Dr. Bryan Goldstein, a pediatric interventional cardiologist at Cincinnati Children's Hospital Medical Center, jumps at the chance to be a problem solver. Two years ago he collaborated with other doctors to save the life of a liver transplant patient. The approach he developed is now being used to save other lives.
The 14-year-old patient, Leah, (at the family's request we're not using her last name) had cystic fibrosis and a failing liver. A few months after a liver transplant she started having problems including trouble breathing and fluid in the abdomen. The specifics are detailed in the October 25, 2016 issue of The Journal Of Pediatrics.
Doctors determined the blood vessel connections with the new organ didn't fit right and blood wasn't getting out of the liver. Goldstein drew an idea on a napkin for transplant hepatologist John Bucuvalas. It involved an off-the-shelf stent used to treat narrowing of blood vessels, but it allowed for growth.
"In this approach, what we've done is used a balloon expandable stainless-steel stent. We've used a number of different balloons to shape that stent to match the patient's blood vessels and the patient's anatomy," says Goldstein.
The stents grow over time to match the blood vessels.
Surgeon Greg Tiao likes the idea but still has some reservations. "One of the consequences though is by having this expandable stent in the blood vessel, should the patient ever need to be transplanted in the future, for whatever the reason, having that metal int he area that we have to reconstruct venus outflow in the future can create some technology challenges."
In the video below you see an unobstructed flow between Leah's heart and her liver thanks to a stent that grows with the child's body. It has a specialized "hole" that accommodates her liver vein connected to the inferior vena cava (IVC).
Since this first case in 2015, Children's has helped a half a dozen more patients in similar situations.