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PLE surgery

Catherine

Moderator
I know this relates to PLE in heart patients but it is a cure in these patients.

http://www.heraldsun.com.au/news/vi...s/news-story/0eb297a3ed8fb7175a6d2a147b565307

http://www.couriermail.com.au/news/...s/news-story/0eb297a3ed8fb7175a6d2a147b565307

Surgeons design a new world-first surgery to cure heart kids

Lucie van den Berg, Medical reporter, Herald Sun
February 10, 2017 8:00pm
Subscriber only

SURGEONS at the Royal Children’s Hospital have pioneered a new operation to save the lives of children suffering from a devastating complication of heart surgery.

In an amazing feat, the world-first procedure has cured Victorian patients of a condition that can kill within five years.

After almost 20 years of research and investigation, Associate Professor Christian Brizard, director of Cardiac Surgery Department at the RCH, has performed his unique operation on children with incredible outcomes.

This is a big breakthrough for us and for these patients, it’s never been done before and, on the patients we performed the operation on, their gastroenterologists say they are now cured,” Prof Brizard said.

He started experimenting with the surgery in the laboratory in his native France, but it has taken years of refinement and the invention of a new type of stent before he could trial it in humans.

Melbourne teenager, Chloe Downs, was the first female in the world to have the operation after developing Protein-losing enteropathy (PLE) where proteins leak in the gut.

Her parents, Simone and Stewart, did not hesitate when asked if they wanted to trial the experimental surgery, giving their daughter the chance of a cure.

“It has saved her life and we are so grateful to be able to spend more time with our delightful and joyous daughter,” Mrs Downs said.

Born with half a heart, she underwent a series of operations to re-plump the organ so the blood without oxygen comes back from the body directly into the lungs without going through the heart.

This procedure, know as the Fontan, is performed on an average of one child a week.

It leaves the heart to operate with just one pump and it relies on increased pressure in the veins to push blood into the lungs.

“Most of the organs can tolerate this high venous pressure, particularly the brain, heart and kidneys, but the liver cannot,” Prof Brizard said.

The increased pressure is more than double what is seen in a normal heart and five per cent of patients with a Fontan procedure develop PLE.

It impacts on everything from the immune system and metabolism of the organs to the blood’s ability to clot.

Chloe’s parents signed the 16-year-old up for the experimental surgery after months of suffering and deterioration.

“She had put on weight; her face, stomach and legs were big and swollen from all the fluid that was building up,” Mrs Downs said.

“Not only was she compromised physically, then she was put on a no-fat diet and fluid restrictions so she couldn’t even eat cake at a birthday party or drink water when she wanted and her gut was a real mess: it was horrible.”

“We were beginning to lose hope when they told us they had an experimental operation that could work on Chloe and we thought we would try it.”

The surgery restores a normal pressure in the liver and gut, stopping the
proteins leaking.

During the pioneering operation Prof Brizard connects the three veins of the liver directly to the heart so the blood flowing from the gut and liver bypasses the lungs.

But he also threads a stent- the diameter of a twenty cent coin and 8cm long- into a vein in the thigh and up into the main lower vein of the body.

This permanently isolates the liver from the main vein and prevents blood from that vein flowing into the liver.


“We need to add the stent because we can only allow a small fraction of the blood to bypass the lungs otherwise the patients can become very blue.

“As a result the liver and only the liver drains through the heart and this stops the high pressure damaging the liver and the gut.”

The operation was only recently made possible because of the invention of a mesh-covered stent that can be customised to fit in patient’s veins.

For Chloe, it has been a year long recovery from the surgery filled with worry and setbacks, but, it has been a success.

While she still faces some restrictions, Chloe’s swelling subsided almost immediately with more than 15kg draining away and her reliance on medication is reducing.

“We are so grateful to have Chloe in our lives and our surgeon Christian is amazing; how can you not just love the person who he has saved your child’s life so many times?”

“Our hope is that now others can get this surgery and a chance at a future because it really has been life-changing for Chloe.”

“The simple milestones are huge for us when you have such a sick child you don’t take anything for granted.”

“And we are so proud of her, despite her sickness she is such a joy and a delight and we feel privileged that we have been chosen to parent such a unique and incredible young woman.”

As for her part in helping surgeons pioneer an entirely new surgery that will help children worldwide, Chloe couldn’t be more pleased.

“Thank you to all the doctors and nurses and especially Christian Brizard for doing the surgery and looking after me and thank you to my family and friends for your support and prayers,” she said.
 
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