First-for-SA heart procedure saves tiny two-month old baby Miané

Youngest patient to undergo a successful cardiac ablation procedure

Monday, June 22 2015

Suffering from a life threatening heart condition, two-month old Miané Burger, from Kriel in Mpumalanga, successfully underwent an emergency procedure at Netcare Sunninghill Hospital in Johannesburg recently to save her young life. It is the first time in the history of South African medicine that an ablation heart procedure has been performed on such a young baby.

According to paediatric cardiologist Dr Kenny Govendrageloo, who practices at the hospital, the heart ablation procedure performed on baby Miané, who suffered from a dangerously fast heartbeat and weighed just 3.3 kg at the time of the procedure, was a success. He adds that such procedures are sometimes performed on children weighing around 10 kg in this country but not to date on such a tiny baby.

“While we will have to monitor her closely over the coming weeks, baby Miané has a stable heart rhythm for the very first time in her young life and we are hopeful that we have been able to fully correct her heart problem. She is now putting on weight rapidly, and her parents, Marlene and Schalk, are thrilled that they are now able to hold and cuddle her,” explains Dr Govendrageloo.

Jacques du Plessis, managing director of the Netcare hospital division, congratulated the highly experienced cardiac team at Netcare Sunninghill Hospital who operated on Miané and saved her life. “This was truly a collaborative effort which included international consultation, and we are absolutely delighted by the outcome. The procedure is a significant step forward for paediatric heart medicine in our country,” added Du Plessis.

Dr Govendrageloo says that baby Miané had a rapid heartbeat of some 224 beats per minute even before her birth. She consequently had to be delivered by emergency caesarean section prematurely at 33 weeks in a hospital in Trichardt, Mpumalanga, on 20 April 2015, weighing 2 kg at birth. Her paediatrician, Dr Mario Karl, was in constant contact with the team at Netcare Sunninghill Hospital during the struggle to stabilise her heart rhythm. When that failed, every effort was made to get her strong enough so that she could be airlifted to Netcare Sunninghill Hospital, which has a specialist cardiac unit for children.

“Once baby Miané was in our care, we tried conventional medicines as well as electrical cardioversion to try to shock her heart into a normal rhythm, but none of these approaches succeeded in stabilising her. There were brief periods of normal heart rhythm interspersed with an abnormally fast rhythm of 210 beats per minute and we soon realised that we had no other choice than to perform an ablation procedure to try and save her. However, I can tell you we were extremely apprehensive about doing the procedure on such a small baby!”

According to Dr Govendrageloo, the cardiac team initially hoped that they could keep Miané stable enough for her to gain an additional two kilograms, so she would weigh at least four or five kilograms for the procedure. However, despite their very best efforts, the team soon realised that baby Miané was in danger of going into complete heart failure and they decided to perform an emergency procedure in an attempt to save her.

“We had to brief her parents on the potential risks of this operation on such a young child. These had to be weighed against the risk of not operating, as her condition had become critical,” observes Dr Govendrageloo.

“I think the medical team, which included Dr Andrew Thornton, a cardiologist specialising in heart rhythm disorders and her paediatrian, Dr Christa Swanepoel broke a massive mental barrier when they performed this highly intricate procedure. Prior to this, they would simply never have considered doing an ablation on such a tiny child. The team have clearly demonstrated that in the hands of a skilled and experienced team such a procedure can indeed be successfully undertaken,” explains Jacques du Plessis.

Dr Thornton, who also practises at Netcare Sunninghill Hospital, says an ablation procedure involves a special catheter being inserted through a vein which is remotely navigated up to the heart.

In baby Miané’s case, the doctors initially planned to perform a cryoablation procedure, which destroys the troublesome piece of heart tissue by freezing it. “However, it soon became clear that the catheter necessary for a cryoablation procedure was too large for the diminutive patient, and so we had to change tack and instead use a smaller electrode catheter, to ablate the tissue using radiofrequency energy,” observes Dr Thornton.

“Once the abnormal pathway had been destroyed, we took the precaution of waiting 20 minutes to see how baby Miané responded before taking her out of the operating theatre. To our absolute delight, the racing heart rate did not return. The following morning, she was taken off the ventilator and had a completely normal heart rhythm.”

Dr Govendrageloo describes the procedure of about two and a half hours as “a real team effort”, which would not have been possible without Dr Thornton, anaesthologist Dr Deane Murfin, and the dedicated nursing team at hospital’s cardiac unit.

“We were fortunate that Netcare Sunninghill Hospital has a dedicated paediatric cardiac unit with state-of-the-art equipment, as well as an electrophysiology laboratory, which is used for the diagnosis and treatment of heart rhythm disorders. In addition we could call on the services of Dr Thornton, who is an expert in the field of adult health rhythm disorders.”

Dr Govendrageloo says that the team also had the benefit of being able to call on international expertise to assist. “There are no doctors who specialise in heart rhythm disorders in children, or paediatric electrophysiology, in South Africa, so we were most fortunate to also be able to send baby Miané’s medical records and scans to paediatric electrophysiologist Dr J Philip Saul from the USA and consult with him regarding her treatment.”

While the signs are very hopeful for baby Miané, Dr Thornton says that she is not completely “out of the woods” yet, as there is a 10 to 20 per cent chance of the condition reoccurring. “We have to wait for the medication we gave baby Miané prior to the operation to wear off before we can determine whether the surgery has completely corrected the heart defect. We will only be sure in two months’ time and are hoping we have cured her of her condition.”

The general manager of Netcare Sunninghill Hospital, Pieter Louw described the ablation procedure as “remarkable” and paid tribute to the team that was responsible for baby Miané’s care.

“We are honoured to be able to work with such outstanding specialists as Dr Govendrageloo, Dr Thornton and Dr Swanepoel. That they were able to successfully perform this operation on such a tiny baby demonstrates their outstanding expertise as well as the enormous care they have for their patients. We wish the baby Miané and her proud mom and dad all the very best” Louw stated.


Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare
Contact : Martina Nicholson, Graeme Swinney, Sarah Wilson or Meggan Saville
Telephone: (011) 469 3016
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