Heart specialists - Drs. Fadi Bitar, Issam El Rassi and Mariam Arabi, in collaboration with pediatric cardiac anesthesiologist Dr. Roland Kaddoum, at the American University of Beirut Medical Center’s (AUBMC) Children’s Heart Center (CHC) successfully performed the cutting-edge Hybrid Norwood heart surgery to treat a week-old baby with Hypoplastic Left Heart Syndrome (HLHS). AUBMC is the first hospital in Lebanon and the region to use hybrid surgery for the treatment of HLHS, a procedure which has only been carried out in very few selected centers in the US, Canada and Europe.
The HLHS is a rare congenital heart disease where the left side of the heart is severely underdeveloped. Hearts with HLHS have a markedly reduced blood flow from the heart to the body due to constricting ducts and the flooding of the lungs with excessive blood.
Hybrids are usually performed in a catheterization lab rather than the operating room and this novel technique of hybrid surgery is a collective work by cardiac surgeons and interventional cardiologists (for catheter management) to offer a safe surgical result. The chest was opened briefly so surgeons can access the heart and pulmonary arteries – or the vessels going from the heart to each lung. Through small openings, pediatric cardiac surgeon El Rassi placed restrictive bands around these vessels to restrict blood flow to the lungs. Then, Professor and Director of the Children’s Heart Center, Dr. Fadi Bitar inserted a stent - a tiny mesh tube- into the ductus that served to keep the ductus open without medications and increase blood flow to the baby’s body. Expanding the stent, Dr. Bitar secured the vessel, allowing blood to continue circulating through the body. The surgery took less than an hour. “The baby did very well, it went very smoothly,” stated Dr. Bitar.
The “Hybrid Norwood Procedure” was the first of three surgeries required for this newborn’s condition. Its aim was to regulate the excessive blood flow to the lungs and provide adequate blood supply to the whole body by tightening the lungs vessels with bands and widening the ductus. The Hybrid Norwood Procedure offers great hope to the vast majority of infants with HLHS who would probably not survive a month without intervention. The newborn was discharged from CHC at AUBMC one week post operation in a healthy condition, and is now a healthy four months old baby.
"We have the tools to treat many congenital heart problems using a catheter these days that would have required major surgery just a few years ago," said Dr. Bitar. "We now can get the same rewards with fewer risks," he added. Dr. El Rassi, who recently joined CHC to collaborate with the center’s team on such operations and lead the congenital heart surgery program, said the baby will need “a second surgery later on, but he will be bigger and stronger to tolerate the procedure.” That second surgery, the Glenn procedure, will take place in four to six months and will involve the complex reconstruction of the aorta arch. A third surgery, the Fontan, will be performed at a later stage.
