Melody heart valve puts teen back in the game

Fourteen-year-old Rebecca Hemm of Moline, Ill., was born with pulmonary valve stenosis but, in many ways, she is one of the lucky ones. Babies born with heart problems often need life-saving surgery very soon after birth. Happily, she didn’t need open-heart surgery to replace the valve until she was four years old.

Rebecca Hemm
Rebecca Hemm, University of Iowa Children’s Hospital patient

In 2011, Rebecca was among the first to receive a Melody Transcatheter Pulmonary Valve at University of Iowa Children’s Hospital, the only site in Iowa to offer this minimally invasive option. The Melody Valve offers children and adults with a failing pulmonary valve conduit an option for treatment without additional open-heart surgery.

Abhay Divekar, MD
Abhay Divekar, MD

Rebecca’s cardiologist, Abhay Divekar, MD, clinical associate professor of pediatrics, says, “The Melody Valve is not a substitute for surgery, but it prevents or delays the next operation, and helps reduce the number of surgeries over a lifetime.”

The procedure takes one-to-two-hours and is performed in the cardiac catheterization suite. The cardiologist inserts a specially designed heart valve via a catheter into a vein in the leg and guides it to the heart. The heart valve is attached to a stent that expands with the help of a balloon to push the blocked pulmonary conduit open. The heart valve prevents blood from leaking back into the ventricle or pumping chamber.

Previously, these patients would have had a stent put in, but without a valve, blood then leaks back into the ventricle.

Patients are asleep for the procedure. Unlike open-heart surgery, with its week-long hospitalization, the patient usually goes home the next day.

Rebecca’s first surgery to replace her pulmonary valve was performed in the Hemms’ hometown of Bern, Switzerland. “Even before her first surgery, she seemed fine,” says her mother, Monika, recalling how relieved she and Rebecca’s father, Arthur, were. But by the time she was four, “tests showed that blood wasn’t getting pumped through to her lungs.”

Rebecca came through the original operation very well, but the prospect of another open-heart surgery was a concern. “It’s so hard to watch your own child go through major surgery,” says Monika.

When the family moved to the United States in 2007, her parents brought her to the outreach clinic in Genesis Heart Institute to be followed by UI Children’s Hospital pediatric cardiologists.

Rebecca didn’t need any additional procedures until 2010, when UI doctors were able to perform balloon angioplasty from a vein in her groin up to the heart to break up calcification that had accumulated on the valve.

By fall 2011, when it was clear that it was time to operate on her valve again, the Melody Valve was offered as an option for the first time. Monika Hemm says she’s glad her daughter received the Melody Valve through a minimally invasive procedure. Rebecca went home the next day and was back at school two days after that. “It was a very good experience,” says Monika.

“The whole thing went very quickly and was such a change from her surgery in 2003,” says Monika. “This time, she was in the recovery room for about half an hour and came up to her room right after that. She got up out of bed that night and we took her home the next day.”

Divekar adds, “Rebecca was a great candidate and we’re happy the procedure prevented and delayed the next operation.”

In Rebecca’s case, instead of needing several surgeries over her lifetime, she might just need one or two. Because the procedure is relatively new in the U.S., UI Children’s Hospital staff work with the patient’s insurance company.

Candidates for the Melody Valve must have a previously placed surgical conduit that contains a tube or valve. Patients can be adults or children but must weigh over 60 pounds.

Today, life is back to normal for the eighth grader at John Deere Middle School in Moline, Ill., where Rebecca played tennis on her school team last fall and sings in the choir. She enjoys spending time with her older sister, Cynthia, and younger sister, Tina.

What’s new?

The Melody Valve itself is not new. The method of implantation is. The updated procedure is simpler because it’s done in a cardiac catheterization lab, not the operating room. Physicians thread a catheter through a vein in the leg up to the heart. The replacement valve is attached to a stent that expands with the help of a balloon.

For more information, call UI Children’s Hospital, Pediatric Cardiology, at 319-356-2229.

–Spring/Summer 2013