo feels like going to gym a week after he underwent unique heart surgery. Picture: Moeletsi Mabe

ANNA BISARO

anna.bisaro@inl.co.za

It was heart surgery without ever having to cut open his chest.

Gerhardus Prinsloo, 65, underwent a life-saving procedure on May 24 – the first of this type of procedure to be done by a team of SA private sector doctors.

“I wasn’t really worried about the procedure,” Prinsloo said. “I’m a religious man and in my mind said ‘well, God is going to take care of me one way or the other’.”

A team at Netcare Union Hospital in Alberton closed a 4mm life-threatening, leaking hole in his heart using a catheter, wires and 3D real-time trans-oesophageal imaging.

By puncturing a small hole in the groin, the wires carrying the plug for the hole entered the 4- to 5cm-wide blood vessels and eventually made their way with a small plug to the hole in Prinsloo’s heart.

The winged plug is delivered by the catheter and becomes a part of the heart as the tissue eventually grows over it. An alternative to this procedure is open-heart surgery.

The trans-oesophageal imaging makes this hour-and-a-half-long procedure groundbreaking as doctors used to rely on X-rays to try to blindly close leaking valves.

“It used to be like trying to thread a needle, but you could not see the hole,” cardiologist Dr Chris Zambakides said.

X-rays show only iron and nickel. they could not provide doctors with images of tissue, where the hole actually is, he said.

“Originally, success rates in repairing such leaks were very low, but now, with newer catheters and wires available, live 3D TEE (3D trans-oesophageal echocardiography) and the team approach to procedures, outcomes have improved considerably. We are seeing success rates of up to 90 percent being achieved around the world,” Zambakides said.

Prinsloo’s paravascular leak, which allowed too much blood to enter the left chamber of the heart, developed as a result of a valve-replacement operation he had in 1999.

Zambakides, who performed the procedure, said scar tissue from the previous open-heart surgery could complicate a second one. It is also risky to open up for surgery when the patient is experiencing heart failure, as Prinsloo was at the time of the procedure.

After the procedure, Prinsloo felt well enough to drive himself home from the hospital a day-and-a-half later.

Prinsloo first knew there was a problem almost two months ago when he starting having irregular heartbeats and experiencing shortness of breath – some warning signs of heart failure.

Tests confirmed the leaking valve, and his physician referred him to Zambakides.

The first time a successful paravalvular closure was done in SA was the middle of last year at Chris Hani Baragwanath Academic Hospital by a team of foreign doctors. The procedure has been performed at Sunninghill Hospital in Sandton for teaching purposes, again by overseas doctors.

Between 3 and 6 percent of patients who have diseased heart valves replaced will develop a leak between the artificial valve and surrounding tissue.

Now that the procedure has been successfully completed, Zambakides has high hopes for the future.

“Now that we know that we can do it, the plan is to develop centres. You need the team approach, the technology and the expertise.”

A little more than a week later, Prinsloo said he feels like he should go back to the gym, but will wait at least another two weeks.

“i actually feel perfect. I’m feeling on top of the world,” he said.