Complex surgery first of its kind worldwide Doctors in Bonn save girl (15) with unique technique
Bonn · For 14 years, Adea was able to lead a largely normal life - despite severe heart disease. But then she received a shocking diagnosis. Doctors in Bonn have now saved her with a technique that is unique worldwide.
Only the access at the neck, through which Adea Cerkini receives infusions, still bears witness to the serious heart operation that took place only a few days ago. The 15-year-old from Kosovo smiles as her two life-savers approach her bedside at the University Hospital (UKB) in Bonn. Adea suffers from a congenital heart defect, which the head doctors Farhad Bakhtiary and Boulos Asfour have remedied for the time being. In doing so, they entered new surgical territory themselves: the complex operation was the first of its kind worldwide.
The heart defect has accompanied Adea all her life. Doctors call it a complete atrioventricular septal defect (AVSD) when the septum between the atria and the ventricles is malformed. Such heart defects account for only about three percent of all congenital heart defects. Half of the affected children, like Adea, have Down's syndrome. The 15-year-old had a hole in both the atria, the smaller cavities of the heart, and the ventricles, the larger cavities of the heart.
After 14 years, a new operation became necessary
That is why she was operated on for the first time in December 2008, when she was still an infant. The hole was closed with a kind of patch. For 14 years, Adea was able to lead an almost normal life - until a new diagnosis was made last autumn during the annual routine check-up in Kosovo: Adea suffers from subvalvular aortic stenosis, a narrowing of the aorta below the aortic valve - caused by hardened tissue that has developed and grown over time.
This put more and more strain on her small body, as Farhad Bakhtiary, Director of the Clinic for Cardiac Surgery, explains. The narrowed aorta caused a functional weakness of the heart and shortness of breath even with the slightest exertion. "The left ventricle of the heart, as the main pumping chamber, pumps oxygen-rich blood into the body through the aortic valve via the main artery. If the opening to the aorta is too narrow, as in Adea's case, a bottleneck forms, figuratively speaking, and the left ventricle has to work harder and build up more blood pressure to pump enough blood into the body," says Bakhtiary. This extra work causes the heart muscle to thicken. And the narrower the area, the less oxygen-rich blood gets into the body.
In this case, only an operation to remove the excess tissue can help. But such a special operation is hardly possible in Kosovo, where medical care is much worse than in Germany. Therefore, relatives of the family living in Germany researched experts in Europe. For several weeks, they were in contact with various clinics in Germany and finally decided on the UKB. Afterwards, the relatives took care of the financing of the vital operation, which costs several tens of thousands of euros.
Worldwide unique operation in Bonn
The operation performed by the Bonn doctors is unique worldwide. Bakhtiary used an endoscope for this new operation and did not open the entire chest, as is usually done and had been done before with Adea. That would have put a lot of strain on the 15-year-old. "I looked at all the documents, ultrasound and CT images very carefully and then, together with my colleague Boulos Asfour, decided on a minimally invasive and fully endoscopic operation," Bakhtiary explains his procedure. This was only possible because the two surgeons have a lot of experience in the field. "While Professor Bakhtiary brought in his outstanding expertise from countless adult operations, I, as an experienced paediatric heart surgeon, was able to contribute to the fact that we were able to successfully transfer the innovative method to our young patient," says Asfour, who heads the Department of Paediatric Heart Surgery.
For several days, the two planned each incision. "We discussed all strategies eye-to-eye," says Bakhtiary. And if something doesn't go as planned? "Then there is a plan B, C or even D. The more experienced you are, the more far-sighted you think." The surgery itself took just two and a half hours. Through a small access between two ribs, Asfour and Bakhtiary reached the aorta. They worked with the smallest of tools using only screens and orienting themselves with cameras inside.
Children recover faster and better with new technology
"I was not nervous, but rather very concentrated. Such an operation is something special, if only because it is not routine," says 47-year-old Bakhtiary, who has a daughter himself. His wish is to use the gentle method more often on children with heart disease. "They can be discharged faster, need less painkillers and their growth is not disturbed." Adea was able to walk around the ward just two days after surgery. Adea's mother Shqipe Cerkini could hardly believe it, she said. "She was looking for wounds and it was only then that she understood the magnitude of it. She was completely speechless." Adea is now in the normal ward. She is due to return home at the end of the week. She now has the perspective of being able to lead a normal life. "We cannot express our gratitude in words," says Shqipe Cerkini. (Original text: Nicolas Ottersbach / Translation: Mareike Graepel)