Pediatric Interventional Cardiologist at the Wolfson Children’s Hospital in Jacksonville, FL, Dr. Robert English, MD talks about a new device that is implanted into baby Jaden’s heart to save his life.
Interview conducted by Ivanhoe Broadcast News in December 2022.
Tell me when you first saw Jayden, what was he like?
ENGLISH: Jaden was born prematurely so he’s very small. When I found out about him, he’d been in the hospital for a few months and they got us involved because they were having trouble getting him off of respiratory support. He required being on a ventilator and he-he had a blood vessel in his chest that ordinarily closes after you’re born, but when you’re born prematurely, sometimes it doesn’t close. That blood vessel causes extra blood flow to go through your lungs, which makes it hard to get off of respiratory support. We were asked to get involved and see if we can help him.
Could that be fatal for him, in the long run?
ENGLISH: It’s not usually fatal. It just requires them to be in the hospital for much longer and sometimes to go home on a ventilator actually.
You use something called a Piccolo?
ENGLISH: The blood vessel that stayed open is called a PDA, which stands for patent ductus arteriosus.We’ve been closing them in the cath lab for decades. The devices that we have to close them are for bigger kids. We’ve never really had a device that was small enough to use in a tiny baby until the piccolo device came out. The piccolo was specifically designed to close the PDA in tiny little babies. That’s having that device enabled us to take him to the cath lab and do this there, as opposed to him having an open surgery to close it.
How does the piccolo device work?
ENGLISH: Basically, it’s just like a plug. It goes into the vessel and plugs the vessel up.
It’s as small as a dime?
ENGLISH: It’s a lot smaller than a dime, you could probably fit eight of them on a dime. It’s on the range of three millimeters in diameter, four millimeters in diameter. They come in different sizes depending on the shape of that child’s PDA. We have all different sizes to try, but they get a small as about three millimeters in diameter
Could you tell almost immediately that this was working for Jaden?
ENGLISH: In a lot of babies, their chest x-ray changes right away and it looks a lot better. He had been in the hospital for a while and so the changes on his chest X-ray weren’t evident right away. He needed less ventilatory support right away. After about a week of putting the device in, his tube came out and ordinarily you have to just put it right back in to give him respiratory support, but they decided to see how he did without it and he did fine without it, so we didn’t have to put it back in.
What does this mean for Jaden?
ENGLISH: A quicker discharge from the hospital and healthier lungs long-term. Healthier lungs long-term is great because running and playing will be better for him.
What are the differences between open surgery and this minimally invasive cath?
ENGLISH: Both procedures probably take honestly about the same amount of time. When it’s done surgically they make an incision in the side and to be able to get down to the vessel that they’re going to close they have to push the lung out of the way. Then of course they have to sew everything back up and that process of pushing the lung out of the way when it’s already fragile, causes the child to take a couple of days to recover from that. There is the risk of infection and so forth from an open incision. A catheter procedure is better because the child recovers from the procedure immediately and the risk of infection is much lower.
Why couldn’t you do it on a baby?
ENGLISH: It might depend on the shape of the PDA that they have in particular, because these vessels come in all shapes and sizes. Sometimes the children are too unstable to be able to even take them to the cath lab. Sometimes size is an issue. Jayden was the smallest baby we’ve ever done here. Certainly there is going to be a limit to how small you can go with just the size of the catheter.
Will the Piccolo device be able to stay in forever?
ENGLISH: It will stay in forever. It will become a part of him. His blood vessel will grow into it and fix it into place there.
Does it heal itself like it should have?
ENGLISH: Yes, it gets covered up on the inside. The piccolo serves as the initial plug and then his body will fill in the rest of it and seal off that plug.
Would these children just have to have a respirator forever if they’ve never?
ENGLISH: No. Most of the time, even in children who have to go home on a ventilator, they eventually come off of it most of the time. It just takes time to gradually wean that support down.
Since they close on their own after, how long does that usually take?
ENGLISH: It can vary, but most kids it’s closed or nearly closed in the first day. In some kids it takes a few days or weeks longer. If it’s been opened for a month or two, chances are it’s not going to close at that point.
END OF INTERVIEW
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Wesley Roberts
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