Device gives young patient's heart time to heal, then function on its own

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Bill Wade, Post-Gazette photos
Carlos White, 18, gets a hug from nurse Lucy Thompson during his visit to Children's Hospital for a check-up.
Click photo for larger image.

They say that time will heal a broken heart.

It was true for Carlos White, who got the weeks he needed to mend when a left ventricular assist device was implanted in his chest to help his heart pump blood more effectively.

But unlike most people, Carlos, now 18, didn't have to get a heart transplant in order for the LVAD to be removed. To the delight of his doctors, the device was taken out because he no longer needed it. His own heart got better.

"This is really the first device we put in and took out in the same [hospital] admission, without having a heart transplant in between," said Dr. Victor Morell, chief of cardiothoracic surgery at Children's Hospital.

He added, "It's very unusual to get such a quick recovery."

Everything about Carlos' story seems to have happened at a rapid pace, and it's so remarkable that the surgeon is planning to report it in a medical journal.

On Oct. 22, the 17-year-old arrived at his North Side home just as his mother, Mia Allie, was about to leave for work. She thought he was wheezing and, because he has asthma, she told him to go to the emergency room at Allegheny General Hospital with his grandmother.

Doctors there found that his heartbeat was fast and a bit erratic, with a rhythm abnormality that started in the upper chambers of the heart, called the atria.

For a few weeks before that October day, at times "my heart did feel like it was beating real fast," Carlos said. "I didn't think anything of it."

Cardiologist Dr. Eric Quivers listens through a stethoscope to Carlos White's breathing. The young man's torso bears the scars of surgery to implant a heart assist device, which was later taken out.
Click photo for larger image.

The arrhythmia that led to the death last week of Army women's basketball coach, Maggie Dixon, probably began in the lower chambers or ventricles, which is more deadly, and autopsy reports indicate that she had an enlarged heart and mitral valve prolapse.

Carlos was transferred to an intensive care unit because he was getting worse, but he was still well enough to get up, walk to the gurney and climb on, his mother said.

"Next thing we know, they came and said he went into cardiac arrest and they had to bring him back," Ms. Allie remembered.

Desperate to stabilize him, surgeon Dr. David Dean put in an assist device that supported both the right ventricle, which pushes blood to the lungs to get oxygenated, and the left, which pumps oxygen-rich blood to the body.

Carlos probably had a cardiomyopathy, or heart muscle disease, perhaps caused by a virus, Dr. Dean said. He was transferred to Children's because Allegheny General does not perform pediatric heart transplants, and there was concern that Carlos might need one.

The Children's doctors thought that Carlos either had a cardiomyopathy that was causing arrhythmias or his erratic heartbeat was impairing the organ's pumping ability. Examination of his heart tissue did not show inflammation that often accompanies a viral infection, said Dr. Eric Quivers, director of the hospital's preventive cardiology clinic.

Regardless of the cause, "He was in pretty bad shape," Dr. Morell said. "We weren't sure if his ventricle was going to recover."

Carlos was put on the heart transplant list, just in case. His liver was failing, he needed dialysis to do the work of his kidneys, and fluid had accumulated in his lungs.

Children's surgeons took him back to the operating room to put in an LVAD, which could stay in place longer than a biventricular device. They hoped to buy time to correct his heartbeat irregularity, and that in turn would improve his heart function.

More typically, LVADS are used as a so-called "bridge to transplant" in children with a severe cardiomyopathy. They have been used as a "bridge to recovery" in some adult patients.

Mia Allie, left, and her son, Carlos White, chat with nurse practitioner Erin Colvin during a visit to Children's Hospital last month.
Click photo for larger image.

With the device in place, doctors treated Carlos' arrhythmia, and he steadily improved. Soon, he didn't need a ventilator to breathe for him. Once awake and aware of what was happening, he couldn't imagine a heart transplant in his future.

"I knew I wasn't going to need one," Carlos said. As for the LVAD, "you could hear it beeping all night."

"It sounded like a bomb," said his mother, laughing. Neither expected that he would need it for long.

And by mid-December, after tests showed that Carlos' heart was pumping well, the assist device was taken out. "For us it was a surprise," Dr. Morell said. "It only took about a month or so and his ventricle had recovered."

Three days before Christmas, Carlos was discharged from the hospital.

"His [heart] function is not quite back to normal," said Dr. Quivers. "The main thing is that we're able to support him with oral medications and he's able to go around and do things."

Between hospital admission and discharge, the former football player's weight dropped from 178 pounds to 127. He's picked up close to 30 pounds since he's been home, and he is getting physical therapy.

Carlos currently takes five medications, including blood pressure and anti-arrhythmics drugs, but he might eventually be able to stop taking a few of them.

"I really don't care as long as they keep me healthy," he said. "I have to take a couple of them forever."

He plans to go to community college in the fall. His mother thinks he'd be a good teacher; he jokes he's spent enough time in the hospital to be a heart surgeon.

"This has been a heck of a turnaround," Dr. Quivers said. "It was really uplifting to have him be able to recover."


Anita Srikameswaran can be reached at anitas@post-gazette.com or 412-263-3858.


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