Thursday, April 13, 2006

A 12-year-old Welsh girl is thought to be the first patient ever to have a heart transplant reversed, meaning her donor heart was removed and her original heart, which had remained in her body, was reconnected.

“Her original heart … is now a normal heart. This is a very happy ending,” Sir Magdi Yacoub, an Egyptian-born cardiac surgeon, who performed Hannah Clark’s original transplant and served as an adviser to surgeons who performed her reversal at Great Ormond Street Children’s Hospital in London on Feb. 20, told BBC Radio.

“This is a unique case. We are delighted that Hannah is doing so well,” Dr. Yacoub said.

He pointed out that Hannah’s reversed heart transplant was the first ever performed in the United Kingdom and “may be unique in the world.”

Unlike most transplant patients, Hannah, of Mountain Ash in South Wales, underwent what is known as a “piggyback” transplant when she received a donor heart a decade ago.

In the piggyback, or heterotopic heart transplant, Hannah’s new heart was placed in the right side of her chest and attached three ways to her original heart, which was left in position.

At the time, Hannah was suffering from cardiomyopathy, a condition in which the heart muscle becomes inflamed and functions poorly. Her heart was twice the normal size, and doctors said it would likely give out within a year.

In a heterotopic transplant, “both hearts can pump, but the new heart takes most of the load,” the hospital said.

Dr. Richard H. Cooke, medical director of cardiac transplantation at Washington Hospital Center, said yesterday such transplants are not common, but they were more popular 10 years ago than they are today. “There were once the fears that a transplanted heart would fail acutely and that you couldn’t manage immunosuppression. So it was felt that a patient having two hearts would have better circulation through the lungs” and be better off overall, he explained.

The reason Dr. Yacoub left Hannah’s own heart intact is that he has long believed that a heart damaged by cardiomyopathy might be able to recover if it is given a long enough rest through the contributions of a donor heart.

Hannah’s donor heart worked well until November, when a routine examination showed that her body was starting to reject it. Her surgeons decided to remove Hannah’s piggyback heart.

Dr. Cooke said cardiac surgeons today can install temporary mechanical “assist” devices to help bolster failing hearts. Such devices, which “buy patients some time,” and which often can be removed after a few months, were neither widely available nor reliable 10 years ago.

He added that the Clark case is “unusual,” given the length of time Hannah bore two hearts.

• Amy Baskerville contributed to this report

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