Groundbreaking surgery makes history in Bloem

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Prof. Francis Smit, Dr Danie Buys, and Prof. Stephen Brown are part of the congenital cardiac team of the Universitas Academic Hospital that recently made history when they performed a first of its kind surgery in Central South Africa.

History was made in Bloemfontein when the congenital cardiac team of the Universitas Academic Hospital performed a unique and highly specialised procedure on a 23-year-old male from Sasolburg last Tuesday.
The patient presented with uncontrolled high blood pressure and was diagnosed with a rare congenital disorder, called an Interrupted Aorta. The 23-year-old’s congenital condition had not been diagnosed since birth. Huge collateral blood vessels supplying the lower body allowed for normal development throughout his life and only his high blood pressure was a clue to his underlying condition. The arteries were large and numerous in the vicinity of the interruption and the risk of a fatal haemorrhage was extremely high and had to be reckoned with in a surgical approach.
A complete team, consisting of paediatric cardiologists (Dr Danie Buys and Prof. Stephen Brown), adult cardiologist (Dr Derek Aucamp), cardiothoracic surgeon (Prof. Francis Smit) and anaesthesiologist (Dr Pieter de Wet), all from the UFS School of Medicine, were assembled to help the patient. After careful investigation, using technologically advanced scans with 3-dimensional reconstructions, it was decided to attempt a percutaneous intervention via the vessels in the groin. Rare cases have been reported in the rest of the world using this technique, however, it had never been performed in Central South Africa.
The whole team, which included perfusionists and clinical technologists, were assembled for the procedure, which was carried out in the ultra-modern hybrid paediatric catheterisation laboratory suite of the Paediatric Cardiology Unit at Universitas Academic Hospital. The patient was catheterised from the arm by Aucamp and a snare was placed at the blind end of the proximal aorta to act as a “bulls-eye” to aim for. Buys and Brown, the paediatric cardiology team, then placed a catheter from the femoral artery in the groin, into the blind ending lower aorta. Using a dedicated radio frequency perforation system, a thin (0.020 inch) wire was used to burn through into the adjacent aorta. This technique requires skill and precision. A small channel was then created, using a balloon for the placement of a stent. The special stent with an outer cover of surgical waterproof fabric was then advanced within a 4mm long sheath and subsequently inflated to 12mm by a special balloon. As a result, the integrity and continuity of the aorta were safely and successfully restored. The whole procedure was performed under surgical cover in case of injury to the aorta during the procedure.
The patient could go home after 24 hours with a markedly improved blood pressure and a lot less medication. The patient commented how impressed he was by the highly specialised care he had received as a public sector patient and is looking forward to not taking five different drugs to control his blood pressure anymore!

First angiogram showing two blind ending vessels.
First angiogram showing two blind ending vessels.
Snare as target in proximal aorta, wire in position before burning through.
Snare as target in proximal aorta, wire in position before burning through.
Wire burned through into proximal aorta.
Wire burned through into proximal aorta.
Balloon inflated to make space for stent.
Balloon inflated to make space for stent.
Stent being inflated.
Stent being inflated.
Final result, continuity restored.
Final result, continuity restored.