Successful application of hybrid technique in treatment of complex ventricular septal defect for youngest pediatric patient in Viet Duc University Hospital

01/10/2020 07:40

On the 17^th July 2020, Viet Duc University Hospital applied for the first time ever a Hybrid technique in the treatment of complex congenital heart defect for a 5 month-old patient diagnosed a serious ventricular septal defect on the muscular part associating with severe pulmonary arterial hypertension and was sponsored by “Trai tim cho em – Heart For You ” Program.

 

Since a little girl Ngo Bao T. was born on the late January 2020, she has been suffering from a long and severe pneumonia and doctors in Nghe An Pediatric and Obstetric Hospital found out a huge ventricular septal defect on the muscular part near the heart tip (10 – 12 mm) and not able to correct by conventional surgeries (open heart surgery) or catheter procedure (using mesh device). Additionally, her family was also very poor so after multiple consultations, she was transferred to Cardiovascular and Thoracic Center, Viet Duc University Hospital on early July 2020 for a treatment plan and having financial support from “Trai tim cho em” Program.

 

After performing all specialized tests, the last diagnosis of Viet Duc University Hospital’s doctors was a large ventricular septal defect on the muscular part with size of 10 mm, 2-way shunt, very low pressure difference, dilated left ventricle (Dd 31mm), compensated heart function (EF 64%), severe pulmonary arterial hypertension (70mmHg), large dilatation of the body and 2 branches of pulmonary arteries, malnutrition and undergrowth (4kg). Without any intervention to correct a ventricular septal defect immediately, her disease will soon become to the end stage. Unfortunately, it was impossible to be done by conventional open heart surgery because defect location was too difficult to access. Percutaneous intervention cannot be done also because it was challenging to put the device on to defect site and with high risk of severe vascular trauma in pediatric patient. After a careful consultation, the Cardiovascular and Thoracic Center made a brave choice of using Hybrid technique for the patient that was very challenging but the most complete solution. 

 

Hybrid technique in cardiovascular intervention was defined as the combination at the same time of 2 advanced techniques: “cardiovascular surgery” and “cardiovascular intervention” in management of very complex diseases that cannot be treated well with any separated technique. Viet Duc University Hospital is the first Vietnamese medical facility launching a cardiovascular Hybrid unit since 2012 with successful experience from hundreds cases of aortic or peripheral vascular diseases. However, for congenital heart defect, because of the pathological characteristics, chance of using Hybrid technique is quite rare. There are several major hospitals nationwide that performed few cases in older kids.

 

This Hybrid (surgery – intervention) technique was performed for the little girl Ngo Bao T. in the morning of the 17^th July 2020 at the Hybrid Operating Room of Cardiovascular and Thoracic Center, Viet Duc University Hospital. Under  general anesthesia, surgical team opened sternum, exposed the anterior surface of right ventricle and prepared the site to insert the device into the heart. Following that, intervention team conducted the catheterization into left ventricular chamber for the cardiography, direct catheterization onto the selected site at right ventricle, inserted the guided wire passing through the ventricular septal defect to left ventricle and up to the aorta, then closure device (the large type of 18x20mm) following the guided wire to the left ventricle and skillfully set the device’s wings one by one to completely close the ventricular septal defect. After carefully assessing the result by the cardiography and intra-thoracic echocardiography, all devices and guided wires were removed. Surgeons checked hemostasis and closed the sternum.

 

Due to her severe pulmonary arterial hypertension and malnutrition so post-operating care was quite hard. The intubation was removed on 7^th day and discharged 2 weeks after on the 6^th August 2020  and no extra cost for this. The re-examination after 10 days was with good result. The patient’s family was very happy and highly appreciated the Viet Duc University Hospital’s medical team and the sponsors for bringing the immeasurable joy to her family and the good quality of life for that girl.

 

According to Ass. Prof. NGUYEN Huu Uoc, MD., PhD., Director of Cardiovascular and Thoracic Center, Viet Duc University Hospital, this is the 2^nd Hybrid case in the treatment of congenital heart disease at Viet Duc University Hospital and the youngest one in Vietnam at the age of 5 months who benefits from this technique.