MUMBAI: While angioplasty is a term associated with elderly patients, an 11-year-old city boy underwent the procedure on Saturday due to what doctors believe could be heart disease transmitted from the elderly donor’s heart transplanted into him 15 months ago. In September, he had developed breathlessness that led to discovery of a blockage.
In a country where heart donations are difficult to come by, paediatric heart failure patients often get hearts from donors who are decades older than them. The boy (name withheld for reasons of privacy) was 10 in July 2019 when he got a 60-year-old donor heart. He had to undergo the transplant following a heart failure diagnosis in August 2018.
“The boy was recovering extremely well from the transplant and had even begun playing cricket,” said cardiologist Dr Hasmukh Ravat from Fortis Hospital, Mulund, who operated on him on Saturday. For the child’s parents, who don’t want to be named, the September episode hurtled them back to his heart failure diagnosis in August 2018. “He had come back from playing football and complained of breathlessness,” said his mother. His heart continued to weaken thereafter, with him needing a mechanical pump implanted in his chest as well as specialized procedures to stay alive. “When we heard a heart from an O blood group donor was available in Indore, we agreed as time was running out,” she said.
The elderly heart, however, brought age-related cardiac problems such as plaque build-up in arteries, believes Dr Ravat. Donor-transmitted coronary atherosclerosis is a well-known entity in medical literature.
The family’s woes didn’t end here. The blockage was in the left main artery (one of the most important blood vessels in the body) that is to this day a contentious topic between cardiologists and heart surgeons; while surgery is supposed to be the best bet, new studies have shown that stents are not inferior to surgery in patients with moderate blockages. “We expected the procedure to be lengthy, but it was uneventful. We used special image guiding techniques to finish the procedure in 30 minutes,” said Dr Ravat, who operated along with Dr Atul Limaye and Dr Swati Garekar.
Dr Prafulla Kerkar, who heads the cardiology department of KEM Hospital, Parel, said the blockage could have been a “double whammy” caused by an elderly donor and the use of immunosuppressant drugs to avoid rejection of the donor heart.
Dr K R Balakrishnan, who has done the highest number paediatric heart transplants in the country at 120, said the practice of old donors for paediatric patients cannot be avoided in India. “In the US (where deceased donations are higher than in India), it would be rare for a paediatric recipient to get a heart from elderly donors, but here we have transplanted from 55-to 60-year-old donors to seven-year-old children,” he said. Of the 120 paediatric transplants, four needed angioplasty later due to blockages. When a paediatric patient is in urgent need of a heart, the doctor is more likely to think about saving the child’s life with elderly donor than about transmitting cardiac disease. “After the life-saving transplant, a simple angioplasty can always be done at a later date if needed,” said Dr Balakrishnan.
As for the little boy, his smiles and cricketing banter belie the fact that he has undergone a specialty procedure. Confessing he is an “average student”, all he desires is to emulate his ‘hero’, batsman Rohit Sharma. “I only want to play cricket,” he said.