Victor Bautista, MD, Chief of Pediatric Congenital Heart Surgery at CHRISTUS Children’s talks about treating aortic coarctation with heart surgery.
Interview conducted by Ivanhoe Broadcast News in 2024.
What is the G Wares factor about Emmitt’s surgery?
Bautista: The most important factor for Emmitt’s surgery is the team approach that we usually undertake here at CHRISTUS Children’s for those patients. Patients are discussed within the heart center and then in coordination with the family, we decide the best option for those patients. Specifically for this patient, two possibilities were feasible: intervention in the cath lab or surgery. After in-depth discussions within the team and also with the family, we decided altogether that the best way to proceed for this patient was to undergo surgery.
This is very much a team approach, not just with your team but also with the family. Is there a right or wrong decision between the two possibilities?
Bautista: No, but to make that decision, you need to have all the information. There are pros and cons for the surgery as well as for the intervention in the cath lab. The family needs to be aware of what are the possible complications and the long-term outcomes of each procedure to make a very well-educated decision for their child on this occasion.
You cut out the damaged portion, is that correct?
Bautista: Yeah. Coarctation of the aorta is a narrowing in the main vessel of the body, which is called the aorta. It’s a narrowing that can be dilated from the inside in the cath lab or surgery, what we do is we cut out all the sick tissue and we put together healthy native tissue, with healthy native tissue. Unlike the intervention in the cath lab, we remove the sick tissue. That is an advantage. Down the road, the possibility of that tissue narrowing down again is not there anymore because with surgery, that tissue is gone, unlike what you do in the cath lab, where you dilate that native tissue with a ballon and sometimes with a stent too, but twith this approach the sick tissue remains inside the body.
How do you know that the rest of the tissue won’t get sick as you say?
Bautista: During the intraoperative assessment, we can see the consistency, the type of tissue we are dealing with, and, typically, that area of the aorta is very narrow, very thick, very fibrotic. We know where that tissue ends. Then we cut all that tissue out and we see a very pliable, nice, thin tissue, and then we put that together.
Is any part of this robotic? Describe the surgery to us?
Bautista: We do this through minimally invasive surgery. We don’t do robotics. Robotics for pediatric patients is something that is not widespread, it’s rare. But we use a minimally invasive incision, limited thoracotomy. Actually from the front, you cannot see any kind of scar. You only have a small scar on the left side on the back.
Emmitt had this stone at the age of eight. If somebody had been listening, they might have caught this. For parents who are watching and maybe there’s something a little bit off about the child, what would you recommend to them to prevent this from happening to their child?
Bautista: This is something that the general pediatricians can pick up easily in the outpatient clinics because these don’t have symptoms most of the time, but they have elevated blood pressure. For an adult or elderly patient to have elevated blood pressure is something very common. But for a baby, a small kid or even a teenager to have elevated blood pressure that is not that common and that should raise a concern about the possibility that the patient has coarctation of the aorta. This diagnosis should therefore be ruled out because it can done very easily without going to a major hospital or anything like that.
Describe Emmitt and his overall personality and good health from before and after.
Bautista: The kid didn’t have symptoms, as I said, that was something that was found by his pediatrician. They saw that the patient had elevated blood pressure. Then they measured the blood pressure in the arms and the legs and they found out that there was a gap. There was a gradient/obstruction because below the narrowing the blood pressure is less and above the narrowing is more elevated. You can hear a thrill, a murmur. With those two things, they got an echocardiography that helps see the area, the grade of narrowing, and everything, and with that, you can get the diagnosis. For this specific patient, and in preparation for any kind of procedure, we also got a CTA, just to see the anatomy in detail and don’t miss any other concomitant defects or anything that could be going on.
Is there no way to suspect that he’s going to have this problem again or anything that’s going to go wrong from there?
Bautista: We were able to do a successful operation, remove all the sick tissue, and put together healthy native tissue with healthy native tissue. In all the studies that we did after that, there is a much better opening of the area. There is no gradient and no obstruction in the area. Since we didn’t leave any prosthetic material. It’s all his native tissue and so It’s very unlikely that this patient will have problems down the road with that. If he has any kind of problems, those could be solved in the cath lab without going to the operating room again. But I doubt that he needs any further intervention.
Do you know where this originates or is it genetic?
Bautista: The hypothesis is there is a communication between the pulmonary artery and the aorta that is mandatory to have it as a fetus when the baby is inside the mom’s belly before the delivery. That connection between the pulmonary artery and the aorta is called ductus arteriosus. Communication naturally closes right after birth, a few days, or a few weeks after birth. If there is excessive closure of that anomic area, you end up pulling from the aorta and narrowing the aorta at a very specific side, which is called the aortic isthmus. Coarctation of the aorta is probably related to an excessive closure of the ductus arteriosus.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
CHRISTUS Children’s Heart Center (210) 704-8829.
For media inquiries – Gloria Madera gloria.madera@christushealth.org
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