Newswise — A team at Children’s Hospital Los Angeles recently became the first in the world to use a new basket-shaped retrieval device to successfully remove a large atrial clot (blood clot).
The procedure was done in Cardiac catheterization lab This was the fourth use of the device, which was manufactured by ŌNŌCOR and received FDA approval in May. The team also used vascular traps and electrocautery to remove the clot.
“Traditionally, the only options for these pediatric patients have been watchful waiting or open-heart surgery,” he says. Darren Berman, MDDirector of Congenital Interventional Catheters in Cairo Heart Institute At Children’s Hospital Los Angeles. “This was a novel solution to a clinical dilemma we often encounter.”
The patient was initially referred to a cardiac surgeon John Cleveland, MDto perform open-heart surgery to remove the large clot with a diameter of 3 x 2 cm.
But the teen also needed a separate, crucial surgery to treat another condition. Open-heart surgery and subsequent recovery can cause significant and potentially harmful delays to this other procedure.
“We needed the least invasive solution to remove the clot – one that doesn’t lead to long recovery time,” explains Dr. Cleveland.
He sought Dr. Berman to discuss the possibility of an angioplasty. “I immediately thought of this new retrieval system,” Dr. Berman says. “We were in the process of putting it on our shelves, but we haven’t had it yet.”
Two days later, he had the machine and sample system to practice on at his desk. he and Neil Patel, MDThe Congenital Interventional Cardiologist at the Heart Institute began careful planning for the new procedure and the sequence of steps they would take.
The tool is a “rescue” tool for removing infected stents or other percutaneous implants, as well as biological materials, from the vascular system. The retrieval basket is made of a nickel-titanium alloy, a relatively soft metal that allows it to be fully compressed within a catheter. An intravascular ambush is placed inside it.
“Hold onto what you’re trying to remove with the trap, then advance the basket over it or pull the thing in the basket,” Dr. Berman explains. “And then you press that basket and everything inside it back down into the catheter, so you can pull it out of the body.”
This particular case will be more complicated. This was not a floating object that had been migrated from its intended location. It was a blood clot attached to the wall of the heart.
“What we didn’t know was how easy it was to remove the clot,” he adds. “Or if it will pay off at all.”
Just three days after Dr. Berman’s initial conversation with Dr. Cleveland, the team was in the catheter lab, ready for the procedure.
First, a cardiac anesthesiologist Clementine Fu, DoAnesthesia is safely administered to the patient. Next, the echocardiologist Pierre Wong, MDinsert a probe down the patient’s esophagus to perform a 3D transesophageal echocardiogram (TEE), which would guide the entire procedure in combination with an X-ray system in the catheter lab.
Once the TEE confirmed the exact size and location of the clot, Dr. Berman and Dr. Patel inserted a large catheter into the patient’s neck vein – the most direct path to access the mass.
With the guidance of an X-ray system and direct TEE imaging, the team wrapped the trap around the clot and developed the basket device on top of it. Then Dr. Berman gently stretched the clot.
The first big piece came out easily. However, the rest was firmly attached to the base of the right atrium – and it didn’t budge.
But the team planned for that scenario, preparing to implement a technique inspired by interventional cardiologists at the University of Washington in Seattle. In early August, that group used the same device to remove a benign atrial tumor in an adult patient — using electrocautery to cut the tumor away from the atrial wall before extracting it with a retrieval tool.
In a similar way, Dr. Berman has now used a specialized electrocautery ambush – obtained from CHLA Gastrointestinal Diseases The team — to carefully cauterize and separate the rest of the blood clot from the heart.
“Electrocautery was a key factor in separating a clot – similar to the way a gastroenterologist would remove a tumor from the digestive tract,” Dr. Berman explains. “Then we used the retrieval tool to pick it up and remove it safely, without any particulates breaking or breaking off.”
The patient recovered well. Most importantly, the teen was then able to undergo the critical surgery necessary to address the other condition – without any delays in this schedule.
This success, says Dr. Berman, was a team effort not only of interventional cardiologists, but also of Dr. Fu, Dr. Wong, Cath’s lab team, Dr. Cleveland and his surgical team — who were standing during the procedure. If open heart surgery is required.
“This really highlights the amazing collaboration within our Heart Institute,” says Dr. Berman. “By working together, we have been able to find an innovative way to address this challenging issue and ensure the best patient outcomes.”