A unique intervention at the Department of Cardiology

Specialists from the Department of Cardiology of the Polish Mother’s Memorial Hospital – Research Institute were the first in Poland to perform a unique procedure – catheterization of brachiocephalic vein in an eight-year-old boy with generalized venous thrombosis. The Intervention can be named a last resort procedure.

The patient is an eight-year-old Alan. The boy was born with a severe heart defect (HLHS – no left ventricle). As Krzysztof Kamecki, Alan’s dad says, he learned about his son’s illness shortly after the delivery. – The examinations we had done during pregnancy showed no abnormalities – he adds.

From a delivery room in one of the private hospitals in Łódź, Alan was transported with an ambulance to PMMH-RI. In the Department of Cardiology, Dr. Anna Mazurek-Kula recognized the defect. On the ninth day of his life the boy underwent cardiac surgery. In HLHS, the defect is “repaired” during a multi-stage treatment. As a rule, three operations are performed. Alan underwent the second at the age of two.

After two years, the third surgery was planned. But during the examinations, it turned out that the patient’s vessels at the pulmonary arteries were narrowed to a large extent, which is why cardiac surgeons offered two additional procedures to prepare Alan for the main surgery.

– We wanted to reduce our son’s suffering and pain, because in addition to cardiac surgery, he underwent several others – says Alan’s dad. – We started looking for help abroad.

The surgery was carried out by cardiac surgeons from the hospital in Munster. It took place in May 2017 and cost PLN160,000. Parents had raised founds on a popular website.

A few months later – in November 2017 – during a follow-up examination, critical narrowing of the brachiocephalic vein was detected. Specialists from Munster were to say that special attention should be payed to it. With time, the boy kept feeling worse and worse with venous pressure constantly rising. The parents asked the doctors from Germany for help and after a long discussion, they received an email saying that they were not able to help Alan in Munster.

“We still tried to get aid from a reputable hospital in the United States,” says Alan’s dad. – They asked us to send all documentation translated into English. Such a translation would take several months.

At the end of December, Alan felt terrible. Finally, with an attack of breathlessness, he was sent to PMMH-RI. It soon became apparent that the so-called plastic bronchitis developed. This complication occurs in patients after HLHS surgery, when plasma components exudate into bronchi. Alan had a life-threatening thrombosis as well.

To save the child prof. Tomasz Moszura made a choice to carry out a very difficult procedure. He decided to get to brachiocephalic vein with a catheter. No one in Poland had carried out such a procedure before. It was very difficult due to the generalized thrombosis of all vessels and the specific anatomy of the child after several cardiac surgeries. The procedure required excellent manual skills from the operator, but an eight-millimeter stent was successfully placed. Due to the widening of the brachiocephalic and upper main veins, venous pressure halved immediately.

A few weeks after the surgery, we are sure that it was successful. Alan is fine. He does not experience shortness of breath, and the symptoms of plastic bronchitis have disappeared.