Welsh Girl's Heart Takes Over From Transplant

By Mary Jordan and David Brown
Washington Post Foreign Service
Friday, April 14, 2006

LONDON, April 13 -- British doctors announced Thursday that they had successfully removed a heart that had been given to a girl in an unusual transplant procedure and that her own once-failing heart had recovered and was keeping her alive by itself.

The girl's own heart was left in her body during what is known as a "piggyback" transplant in 1996. The organ now appears to be working after a decade of rest.

While damaged hearts have recovered with the help of mechanical devices, British doctors said Thursday they believed the case of 12-year-old Hannah Clark, of Mountain Ash, Wales, was the first in which a heart had healed after a full transplant and so long after the initial procedure.

"This is as far as we know the only such case in the U.K. and may be unique in the world," the doctors who performed the latest procedure said in a statement. "We are delighted that Hannah is doing so well."

Other surgeons said the outcome was unquestionably rare but said it was possible other such cases existed and that improved medical procedures make the importance of the finding uncertain.

As a toddler, Hannah suffered from cardiomyopathy, a condition that made her heart flabby, pump blood weakly and double in size. As a result, she received a piggyback transplant, technically known as a heterotopic transplant, a procedure used when the new organ is very small, when there are doubts about its condition, or when the removal of the native heart would create complicating conditions.

She began to reject the transplanted organ this year, and surgeons removed it on Feb. 20. When they did, they found that her own heart had repaired itself.

"The significance of this case may be to encourage us to look at the heart's ability to recover," Magdi Yacoub and Victor Tsang, two surgeons involved in the procedure at Great Ormond Street Hospital in London, said in a joint statement.

The donor heart was placed in the right side of Hannah's chest and connected to her own heart's aorta, right atrium and left atrium. "This means both hearts can pump, but the new heart takes most of the load," the physicians said.

UK Transplant, a government agency overseeing organ donations and transplants, said that since it began keeping records in 1995, there had been 43 piggyback heart transplants in Britain. Great Ormond Street physicians said this was the first instance they knew of in which a donor heart was removed and the person's own heart began functioning properly again.

Peter Weissberg, medical director of the British Heart Foundation, called it "an exciting and important event." But he noted that in a case such as Hannah's today, doctors would implant a mechanical heart, called a ventricular assist device, instead of doing a piggyback transplant. The device is designed to take over the work of an inflamed heart, allowing it to recover, and can be removed after a few months.

"Ten years ago, such devices were not sufficiently reliable, which is why Hannah received a donor heart alongside her own," Weissberg said.

A team of German surgeons reported in 2000 that out of 23 patients with Hannah's condition who had received the devices and had them removed up to two years later, 13 survived with their own recovered hearts.

John W. C. Entwistle III, a heart surgeon at Drexel University College of Medicine in Philadelphia, said he believed there had been other cases like Hannah's, but he said they were extremely rare.

"I am sure that there are cases in which the native heart has recovered after a period of support, but I have never seen a report myself," he said.

Yacoub, a renowned heart specialist who performed the original transplant, came out of retirement to advise the team at Great Ormond Street. He told the BBC he was delighted he had decided to leave Hannah's diseased heart inside her body a decade ago.

"At the time, we had the idea that she had this very severe muscle disease and there was the outside possibility that her heart would recover," he said. "That was the idea and it worked out, so that was wonderful. Now she is a happy little girl with her own normal heart. The complications have all gone. This is a very happy ending."

Hannah's mother, Elizabeth Clark, told reporters that the operation, which had been expected to take at least eight hours, was finished in just four. "They also said she could be in intensive care for weeks, maybe months -- they just didn't know because it was the first time it had been done," she said. "Hannah recovered so well she was able to come home within five days."

Clark said her daughter was looking forward to going back to school next week. Hannah has also recently been suffering from lymphoid cancer but is currently in remission.

"It's nothing short of a miracle," her mother said.

Brown reported from Washington.

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