In a brightly lit area of the University’s C.S. Mott Children’s and Women’s Hospital, where visitors are greeted by a life-size figure of a Sesame Street character and a room full of games and toys, one wouldn’t expect to find 28-year-old patient Lisa Snider.
But Snider is no stranger here.
Due to a heart condition called Tetralogy of Fallot that Snider has had since birth, her treatment over the years has involved a team of pediatric cardiologists and nurses — most recently those working in the Congenital Heart Center in the pediatric cardiology wing at Mott.
A Grand Rapids, Mich. resident, Snider was recommended to go to Mott for a new, minimally invasive heart valve replacement surgery. Born with a hole in her heart, Snider’s arteries were smaller than average and needed to be artificially enlarged.
To improve her condition — which consists of four congenital heart defects — Snider underwent two open-heart surgeries, one during infancy and the other at age four. Snider expected to need an additional surgery at age 12, but her heart managed to continue functioning without serious medical intervention from her adolescence into her late 20s.
“It was a miracle that I didn’t die in the last 15 years,” she said in a phone interview.
But as Snider and her husband began plans to conceive their first child last year, her doctors advised her to have another surgery to provide additional support for her heart before it would undergo strain from pregnancy.
Snider’s procedure — currently available at a limited number of hospitals throughout the country — uses the Melody Transcatheter Pulmonary Valve, which was approved by the U.S. Food and Drug Administration in January 2010. The valve is inserted via a catheter into the leg, maneuvered through the torso and placed between the right ventricle of the heart and pulmonary artery.
Though the procedure is still in its pilot stages, it has already exhibited high success rates in Europe.
Since a catheter is used to guide the valve into the heart, the procedure is considered less invasive than open-heart surgery. This knowledge, in addition to support from her family and friends, allowed Snider to put her full faith in the new procedure, which she had last April.
“We just prayed and knew it was going to be good,” Snider said. “We weren’t really worried.”
Before the introduction of the Melody Valve, patients often underwent high-risk open-heart surgeries to replace faulty valves that had grown weak over time, according to Aimee Armstrong, a pediatric interventional cardiologist at Mott and Snider’s primary surgeon.
Open-heart surgeries often cause scar tissue to form over the heart, said Armstrong, who is also an assistant professor in the Department of Pediatrics and Communicable Diseases at the University’s Medical School.
“This complicates future surgeries,” she said.
However, the introduction of the Melody Valve eliminated this complication risk for Snider. She said she was discharged from the hospital the day after the procedure and back at work the next week.
Snider said that in the months following the procedure, she felt well and recuperated quickly. She added that she leads a normal life and can participate in one of her favorite hobbies, dancing, with a church group.
“We perform three to four times a month, and I’ve never had problems,” she said.
Snider added that with full support from her doctors, she and her husband were quickly back on track to try to have children.
“The doctors told us, ‘Your (artery) blockage is trivial. You can start (having children) at any time.’ That was just awesome for us,” she said.
A big endeavor to save a little heart
Two-year-old Mira Larrison underwent heart surgery even before she was born.
Due to a congenital heart condition known as hypoplastic left heart syndrome, the left side of Mira’s heart wasn’t developing properly when she was in her mother’s womb. Of more immediate concern to doctors was the lack of a hole between the two sides of her heart, a defect that was causing blood and pressure buildup in the lungs.
“We felt that she was an extremely high-risk patient,” Armstrong, one of Mira’s surgeons, said.
So when Mira’s mother, Katie Larrison of Algonac, Mich., reached the 30th week in her pregnancy, doctors at Mott’s Congenital Heart Center decided in-utero intervention was necessary to improve the baby’s condition. Katie underwent an innovative surgery in December 2008 in which a team of University nurses and physicians, including Armstrong, created a hole between the left and right atria of Mira’s fetal heart.
Despite the risks — elevated by Mira’s Turner syndrome, a rare chromosomal disorder affecting approximately one in 2,500 females — the surgery was successful, with Mira boasting strong vital signs upon her delivery the following January. Acting quickly after the birth, Armstrong began implementing a plan that would involve additional procedures to carefully “re-route” the infant’s heart to allow her right ventricle to do the work of the faulty left ventricle for the entire body.
With special attention paid to Mira’s Turner syndrome, Armstrong and Jennifer Hirsch, also a pediatric cardiac surgeon at Mott, performed multiple minimally invasive procedures on Mira in an effort to improve the blood flow in her heart. Hypoplastic left heart syndrome can never be fully corrected, Armstrong said, though surgeries like this can improve heart function.
“We did newer, more innovative hybrid procedures to ‘re-route’ the blood going through her heart using stents and bands,” Armstrong explained.
Armstrong said she never expected to make medical history by becoming one of the first interventionalists in the nation to perform this series of unconventional surgeries on a developing infant, both pre- and post-delivery, and yield positive results.
But even after her successful procedures, Mira’s health still wasn’t 100 percent.
“(Mira) was on a heart transplant list for six months because the pressure in her heart and lungs was elevated, likely due to the severe former heart disease,” Armstrong said.
Six months later, though, Mira showed significant improvement as pressure normalized, bringing the Larrisons some much-needed relief as their daughter was removed from the transplant list.
With Mira back on track for her series of surgeries, Katie said she and her husband Jeremy were nervous as Mira underwent her next procedure at Mott, but said they were comforted by the preparedness of Mira’s medical team.
“(The doctors) would play out different scenarios,” Katie said. “There was always a plan. We always knew who was involved in her care.”
Armstrong said Mira may need another surgery around her third birthday. But for now, Mira’s life is steadily approaching normalcy.
“She’s much happier,” Katie said.
With an obvious tone of pride in her voice, Katie added that her daughter began to “scoot on her butt” when she was about 20 months old.
“She’s doing much better since her surgery,” Katie said. “(My husband and I) have been able to breathe more deeply.”