In June, newborn Christina Hohensee helped make Minnesota medical history when she became the smallest baby in the state—and only the third statewide—to receive a newly approved device designed to fix a hole in her heart.
Christina was just six weeks old when she underwent a minimally invasive procedure at the Heart Center at University of Minnesota Masonic Children’s Hospital. Using a tiny catheter guided through Christina’s blood vessels, Pediatric Interventional Cardiologist Gurumurthy Hiremath, MD, FACC, FSCAI, implanted an Amplatzer Piccolo Occluder device in her heart.
University of Minnesota Masonic Children’s Hospital is the first hospital in the state to have the newly FDA-approved device, which was originally developed here. The device is designed to correct a condition known as patent ductus arteriosus (PDA). PDA is a relatively common heart condition among premature babies, affecting up to 20 percent of preemies. It occurs when a naturally occurring hole in the aorta, called the ductus arteriosus, fails to close prior to birth.
“PDA is a normal structure, present in all of us before we are born,” said Hiremath, who has performed all three Piccolo procedures at University of Minnesota Masonic Children’s Hospital. “The ductus arteriosus closes shortly after birth in a typical, full-term baby. But in premature babies, the hole often does not close.”
After birth, PDA floods the newborn’s underdeveloped lungs with extra blood, greatly increasing stress on the respiratory and circulatory systems. The first-line treatment is to use medication to get the hole to close, but in many cases, medication alone is not effective. That leaves surgical intervention.
Until a few years ago, a significant open surgery was the only viable option for infants with a PDA. The procedure involves a large incision. For premature babies, who are already vulnerable, the procedure can result in complications.
To solve this problem, physicians at University of Minnesota Masonic Children’s Hospital began using a minimally invasive technique called transcatheter PDA closure. This approach allows a specialist to close the PDA using a catheter to thread a tiny device up through the blood vessels. The catheter is inserted through a tiny pinprick in the groin, then guided to the heart to the site of the PDA and inflated to plug the hole. The advantages of this procedure are that there is no incision and a lower chance of complications.
Though this method is very similar to the Piccolo procedure—which is also implanted with a catheter—the device used previously was originally designed for adults and adapted for use in infants. For this reason, the equipment often wasn’t small enough for premature babies.
“The blood vessels in a tiny baby are barely a millimeter, so without small enough catheters and equipment, we were not always able use this technique to help premature babies,” Hiremath said.
Now that the Piccolo has been approved by the FDA, premature babies can have a transcatheter PDA closure, fixing the PDA with a puncture so small that it doesn’t even require a Band-Aid. Christina Hohensee is the latest preemie to benefit from University of Minnesota Masonic Children’s Hospital’s leading-edge approach in this area.
Christina’s parents, Mary Lou and Nate Hohensee, were looking forward to the birth of their daughter, who was due August 10. But after Mary Lou began to develop life-threatening pregnancy complications, the baby had to be delivered earlier. Baby Christina was born on May 1, weighing 1 pound, 7 ounces and measuring just over 12 inches long.
Christina had a PDA, which did not respond to medication. The Hohensees met with Gurumurthy Hiremath and his pediatric cardiology team to discuss surgical options. “We were nervous about the new procedure, because we didn’t know much about the device,” Mary Lou said. “Dr. Hiremath explained both procedures to us, which gave us a lot more confidence. This option is much less invasive, with less downtime and an easier recovery. We were confident that this was the route we wanted to go.”
On June 13, baby Christina had the procedure. She weighed just 2.5 pounds. “Everything went great. She recovered with no problem—you couldn’t even see the puncture,” Mary Lou said.
Two weeks after the procedure, little Christina had grown to over 3 pounds.
“She is doing much better. No one expected her to be doing so well so early, but since her surgery she has taken off like a rocket,” Mary Lou said. “I’m very happy to share our story so that other families know that this procedure is an option.”
“Once the PDA is closed, it’s closed. It’s a permanent fix,” Hiremath said. “It‘s very exciting to have this option for tiny babies.”