Weaving Indigenous Textile Art Into Cardiac Devices

Abstract

ongenital structural heart defects are more frequent at higher altitudes possibly because of effects of low oxygen tension on pulmonary vascular resistance. 1 As pediatric cardiologists living in La Paz, Bolivia (altitude, 12 000 feet [4000 m]), we frequently encounter children with large functionally limiting defects-primarily patent ductus arteriosus with left atrial and ventricular dilation as large as the postductal aorta and atrial septal defects lacking appropriate borders for percutaneous occlusive therapythat cannot easily be managed with commercially available devices. Because open corrective heart surgery is unimaginable for all but the most extreme cases in La Paz, Bolivia, we sought to develop an alternative percutaneous solution, a biocompatible occlusive device that would be durable across a lifetime of cardiac cycles.Commercial devices to occlude structural heart defects comprise woven mesh discs that expand to fill the defect. Many of our patients are indigenous Aymara people for whom weaving is an essential skill. It occurred to us that the skills of Aymara weavers visible everywhere in the textiles of our culture might be used to develop an occlusive device unique to the needs of our patient population. We formed a multidisciplinary team of weaver artisans, biomedical engineers, and physicians to pursue the idea. The artisans helped us identify a weaving pattern appropriate to the materials and bioengineering requirements of the devices: the Andean cross or chakana, a simple cross with a superimposed square. Symbolically the chakana is said to represent pure symmetry of a universe without beginning, end, center, or direction. Practically, it was an already-familiar pattern and technique that could be used to weave a device of variable size using a single strand of material without soldered or welded connections so it could not corrode or break. The biomedical engineers helped us identify nitinol, a nickel-titanium alloy, as the ideal material because it is elastic and has structural "memory," so it can be collapsed and delivered within a catheter to the heart where it can expand to its original shape and occlude even the largest of structural defects.After extensive development and testing, we now have a team of about 40 craftswomen who undergo 4 months of training to perfect their weaving skills in the laboratory so they can reliably reproduce the double-disk net design of the occluders within basic requirements of quality control, steriliza-

JAMA’s The Arts and Medicine Section at 5 Years—Progress and Opportunities

“…Exemplar essays include but are not limited to descriptions of a tattoo practice to help women recover from disfiguring breast cancer surgery; indigenous weaving techniques to create occlusive devices for infants with congenital cardiac septal defects; a program to encourage patients to develop their own art for their clinical spaces; and use of works of poetry and music to advance relationships with patients …”