When a child's heart fails, a transplant is often the only hope, but to keep kids alive while they wait doctors may use artificial pumps.
Some are too big and some require major surgery, but now, there's a small device that's changing the game for some of the smallest heart patients.
Card games are a good distraction for sisters Emily and Shayde Smith. Both suffer from a serious heart condition known as restrictive cardiomyopathy.
Four years ago, little sister, Emily, had a transplant to replace her failing heart, but a couple months ago her body started to reject the donor heart.
"We had to determine a way to support Emily as quickly as possible, or we were worried that we were going to lose her," explained Vivian Dimas, MD, Interventional Cardiologist at Children's Medical Center in Dallas.
Doctors used the world's smallest heart pump, to keep Emily alive. Instead of major open-heart surgery, the Impella is inserted through an artery in the leg. A catheter pulls the blood out of the heart's left ventricle and ejects it to the aorta, so the heart can pump blood. Emily used the device for five days.
"If we wouldn't have had that, she wouldn't have made it," says Emily and Shayde’s Mom Natalie Van Noy.
Emily got a second heart transplant. Now, Shayde needs a transplant, too. Emily will be by Shayde's side through it all. Emily wears a mask to protect against infection during her recovery.
The Impella is designed to be a temporary device. Right now it's FDA for up to six hours in adults. For kids like Emily it's being used off-label for up to seven days.
It can be used for patients as young as nine, and doctors are now working on a smaller pump they hope can help patients as young as three.
TOPIC: The World's Smallest Heart Pump
REPORT: MB# 3586
BACKGROUND: Restrictive cardiomyopathy refers to the changes and weakening of the heart. Patients with restrictive cardiomyopathy have a normal size heart or it can be slightly enlarged, but the heart does not relax normally during the time between heartbeats when the blood returns from the body. As the disease develops, the heart may not properly pump blood. The abnormal heart function can then affect the liver, lungs, and other body systems. It can affect both ventricles. It is a rare condition, but the common causes are amyloidosis and scarring of the heart from an unknown cause (idiopathic myocardial fibrosis). Other causes can include: carcinoid heart disease, iron overload (hemochromatosis), diseases of the heart lining, sarcoidosis, scleroderma, scarring after radiation or chemotherapy, and tumors of the heart. (Source: www.ncbi.nlm.nih.gov
SYMPTOMS: Symptoms of heart failure are most common in patients with restrictive cardiomyopathy. Common symptoms include: difficulty breathing at night, when active, or when lying flat; cough; fatigue, poor exercise tolerance; swelling of the abdomen; loss of appetite; uneven or rapid pulse; swelling of the feet and ankles; chest pain; decreased concentration or alertness; low urine production; and the need to urinate at night. (Source: www.ncbi.nlm.nih.gov
TREATMENT: When the cause of cardiomyopathy is found, that condition can be treated. The main goal of treatment is to control symptoms and improve the quality of life. They include: steroids, medications to prevent or control uneven or abnormal heart rhythms, chemotherapy, blood thinning medications (like warfarin or aspirin), diuretics to remove fluid and help improve breathing, and a heart transplant can be an option if the heart function is very poor and the patient has severe symptoms. People with this condition can develop heart failure if it gets worse. Problems like "leaky" heart valves can occur. Average survival after diagnosis is 9 years. (Source: www.ncbi.nlm.nih.gov)
NEW TECHNOLOGY: For patients who have to have a heart transplant, things still can go wrong. For example, the body can reject the donor heart. A new technology called the Impella, also known as the "world's smallest heart pump," is a temporary cardiac assist device that is designed to provide a patient's failing heart with full circulatory assistance while allowing the heart to rest. The Impella 2.5 device is a minimally invasive, catheter based system typically inserted in the catheterization lab and is also used to aid the heart in pumping blood. It gives patients, who are considered high risk due to heart dysfunction, an alternative to open heart surgery or angioplasty. It is ideal for patients with decreased heart pumping function and who need revascularization. It is a miniature pump that is inserted through an artery and placed inside the heart. It replicates the natural function of the heart by assisting the heart's pumping chamber to feed blood through the body. (Source:
FOR MORE INFORMATION, PLEASE CONTACT:
Children's Medical Center