Feature | December 09, 2013

Children’s Hospital Los Angeles Heart Surgeons Complete Rare Pediatric Double Melody Valve Heart Procedure

Procedure avoids need for open heart valve replacement surgery

structural heart valve repair children's hospital los angeles

Children's Hospital Los Angeles pediatric interventional cardiologist Frank Ing, M.D., with patient Brian Frounzian.

December 9, 2013 — Seroj Avoyan is a world class Armenian Dhol drum virtuoso whose fingers move with such dexterity they are a blur to the eye. Only the human ear can pick up the beauty of the stunning rhythmic beat produced by his hands. So gifted, he has performed on stage with Yani and was a featured solo performer at the Armenian Music Awards in 2002.
That same year, Seroj had a second thrill: the birth of his son Brian. But within days, doctors heard something wrong with the beat of Brian’s heart. He was born with a life-threatening congenital heart defect that required emergency surgery six days after birth and open heart surgery three weeks later. 
“It was terrible,” said Ruzan Avoyan, the boy’s mother.
The defect, critical pulmonic stenosis, affects the leaflets of the pulmonary valve, making it difficult for blood to flow from the right ventricle to the lungs. He also had an Ebsteinoid Tricuspid valve, a structural insufficiency that prevents the valve from closing tight, allowing blood to leak backwards.
But recently, Brian, now 11, underwent a rare pediatric transcatheter double Melody valve procedure, the first ever performed at Children’s Hospital Los Angeles (CHLA). The procedure, first performed in Germany in 2011, has corrected both defects and instilled Brian, a young swimmer and martial arts aficionado, with newfound energy that was in short supply earlier this year.
Brian just recently returned to Children’s Hospital Los Angeles for his first check-up and he is recovering great, said Frank Ing, M.D. and pediatric cardiologist, CHLA. 
“For the foreseeable future, I believe Brian is safe from needing another surgery,” said Ing.
That is wonderful music to his mom and dad’s ears. Brian is a tough kid, having endured six previous heart surgeries, including an open heart tricuspid valve replacement at age four. Brian progressed in the following years, but more than a year ago he started feeling sluggish compared to his friends. There was a medical explanation: he was outgrowing his leaky replacement Tricuspid valve, which was causing the right side of his heart to expand. This was to be expected as his heart outgrew his replacement part. 
“He kept saying, ‘Mom, why am I getting tired?’” said Ruzan. “He would play with the other kids and always get tired first.” 
Tests on Brian’s heart in 2012 showed his heart function was decreasing and doctors had only a handful of options. At some point, both his pulmonary and tricuspid valves would need to be replaced, potentially with open heart surgery operations. Doctors also considered a relatively new cardiac catheterization procedure that could take care of both valves at once without opening the chest.
Brian’s team at Children’s Hospital Los Angeles opted to do the transcatheter double Melody valve implant. Brian’s cardiologist at Children’s, Matsato Takahashi, reached out to Ing, a new recruit of CHLA. Ing, teaming with Cheryl Takao, M.D., was optimistic a transcatheter double Melody valve implant could do the job, even though it was only recently perfected for children in the past couple of years.
“I have followed Brian as an outpatient most of his life and watched him with a great deal of concern due to progressive deterioration of his right heart due to leaky tricuspid and pulmonic valves,” said Takahashi. “It would have required a very extensive surgery to fix this problem. I was a little apprehensive when Drs. Ing and Takao proposed a double Melody valve procedure, but it turned out the procedure went exceedingly well, and the patient showed much improvement in his cardiac function. I believe this is a tour de force for our interventional team.”
Ing is one of a handful of physicians nationwide who has performed the procedure numerous times. He was recruited by CHLA last September from Texas Children’s Hospital and has been breaking new ground at CHLA using pioneering catheterization stenting and Melody valve implant procedures, which are less invasive than open heart surgery. 
“Recovery time is much faster,” said Ing.
Brian underwent the six-hour transcatheter procedure in May and was standing and walking the next day. Now he’s back to swimming and karate and is starting school in a few weeks, according to Ruzan. 
“He’s doing great, and now he feels normal,” she said. “Just like the other kids.”
Seroj, a colon cancer survivor who has battled serious health problems himself, feels uplifted by his son’s progress. 
“My son is an inspiration,” he said.
For more information: www.chla.org

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