HHT- A Time Bomb-Treatment

Original article in Hebrew by Yifaat Gadot, Hadar Farber, www.nfc.co.il - 01.02.2008

A large group of doctors spent time at the Cardiology Department at Schneider Children's Medical Center of Israel learning from Dr. White, a world expert in HHT, how to treat
patients with this disease.

Only a couple of hours and the expertise of a "virtuoso", as his colleagues call him, were
required to treat one of the HHT patients and prevent a lethal blood emboli reachin his brain
and risking his life.

This patient, one of many, came to Schneider Children's hospital last month.
Dr. White also came to Schneider Children's Hospital to treat him and to support the HHT
clinic at Schneider. He is seeking funds for this unique HHT center.

Dr. White came to participate in the annual meeting of the Israeli HHT patients' foundation.
A group of doctors came to Schneider to watch Dr. White in action. We, being quite curious,
joined them. Patients with HHT may suffer from abnormal blood vessels, called arterio-venous
or AVMs.

This HHT patient, an active man in his fifties, has two lung AVMs. These AVMs should be
treated before they cause complications. This man already had symptoms from blood emboli
(blood clots) reaching the brain through the AVMs. The closure of these AVMs was done to
prevent further emboli to reach the brain.
The closure is done as an ambulatory procedure. The blood vessel is being blocked by a plug.
This procedure- embolization, is done by inserting a small catheter into a large vein in the groin.
The catheter is being advanced into the pulmonary artery and to the AVM. A coil  is being
inserted into the artery that feeds the AVMs and block it. The procedure usually lasts 1-3 hours
and the patient requires a couple of hours for recovery.

We could watch the patient through the cath lab window. He was given light sedation and was
very relaxed, knowing he is being treated by Dr. White. Dr. Elhanan Bruckheimer, the director
of the cath lab at Schneider CMCI was assisting Dr. White. Dr. Bruckheimer has extensive
experience in this procedure, which is done in only a few centers around the world. 

The patient, being awake throughout the catheterization, is asked every once in a while to
hold his breath or to cough, in order to better visualize the malformations.
Dr. White does not forget to update the patient on how the procedure is proceeding and
that "everything is under control". After the catheter is inserted, Dr. White injects contrast
material which demonstrates the location and size of the AVM. In healthy people the
pulmonary arteries split into capillaries, small vessels, where gas exchange is happening.
In HHT patients some blood vessels remain large with no capillary formation.
These large vessels can become a route for emboli to the brain and Dr. White's aim is to
close the blood vessel and prevent these complications.
No doubt, these moments convince us that the future has arrived. Dr. White will catheterize
some more patients and go back to the US.

We will continue with the plan to raise money and to open a HHT center in Israel.

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