For the first time in Israel, an artificial pulmonary artery valve was successfully implanted in children suffering from a congenital heart defect (CHD).
The procedure was conducted via catheterization in the Cardiology Institute at Schneider Children’s and represents a technological breakthrough in the treatment of children and adolescents with structural heart disease requiring pulmonary heart valve replacement. Until today, valve replacement required open-heart surgery. Schneider Children’s is one of 40 centers in the world – and the only one in Israel – to be selected by the manufacturers to utilize the advanced system.

Known as the Medtronic Melody Transcatheter Pulmonary Valve and Ensemble Transcatheter Delivery System, insertion of the valve via a catheter incurs a tiny incision for entry into the femoral artery while the child is under general anesthetic. The folded valve is attached to a metal support (stent) atop a tiny balloon and inserted under screening to the designated target. There, the balloon is inflated until the valve is safely in place, after which the balloon is deflated and withdrawn. At this point, the valve begins to work immediately.

Recovery from the procedure is speedy and the child can be discharged the next day and return to normal activity within a few days. Because of these essential advantages, and especially due to the fact that most children with CHD generally require several open-heart surgeries, transcatheter insertion represents a huge revolution in the treatment of valve defects in general and in children in particular, both from the purely medical point of view as well as from the discomfort and danger to the patient perspectives.

CHD is the most common defect in children in the world, occurring in some 0.8% of all children. About 20% of infants are born with CDH, which interferes with the flow of blood from the right ventricle in the heart to the pulmonary artery. This type of congenital defect generally requires open-heart surgery at a very early age in order to insert an artificial valve to repair the disorder. However, as the child grows, the size of the valve requires continual readjustment while its operational life is limited. As a result, most children with CHD need to undergo several open-heart surgeries throughout their lives to replace the valve.

The addition of this technology to the range of existing treatments available today at Schneider Children’s Cardiac Institute in the field of CHD, places the hospital among the leading centers in the world for this type of treatment. The catheterizations were performed by Dr. Elchanan Bruckheimer, Director of the Catheterization Unit, and Dr. Lee Benson who visited especially from the Hospital for Sick Children in Toronto.

Previously, Dr. Einat Birk, Director of the Institute of Cardiology at Schneider Children’s, and Dr. Bruckheimer had visited the renowned Great Ormond Street Children’s Hospital in London in order to study the methodology and application of the procedure.

The “Melody” transcatheter valve was developed by the Medtronic Company in cooperation with cardiologist, Prof. Phillip Bonhoeffer, Director of the Cardiology Institute at the Great Ormond Street Children’s Hospital in London and pioneer of
the pulmonary heart transcatheter valve replacement technology. 

The valve is made from a cow’s neck vein and operates in the same way as a natural heart valve. It accords blood flow from the right ventricle to the lungs and finally to all organs in the body. Prof. Bonhoeffer implanted the first valve in September 2000. Since then, the valve has been implanted in more than 400 patients in the world.

The valve

February 2008 

Melody animation

"The Jerusalem Post" February 20, 2008