‘Donor heart from Karimnagar was too small for the patient’

It was meant to be just another cardiac surgery, adding to the growing number of heart transplants in the country, but at the end of it, the patient was left surviving with two beating hearts.

Doctors at Apollo Hospital, Jubilee Hills, on Saturday went into the operating room to give a 56-year-old man dying of heart failure a new lease of life. A donor heart was arriving from Karimnagar after its owner, 17-year-old Mekala Naveen Kumar, was declared brain-dead on Friday.

Mandate was to attempt a heart replacement, but when the donor heart arrived, cardio-thoracic surgeon A. Gopala Krishna Gokhale knew he had to attempt a radical procedure.

“The donor heart was of normal fist-size. The recipient’s heart was the size of a small football,” the surgeon said, explaining that the donor’s heart was too small for the recipient. The patient’s lung blood pressure had shot up four times above normal level while the aortic systole pressure had gone down. Time had run out.

“Plan B” was to put the donor’s heart alongside the patient’s heart. The procedure, colloquially referred to as “Piggyback Heart Transplant”, does not require removal of the deceased heart. Only about 150 such procedures have ever been reported, according to Dr. Gokhale.

Finding a matching donor heart from a cadaver is not easy. Besides problems of a match, logistics issue after finding a potential donor does not allow successful transplant. According to Dr. Gokhale, the heart from a brain-dead person has to be restarted within four hours of its being stopped.

Early on Saturday, the Karimnagar police provided a green corridor for transportation of the heart to Hyderabad without traffic snarls. Traffic officials along with a team of doctors from Apollo Reach in Karimnagar, where the donor was declared brain-dead, started at 6.50 a.m. and reached Apollo Hospital in Jubilee hills at 8.50 am.

Doctors cut away some part of the patient heart’s pericardium, to facilitate placing the new heart. The donor’s heart was finally squeezed between the right lung and the original heart in a procedure that lasted seven hours.

“Two hearts in the patient complement each other to facilitate circulation, but beat at different rates. It is once-in-a-lifetime procedure a doctor performs. Patient’s blood pressures are close to normal and he is stable. But there will be other issues in future,” Dr. Gokhale said.

Among them are a complex ECG pattern, two sets of pulses and an increased amount of difficulty in zeroing in on the organ should a heart-related issue arise.