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Pioneering heart procedure saves premature infant

by Lynne Langley
Of The Post and Courier Staff 
Born last week weighing just 2 pounds, Katie Metheny wasn't likely to survive any of the known treatments for her heart problem, a pinhole-sized opening that kept blood from flowing through her lungs. Charleston pediatric cardiologist Dr. Wolfgang Radtke devised an alternative, a combination of minimal surgery and major catheterization that he thought should work.

It did.

Dr. Wolfgang Radtke holds Katie Metheny.

Tuesday, four days after that first-in-the-world treatment, Katie was ready to return to a Greenville intensive care unit, where her twin waited along with her parents, Tobby and Crystal Metheny of Chester. Insurance paperwork delayed Katie's release from the Medical University of South Carolina Tuesday, but medically, she was ready to go, Radtke said.

He expects the baby to have a long, normal life without any future heart surgery. When she's older, she might need another balloon procedure to enlarge the hole he created.

“The baby is doing great. She is healing so  well that when she is older, it will be hard to see  a scar,” said MUSC pediatric surgeon Dr. William Adamson, who made the small incision just below Katie's neck.

The two doctors and pediatric cardiologist Dr. Rani Bandisode expect to write a paper on the treatment they invented. “We want other people to know how well it works,” Radtke explained. “This new approach makes it very predictable and safe.”
 The usual treatments were not, according to Radtke and Adamson.

“There are not many options in a baby that size,” Adamson added.

Traditional open-heart surgery to enlarge the pinhole opening would have had to wait until Katie more than doubled her size. Meanwhile, medicine to keep her alive or a heart-lung machine, which requires blood-thinners, could have caused fatal bleeding in a 2-pound infant.

“This baby probably would not have survived,” Adamson said.

Radtke has performed pioneering work correcting youngsters' heart defects with catheters and balloons, inserted through blood vessels, rather than invasive open-heart surgery.

Katie was born with severe pulmonary valve stenosis, which nearly blocked the opening between her lower right heart chamber and her pulmonary, or lung, artery. “This baby's valve was almost closed. She needed to get blood to her lungs to survive,” Radtke said.

“It is difficult getting to or even finding the hole—so little blood goes through it. It is difficult even in a standard newborn,” he said, adding that Katie is less than a third the size of the average newborn.

She would have needed six to eight weeks in an ICU, on medicine that could have caused heart failure or flooded her lungs, to grow large  enough for that procedure, he said.

Radtke normally inserts a guidewire, catheter and balloon into a large blood vessel in the groin and eases the catheter to the right spot in the heart. But Katie's vessels were tiny, and the very thin catheter was too flimsy to make  the vital 180-degree turn in her heart.

So MUSC pediatric cardiologists called Adamson, who credits Radtke with brainstorming and inventing the new treatment. “Each of the elements we had used in older, larger children but for different procedures,” Adamson said Tuesday.

Wearing 3-1/2 magnification glasses last Friday, Adamson made an incision just above Katie's right collarbone to expose the jugular vein for a small catheter, or sheath, narrower than a cocktail straw.

Radtke inserted a soft guidewire and worked it through the blood vessel to the pinprick of an opening in the heart valve. Then he advanced a balloon over the wire and inflated it to enlarge the hole.

He described the procedure as quick and efficient. “It was quite straight-forward,” he said,  adding Katie was in and out of the catheterization lab in less than two hours.

It was very much like a balloon angioplasty, said Adamson, except the monitors used in adults would not fit 2-pound Katie. Instead, Radtke did careful mathematical calculations, Adamson said. “It was a one-shot pass. He had one shot at blowing up the balloon.”
Editor's note: The article ran Aug. 7 in the Post and Courier and is reprinted with permission. 

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