UAB is first in Alabama to use the Melody Valve to repair heart defects

The new procedure means some patients with congenital heart defects can avoid open heart surgery.

In many ways Dylan Fields is your typical 15-year-old boy. He loves sports, and plays baseball and soccer for his school, Tallassee High, in Central Alabama. What’s not typical about Dylan is his heart defect and, now, the procedure used to repair his heart.

In early February, Dylan received a procedure now being performed at UAB Hospital, a Melody Valve replacement – a pulmonary valve inserted through a catheter. UAB is the first hospital in Alabama to use this new technique, which replaces open-heart surgery. This means Dylan, and others like him, likely will have fewer surgeries than they may have faced a few years ago.

When Dylan came into the world Jan. 29, 1997, he was diagnosed with tetralogy of Fallot, a congenital heart defect involving four abnormalities — including an obstruction of blood flow from his heart to his lungs, a hole between the two bottom chambers of his heart, a misplaced aorta and enlargement of his heart’s right ventricle.

At 6-weeks-old, Dylan had his first open-heart surgery to repair the hole, called a ventricular septal defect, and correct a pulmonary valve obstruction.

When he was 5, Dylan’s mother, Dana Fields, says he became so tired “he didn’t want to eat.” Doctors decided he needed a new pulmonary valve, so during a second open-heart surgery they inserted one from an organ donor, but the experience was initially very taxing.

“He was on the ventilator overnight. He was crying. He had all of this stuff attached to him, and it was hard,” his mom says.

Despite that rough night in intensive care, Dylan made a complete recovery as a typical active little boy — thriving, going to school, playing with his friends and family. Fast-forward 10 years and Dylan, a budding high-school soccer player, started feeling tired again.

“I got short of breath a lot,” Dylan said. “I play mid-field, and it felt pretty bad. I would get out of breath the first two laps.”

“He would go to bed at night and wake up the next morning like he hadn’t even been asleep,” Fields says. “He was pale. He was getting where he couldn’t stay and hang with the other kids his age.”

Fields brought Dylan in to see his cardiologists at UAB -- the replacement valve he received 10 years earlier was failing.

“Dylan had an enlarged right ventricle because of his valve abnormality,” says UAB pediatric cardiologist William McMahon, M.D. “The valve that was replaced when he was 5 no longer worked very well and leaked. When surgeons replace a pulmonary valve, we hope that it is going to last 15 to 20 years. But often dysfunction occurs earlier than that because it becomes blocked or leaks. Dylan developed a substantial amount of leakage, and the pulmonary valve needed to be replaced.”

Until recently, replacing someone’s pulmonary valve required open-heart surgery. But McMahon offered the Fields another option — using the minimally invasive Melody Valve procedure to repair Dylan’s faulty pulmonary valve. The Melody Valve is a newly designed device with a valve mounted inside a stent. The stent is mounted on a balloon catheter and delivered from a small incision in the patient’s groin up into their heart.

McMahon says the Melody Valve is used in a fairly small subset of patients — ones born with congenital heart disease who already have had a pulmonary valve-replacement operation. The procedure, he says, can be a better alternative for patients who need multiple operations to replace the pulmonary valve.

“To some extent each new operation carries additional risk — each time you open the chest cavity and each time a patient goes on cardiac bypass,” he says. “If we can reduce the total number of operations Dylan is going to need in his lifetime by two – by replacing the pulmonary valve with a Melody Valve then in this case – I consider this a better alternative to an open procedure.”

So far, Fields says she is very happy with the Melody Valve and is pleased with the outcome.

“I’m glad we did it,” Fields says. “Unlike when he was younger, I was actually able to see him as soon as he got out (of surgery), and I was able to be in the recovery room with him. It was a lot better. And one of the things I noticed about him was that he had color in his lips and cheeks; they were real pink, and he wasn’t as pale. ”

Dylan’s recovery was short, McMahon says, much like standard catheterization procedures.

“In general a recovery time of two to three days for a procedure such as this is expected, then back to full activity,” he says. “This is compared to four to six weeks for open-heart surgery.”

Dylan, who was able to go back to school about a week after getting his new valve, agrees and says he hopes he will get to play baseball this season.

“Dr. McMahon said that we will talk about it,” he says.

Fields is optimistic.

“We will discuss it more in a couple of weeks but the chances are better than with open heart surgery,” she added. “With open heart there would be no way.”

McMahon, too, is optimistic. He feels good about how long Dylan can go without another open procedure.

“The idea behind the Melody Valve transcatheter therapy is to extend the life of the previously placed surgical valve,” he says. “We did not replace the need for another operation. We know it’s likely Dylan will need another operation to replace this pulmonary valve in the future. But, in Europe where the Melody Valve has been used for five or six years longer than in the United States, more than half the patients go more than five years after Melody Valve implantation before needing surgery. And, some patients are approaching 10 years.”

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