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Franz P. Freudenthal | |
|---|---|
| Born | La Paz, Bolivia |
| Nationality | Bolivian |
| Occupation | Physician |
Franz P. Freudenthal is a Bolivian physician who is known for several medical inventions, including a device that can cure heart ailments in children.[ citation needed ]
Franz P. Freudenthal was born in La Paz, Bolivia to German immigrant parents.
He was inspired to enter medicine by his grandmother, Dr. Ruth Tichauer of Wreszinski, who was born in Königsberg in 1910 daughter Walter Wreszinski and died in La Paz in 1995. [1] He used to go with her as a child on her medical visits in remote rural areas of Bolivia. [1] [2] She was a pioneer in family planning and in outpatient treatment of tuberculosis, and shared her philosophy of life with Freudenthal. [1] He attended the Higher University of San Andrés in La Paz for his undergraduate studies, then did his internship at Children's Hospital of La Paz. He decided to specialize in pediatric cardiology. His wife, Alexandra Heath, is also a doctor. The couple received scholarships to take specialized training in Germany. [2] He performed his first operation on a child in Germany in the 1990s. [1]
Freudenthal became interested in medical devices. [1] He was part of a team that in March 1998 reported encouraging results of tests on neonatal lambs for occlusion of patent ductus arteriosus with a double-helix device at RWTH Aachen University, Germany. The devices used memory-shaped double-cone stainless steel coils mounted on a titanium/nickel core wire. [3] Freudenthal said that by the age of 25 he had treated more than 20 sheep with devices, and at the age of 29 had treated his first patient, a child that could not be cured in any other way. [1]
After returning to Bolivia in 2003 the Freudenthals founded Kardiozentrum, a center for diagnosis and treatment of congenital heart disease. They also created PFM Bolivia, to develop and market medical devices. In 2014 Freudenthal was heading a team of 80 young innovators on a new project to develop a treatment for strokes. [2] Freudenthal has taken out a number of patents including a left atrial appendage occlusion device, embolization device, tissue clip, tissue tack, snare mechanism for surgical retrieval and deployment device for cardiac surgery. [4]
Freudenthal is known for his Nit Occlud device for treatment of an infant heart problem. The prototypes were first tested on sheep, and since then have been used successfully by Freudenthal on hundreds of children, and have been exported around the world. The device treats a congenital disorder in the heart known as a patent ductus arteriosus (PDA). [5] This occurs when the ductus arteriosus blood vessel, which bypasses the lungs before a baby is born, fails to close up soon after birth. The affected infant suffers from labored breathing, failure to gain weight and other problems. The condition is much more common in Bolivia, where the country around La Paz is at an elevation of 4,000 metres (13,000 ft), than in other places. [5]
The device is made from a single wire of nitinol, a flexible alloy of nickel and titanium. [2] Nitinol was originally developed by the US military. [1] The tiny Nit Occlud devices are small and intricate, and difficult to mass-produce. Instead they are woven by Aymara women in a "clean room". It takes about two hours to make each device. [5] The device can be placed without an invasive operation, using cardiac catheterization. [2] Nitinol is able to memorize its shape. The device is folded up and inserted into a catheter which is inserted into the groin and then run through blood vessels to the position in the heart where it is to be placed. The device is released and returns to its original shape, blocking the hole that caused the heart problem. By using a minimally invasive approach the technique addresses the concerns of some indigenous people of Bolivia that to manipulate the heart is to desecrate the soul. [5] It takes about 30 minutes to place the device. [6]
Technically, the Nit-Occlud ASD-R, is a double-umbrella, self-expanding, self-centering and premounted device knitted from a single nitinol wire without any soldering or protruding clamps or screws. The Nit-Occlud is similar to other self-expandable devices, which have provided excellent long-term clinical outcomes. [7] The device has a unique shape that offers various advantages and a special snare-like release mechanism. It ranges in size from 8 to 30 millimetres (0.31 to 1.18 in) in stent diameter. [8] The first human implantation was done at the La Paz Kardiocentrum by Alexandra Heath and coworkers. 53 implantations were made by this group from May 2007 to February 2011. Four attempts failed. Of the 53 implantations, complete closure occurred immediately in 71% of patients, and 100% after six months. [9] Findings are generally very positive, although the erosion rate is not yet known. [10]
In August 2014 it was announced that Freudenthal had won the "Innovators of America" award in the Science and Technology category for his occlusion device to cure congenital heart disease in children. The award is given by Innovative America, is sponsored by the CAF – Development Bank of Latin America and the Caribbean and the Spanish CAF Ezentis group, and was to be presented in Medellín, Colombia on 21 August 2014. [2] As of 2014 the device had cured at least 50,000 children worldwide, and about 500 in Bolivia. [6]
Congenital rubella infection (CRI) occurs when a fetus contracts the rubella virus via maternal-fetal transmission. It can result in various outcomes ranging from asymptomatic infection to congenital defects to miscarriage and fetal death. Congenital rubella syndrome (CRS) refers to a congenital rubella infection that results in various presentations of birth anomalies. If infection occurs 0–11 weeks after conception, the infant has a 90% risk of being affected. If the infection occurs 12–20 weeks after conception, the risk is 20%. Infants are not generally affected if rubella is contracted during the third trimester. Congenital rubella syndrome was discovered in 1941 by Australian Norman McAlister Gregg.
Cyanosis is the change of body tissue color to a bluish-purple hue as a result of having decreased amounts of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Body tissues that show cyanosis are usually in locations where the skin is thinner, including the mucous membranes, lips, nail beds, and ear lobes. Some medications containing amiodarone or silver, Mongolian spots, large birth marks, and the consumption of food products with blue or purple dyes can also result in the bluish skin tissue discoloration and may be mistaken for cyanosis.
Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs through the aorta, which has a higher blood pressure, to the pulmonary artery, which has a lower blood pressure. Symptoms are uncommon at birth and shortly thereafter, but later in the first year of life there is often the onset of an increased work of breathing and failure to gain weight at a normal rate. With time, an uncorrected PDA usually leads to pulmonary hypertension followed by right-sided heart failure.
Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale; however, when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). It is common in patients with a congenital atrial septal aneurysm (ASA).
Blue baby syndrome can refer to conditions that cause cyanosis, or blueness of the skin, in babies as a result of low oxygen levels in the blood. This term has traditionally been applied to cyanosis as a result of:
A congenital heart defect (CHD), also known as a congenital heart anomaly, congenital cardiovascular malformation, and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular disease. Signs and symptoms depend on the specific type of defect. Symptoms can vary from none to life-threatening. When present, symptoms are variable and may include rapid breathing, bluish skin (cyanosis), poor weight gain, and feeling tired. CHD does not cause chest pain. Most congenital heart defects are not associated with other diseases. A complication of CHD is heart failure.
Coarctation of the aorta, also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus inserts. The word coarctation means "pressing or drawing together; narrowing". Coarctations are most common in the aortic arch. The arch may be small in babies with coarctations. Other heart defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in a lack of blood to the lower half of the body. Physiologically its complete form is manifested as interrupted aortic arch.
Helen Brooke Taussig was an American cardiologist, working in Baltimore and Boston, who founded the field of pediatric cardiology. She is credited with developing the concept for a procedure that would extend the lives of children born with Tetralogy of Fallot. This concept was applied in practice as a procedure known as the Blalock-Thomas-Taussig shunt. The procedure was developed by Alfred Blalock and Vivien Thomas, who were Taussig's colleagues at the Johns Hopkins Hospital.
Hypoplastic left heart syndrome (HLHS) is a rare congenital heart defect in which the left side of the heart is severely underdeveloped and incapable of supporting the systemic circulation. It is estimated to account for 2-3% of all congenital heart disease. Early signs and symptoms include poor feeding, cyanosis, and diminished pulse in the extremities. The etiology is believed to be multifactorial resulting from a combination of genetic mutations and defects resulting in altered blood flow in the heart. Several structures can be affected including the left ventricle, aorta, aortic valve, or mitral valve all resulting in decreased systemic blood flow.
Persistent truncus arteriosus (PTA), often referred to simply as truncus arteriosus, is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus fails to properly divide into the pulmonary trunk and aorta. This results in one arterial trunk arising from the heart and providing mixed blood to the coronary arteries, pulmonary arteries, and systemic circulation. For the International Classification of Diseases (ICD-11), the International Paediatric and Congenital Cardiac Code (IPCCC) was developed to standardize the nomenclature of congenital heart disease. Under this system, English is now the official language, and persistent truncus arteriosus should properly be termed common arterial trunk.
In humans, the circulatory system is different before and after birth. The fetal circulation is composed of the placenta, umbilical blood vessels encapsulated by the umbilical cord, heart and systemic blood vessels. A major difference between the fetal circulation and postnatal circulation is that the lungs are not used during the fetal stage resulting in the presence of shunts to move oxygenated blood and nutrients from the placenta to the fetal tissue. At birth, the start of breathing and the severance of the umbilical cord prompt various changes that quickly transform fetal circulation into postnatal circulation.
Prostaglandin E2 (PGE2), also known as dinoprostone, is a naturally occurring prostaglandin with oxytocic properties that is used as a medication. Dinoprostone is used in labor induction, bleeding after delivery, termination of pregnancy, and in newborn babies to keep the ductus arteriosus open. In babies it is used in those with congenital heart defects until surgery can be carried out. It is also used to manage gestational trophoblastic disease. It may be used within the vagina or by injection into a vein.
Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In infants with congenital heart defects, it is delivered by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
Interrupted aortic arch is a very rare heart defect in which the aorta is not completely developed. There is a gap between the ascending and descending thoracic aorta. In a sense it is the complete form of a coarctation of the aorta. Almost all patients also have other cardiac anomalies, including a ventricular septal defect (VSD), aorto-pulmonary window, and truncus arteriosus. There are three types of interrupted aortic arch, with type B being the most common. Interrupted aortic arch is often associated with DiGeorge syndrome.
Fetal hydantoin syndrome, also called fetal dilantin syndrome, is a group of defects caused to the developing fetus by exposure to teratogenic effects of phenytoin. Dilantin is the brand name of the drug phenytoin sodium in the United States, commonly used in the treatment of epilepsy.
Nickel titanium, also known as nitinol, is a metal alloy of nickel and titanium, where the two elements are present in roughly equal atomic percentages. Different alloys are named according to the weight percentage of nickel; e.g., nitinol 55 and nitinol 60.
Atrial septostomy is a surgical procedure in which a small hole is created between the upper two chambers of the heart, the atria. This procedure is primarily used to palliate dextro-Transposition of the great arteries or d-TGA, a life-threatening cyanotic congenital heart defect seen in infants. It is performed prior to an arterial switch operation. Atrial septostomy has also seen limited use as a surgical treatment for pulmonary hypertension. The first atrial septostomy was developed by Vivien Thomas in a canine model and performed in humans by Alfred Blalock. The Rashkind balloon procedure, a common atrial septostomy technique, was developed in 1966 by American cardiologist William Rashkind at the Children's Hospital of Philadelphia.
Left atrial appendage occlusion (LAAO), also referred to as left atrial appendage closure (LAAC), is a treatment strategy to reduce the risk of blood clots from the left atrial appendage entering the bloodstream and causing a stroke in those with non-valvular atrial fibrillation (AF). The left atrial appendage can be occluded, closed, by an endovascular implant, or by ligation. Occlusion of the left atrial appendage is presently approached with medical devices that can be deployed inside of the heart or externally as a ligature. In non-valvular AF, over 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage.
Percutaneous pulmonary valve implantation (PPVI), also known as transcatheter pulmonary valve replacement (TPVR), is the replacement of the pulmonary valve via catheterization through a vein. It is a significantly less invasive procedure in comparison to open heart surgery and is commonly used to treat conditions such as pulmonary atresia.
Pulmonary atresia with ventricular septal defect is a rare birth defect characterized by pulmonary valve atresia occurring alongside a defect on the right ventricular outflow tract.