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Whatever caused Carlos White's enlarged heart, a potentially fatal arrhythmia and a heart attack at the youthful age of 17 remains a mystery. But what's not a mystery is how doctors from the Heart Center at Children's Hospital of Pittsburgh of UPMC were able to nurture his heart back to health through the temporary use of a mechanical pumping device typically used as a bridge to a heart transplant.
Carlos had no history of heart problems prior to the 24 hours before he went into cardiac arrest in the fall of 2005. An asthma sufferer since birth, he was an otherwise healthy, lanky teenager who enjoyed basketball. "Over the summer I'd been playing basketball a whole bunch, and I really didn't feel like my heart was hurting or anything. It was just all of a sudden," he says. In fact, although he'd been playing basketball with friends the previous day, on Saturday, Oct. 22, his health dramatically changed. He was wheezing from asthma enough to concern his mother, Mia Allie. "He hadn't had an asthma attack in a couple years. It was the weekend. We couldn't find his inhaler," she recalled. The family took him to the emergency room of a local hospital. There, his irregular heart rate was detected, and he was kept for observation.
Carlos recalls that he really didn't feel sick enough to be admitted, yet when his heart rhythm hadn't stabilized in 24 hours, doctors decided to move him to the critical care unit. His heart, doctors later told the family, had swollen "like a balloon." While being wheeled to critical care, Carlos went into cardiac arrest. Eleven days later, he awoke at another location - Children's Hospital of Pittsburgh. His heart was stabilizing and being assisted on the left side by a Thoratec ventricular assist device (VAD).
As a leader in the field of pediatric heart and lung transplants, Children's Hospital of Pittsburgh is one of only a handful of pediatric facilities in the United States with credentials to offer VADs, and has done so since the mid-1990s. There, patients as young as newborns have benefited from the pumps, which are usually used as a bridge to a heart transplant. Supporting this surgical specialty, Children's has a team of engineers dedicated to monitoring a patient's condition while on a VAD.
When Carlos arrived at Children's five days after his initial emergency room visit, he already had a VAD device installed from the first hospital. It was supporting both sides of the heart and was not the type of VAD usually used for longer term needs, according to Carlos' surgeon, Victor O. Morell, MD, chief of the Division of Pediatric Cardiothoracic Surgery at Children's Hospital of Pittsburgh.
Even though the VAD was in place, Carlos' condition had not improved at the first hospital, and he was bleeding internally. "Everyone was concerned he might die," said Dr. Morell. Given Children's expertise in pediatric heart care and the possibility that he would need a transplant, a transfer was arranged. Carlos arrived with his chest still open and a breathing tube inserted. In deteriorating condition, Carlos needed kidney dialysis, his liver was failing and fluid was accumulating in his lungs. Still, in closely observing Carlos' condition, Dr. Morell's team determined that the right side of the heart was strong, but that the left side needed support. They replaced the biventricular VAD with a less intrusive univentricular Thoratec unit supporting the left side of the heart and closed his chest. The device worked perfectly, and several days later the breathing tube was removed.
Carlos responded well to medication, and soon it was clear to the medical team that a transplant would not be required. "We suspected that his ventricle could recover, given time; that this was an atrial rhythm dysfunction," Dr. Morell explained. "Lab tests confirmed that there was no abnormality of the muscle itself."
After seven weeks the VAD was removed. By mid-December, Carlos was discharged, making him the first patient of Children's to benefit from a VAD in which a heart transplant was not inevitable.
Looking back on the experience, one of the things about Children's that stands out to Carlos and his mother was the caring that came with the care. "Children's has a lot of compassion," said Mia, "and the doctors explained everything they were going to do."
"The doctors and nurses took good care of me," said Carlos. "The engineers came in every three or four hours to see how I was pumping. They brought me a PlayStation® to play while I was in the hospital."
The reason why Carlos had a rhythm issue that caused his heart to fail may never be known. But thanks to the care he received at Children's, today he is living a normal life as a young adult and looking forward to college.
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