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Bridging the Gap


Dr Kavarana in surgery

MUSC heart failure team uses new approach to help young patients

As the organ responsible for taking blood from the body and enriching it with oxygen before recirculating it, the heart provides a vital function. Any problem with the muscles involved could deprive the body of the circulating blood, and therefore oxygen, that it needs to carry on.

The right side of the heart, known as the right ventricle, sends blood to the lungs while the left side, or the left ventricle, supplies blood to the rest of the body. In left-sided heart failure, or left ventricular dysfunction (LVD), the left pump cannot keep up with the body’s demands.

Heart failure in general, and especially LVD, has been widely studied and treated in adults but not in children. “Most young patients with congestive heart failure will likely need a heart transplant,” said Minoo Kavarana, a pediatric cardiothoracic surgeon at MUSC Children’s Health.

But after hearing about a new procedure in Germany, Kavarana talked with the rest of the team about bringing it to the Southeast.

The average child on the heart transplant list waits two to six months for a new heart, and many are too sick to wait that long. In the past, surgeons have used assist devices to help the heart pump blood more effectively and give the child more time; however, implanting these devices can lead to complications, which led the heart failure team at MUSC to look into a new procedure: reversible pulmonary artery banding (PAB).

As one of the first centers in the Southeast to offer the procedure, MUSC brings a new treatment option to parents. By placing a band around the vessel which carries blood from the right side of the heart to the lungs, surgeons can increase the pressure in the artery. The band causes the partition between the right and left sides of the heart, the ventricular septum, to change its orientation towards the left, giving more support to that side of the heart.

This pressure change may allow the physician to wean these children off both the ventilator and medications they were using, and in some cases, they can even send them home. The key to the procedure’s success, however, is the patient’s type of heart failure. If the child’s condition also affects the right side of the heart, PAB will not work.

While the procedure has only been performed a few times at MUSC for children with LVD, some have recovered and are no longer on the transplant list, and others have used the pulmonary artery band in place of assist devices while waiting for a transplant to become available.

“We like to think of this procedure as either a bridge to transplantation or even a bridge to recovery,” said Kavarana.

To learn more about LVD, read the full version of this article in the spring issue of Progressnotes.