Pediatric Pathways

Landon's Heart is Good to Go Thanks to "Hybrid" Repair

Drs. Anagnostopoulos and Lamers teamed up to fix Landon's heart.It was just a few days before Christmas 2012 when Emily and Nick Bartels of Monroe, Wis. were preparing to bring home their new baby son, Landon, from the hospital for the first time. Just before they were about to leave Monroe Clinic Hospital, however, things changed very quickly. Results from an echocardiogram showed some serious heart problems, meaning that Landon was rushed to American Family Children’s Hospital in Madison.

“We did not get to go home right away,” remembers Landon’s dad, Nick. “Our plans for a happy homecoming would have to wait a little bit.”

Ultimately, the Bartels learned that their baby son had four heart defects: hypoplasia of the transverse aortic arch with coarctation (narrowing) of the aorta, as well as three holes in the heart – two ventricular septal defects (VSD) and one atrial septal defect (ASD). While surgical repair of a baby’s VSD or ASD is normally a fairly routine operation, Landon’s case was especially challenging because one of his VSDs was located deep at the apex of the heart – not an easy place to reach with conventional cardiothoracic surgery.

Landon, with parents Emily and NickEmily and Nick were quickly introduced to physicians, nurses and other team members of the Pediatric Heart Program at UW Health’s American Family Children’s Hospital in Madison. After extensive testing and evaluation, a two-pronged plan of attack was planned for Landon’s heart defects: surgically repair the aortic arch right away, but watch and wait to see if the three holes would close on their own.

“We always want to minimize surgery for a small baby if at all possible,” says Petros Anagnostopoulos, MD, chief of pediatric cardiothoracic surgery at American Family Children’s Hospital. “So, we repaired his coarctation when he was four days old. By the time he was three months old, however, Landon came back to us experiencing heart failure. His two VSDs and ASD failed to begin closing on their own and this could have led to trouble had we not intervened. Moreover, Landon’s aorta remained underdeveloped, requiring a little more work since his first surgery, so we had several concerns to address.”

Knowing that one of the VSDs would be especially challenging to repair surgically, Dr. Anagnostopoulos and pediatric cardiologist Luke Lamers, MD, offered the Bartels family a hybrid solution incorporating the best of both worlds – surgery to repair one VSD and a catheterization-style approach to fix the other one. Landon's ASD was very small and would easily be stitched surgically. On April 2, 2013, Landon returned to American Family Children’s Hospital. There, Dr. Anagnostopoulos partnered with Dr. Lamers to repair Landon’s VSDs in two very different manners.

“After Dr. Anagnostopoulos opened up Landon’s chest and exposed his heart,” says Dr. Lamers, “I focused on the VSD located at the heart’s apex, which was patched by inserting an AmplatzerTM muscular VSD device through a small catheter that went into the anterior wall of the heart. Then, Dr. Anagnostopoulos surgically repaired Landon’s other VSD and further widened the aortic arch. Landon did wonderfully and was home in less than a week.”

Emily, a teacher and track coach in Cuba City, and Nick, who owns a sandblasting business in Monroe, never dreamed about spending so much time in the hospital after their son was born. However, both felt they were in the right place, despite the complexity of the two-pronged approach to correcting Landon’s heart defects.

“Dr. Anagnostopoulos and Dr. Lamers were very upfront with us,” Emily says. “They told us this was a little riskier than a typical surgery to fix a hole in the heart, but we knew Landon was in very capable hands. They patiently answered all of our questions and explained how everything would go. This really eased our anxiety and made Nick and I feel very reassured.”

Now 6 months old, Landon is doing well and should grow normally. His Dean Clinic pediatrician, Kamil Sayegh, MD, and pediatric cardiologist, Larry Weinhaus, MD, see him during periodic check-ups. Landon is looking forward to a happy, healthy life.