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February 3, 2020

A Safer Heartbeat: St. Joseph’s Children’s Hospital pioneers techniques to mend holes in the heart

By Anu Varma Panchal

When it comes to matters of the heart, St. Joseph’s Children’s Hospital stands at the forefront of the very latest trends. Most recently, the hospital has become the first in Florida to use a cutting-edge device that repairs holes in the heart more quickly, easily and safely than any previous technology: the Gore Cardioform ASD Occluder.

Two months ago, 5-year-old Jaycob Jones became one of the first patients in Florida to be treated successfully with this device by Dr. Jeremy Ringewald, pediatric interventional cardiologist and the Medical Director of the Cardiac Catheterization Lab at St. Joseph’s Children’s Hospital.

Jaycob was born with a hole between the two upper chambers of his heart—his atria—which is a condition known as an atrial septal defect.  Had he been born a few decades ago, his only option would have been open-heart surgery. However, for many years, improvements in technology has allowed a cardiologist to insert a small catheter into the blood vessel in the upper leg and advance an implantable device through the catheter to the heart to repair most atrial septal defects.

A simulation of the Gore Cardioform ASD Occluder shows how a long thin tube is inserted into a vein in the groin. This tube snakes up and comes out in the heart. It goes through the hole in the heart’s wall from the right atrium into the left atrium. It then releases a white foam-like material into the left atrium. The foam blooms into a puffy bell-like shape that then collapses into a thick disc—much like how you can compress a paper lantern into a thick wad. The same process occurs on the other side of the hole in the right atrium, and the two discs are sealed into place, creating a “sandwich” over the original hole. In time, the endocardium, or the inside layer of the heart, grows over the foam, which then becomes part of the inner wall of the heart.

It sounds and looks like magic, but like much in medicine, is the result of painstaking years of research and step-by-step improvements. Ringewald explains that the first such device was developed and refined in the early 2000s. He has used five generations of these devices, but previous versions were not quite as effective or safe for larger holes. The most commonly used device occasionally caused an erosion or hole between the inside and outside of the heart. Although this was something that might take months or years to happen and only occurred in about one in 500 patients, it had serious, sometimes even fatal, consequences.

This is the main problem that is avoided by the Gore Cardioform ASD Occluder that was approved last summer, and that Ringewald soon after began using at St. Joseph’s Children’s Hospital with almost 100 percent success. This new version uses a medical grade Gore-Tex fabric and nickel titanium wires, making the device bigger, stronger and more flexible than previous versions. This means that all but the biggest of holes can be mended with permanent security and peace of mind, even ones that are nearly 4 centimeters in diameter.

“It’s very exciting,” says Ringewald. “It means we can close the biggest of holes safely without the worrisome erosion problem.”

For patients like Jaycob and their families, an ASD might have meant hours of open-heart surgery followed by a long and painful recovery period. Instead, Ringewald inserted the Gore Cardioform ASD Occluder during a 2-hour procedure, which generally just means a night’s stay—a prelude to a lifetime of peaceful heartbeats.

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