KZN boy first recipient in Africa of a mechanical heart

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A five-year-old boy from Newcastle in KwaZulu-Natal has become the youngest patient on the African continent to undergo a lifesaving mechanical heart implantation.

Mnotho Mndebele, who had been in a critical condition in intensive care for four consecutive months prior to the ground-breaking operation, had a heart ventricular assist device (HVAD) implanted at Maboneng Heart Institute situated at Netcare Sunninghill Hospital, to keep his severely damaged heart functioning.

Dr Viljee Jonker, a cardiothoracic surgeon who led the implantation team, said that he was delighted with Mnotho’s progress since the procedure was performed a month ago. “The multidisciplinary team at the hospital involved in his treatment and care is absolutely thrilled with his progress, particularly as he had been seriously ill for months before the operation, and his recovery has therefore taken some time,” adds Jonker. “Now he has a new lease on life and is looking forward to going home to his family and friends.”

“We fully expect him to be able to go to school and do everything a normal young boy would do. However, unlike other children he will carry a small external battery pack for his implanted HVAD mechanical heart either on a belt around his waist, or in a small backpack. The batteries for the mechanical heart will have to be recharged every eight hours or so.”

At five years of age and having weighed only some 17 kilograms, Mnotho is the youngest patient in Africa, and one of the smallest and youngest in the world, to have had the benefit of a HVAD mechanical heart implant. He suffered from dilated cardiomyopathy (DCM), a condition in which the left ventricle of the heart becomes enlarged and weakened and is no longer able to pump blood properly. Jonker says that the cause of DCM can often not be determined.

“Mnotho had been on the heart transplant list but paediatric heart donations rarely become available. He had also been in and out of intensive care units at various hospitals in the year leading up to the operation. In his case, we opted to use the HVAD as a bridge to a future heart transplant. In reality, it is a lifeline until such time as a matching donor heart can be found for him to undergo a biological heart transplant,” he explained.

“The mechanical heart will help to restore normal blood flow by enabling the left-sided circulation of the heart to operate more effectively. It can only be used if the right ventricle of the patient’s heart is able to function adequately. It will also enable Mnotho to grow stronger and gain much-needed weight over the next few years, so that he will be healthy enough to undergo a heart transplant when a donor heart finally becomes available. While waiting for a donor heart we expect him to lead a fairly normal life, enjoying typical childhood activities.”

According to Jonker, increasingly more compact and efficient mechanical hearts are being developed. “They are being used more and more throughout the world as either a bridge to a biological heart transplantation, or even as an alternative to transplantation where this is either not possible or an option. Tragically, many people are not aware that we have world class paediatric heart transplantation and repair programmes, such as performed at the Maboneng Heart Institute, in place in South Africa,” Jonker said.

“Far too many children throughout Africa are sadly still left to die from conditions such as cardiomyopathy, a chronic disease of the heart muscle, because it is thought that nothing can be done for them. In fact, as this particular case illustrates, with early and appropriate medical intervention the great majority of children suffering from such conditions can be saved, often ending up living a normal life.

“There are numerous highly effective technologies and procedures available today to assist in the treatment of these conditions at specialised centres, and more awareness of this should be raised, so that children in need will be able to receive treatment timeously,” Jonker said.

The paediatric cardiac transplantation programme of Maboneng Heart Institute largely focuses on assisting children whose only viable hope for survival is major congenital cardiac surgery, a heart transplant or mechanical heart implantation. The Institute not only aims to provide appropriate management of advanced heart failure in paediatric patients and to prevent sudden cardiac events, but also surgically manages the great spectrum of congenital and adult cardiac disease.

“The Maboneng Heart Institute makes a range of life-saving options available to children suffering heart failure,” saysJonker, who heads up the unit’s paediatric cardiac transplant and artificial heart programme. “The prognosis for paediatric cardiomyopathy depends on various factors including the patient’s age and how advanced the heart failure is. The older the child is and the more advanced the stage of heart failure is, the greater the risk for the patient. We have seen good outcomes in patients where the condition is detected and treated early.”

In addition to its transplantation and artificial heart programmes, the Maboneng Heart Institute offers surgery covering the complete spectrum of congenital and acquired cardiac disease. This includes any inborn or acquired cardiac defects as well as a paediatric electrophysiology unit for the diagnoses and treatment of heart rhythm disorders. This enables young patients to be fitted with pacemakers or internal defibrillators to maintain normal heart rhythms, where this may be necessary.

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