Latest products / 30 Jan 2016

Singapore Man Relies On Mechanical Heart While Waiting For Transplant

At just 22, Mr Kevin Wong found himself at death’s door when his blood pressure and heart function dipped to dangerously low levels.He survived, thanks to being implanted with a mechanical heart device – the Heartmate II. Now 25, Mr Wong is waiting for a suitable donor heart while working as a service engineer at Transmedic, a company that distributes medical equipment like the Heartmate II.

“A new heart will make a nice gift,” Mr Wong told The New Paper of his wish for the new year. He suffers from dilated cardiomyopathy, a condition in which the heart becomes weakened and enlarged. “Sometimes, I ask myself how this could have happened. No one else in my family has a heart condition,” he said. 

TNP understands that the cause of his condition is unknown. Even though he played basketball weekly, he never had any problems. Signs of trouble started showing only when he was 22, while he was in his final year in a polytechnic. Walking short distances left him huffing and puffing, but he never thought it could be a heart problem until an unrelated emergency led to his diagnosis. “I ate something wrong during a steamboat dinner and had a stomachache,” he said. The pain was so severe that he was rushed to the hospital.

A medical check-up there revealed more than just a normal stomachache. Doctors discovered that Mr Wong’s heart was functioning at just 25 per cent. A normal person’s heart functions at above 50 per cent. Mr Wong had to immediately undergo an operation to fit him with a pacemaker. This device resynchronises the contractions of the heart’s ventricles by sending tiny electrical impulses to the heart muscle, helping the heart pump blood throughout the body more efficiently.

Mr Wong’s breathlessness, however, continued to worsen. Walking just 50m was enough to make him breathless. His lower limbs, too, started swelling due to fluid overload. He sought a second opinion from private doctors and was advised to get admitted into a public hospital for further treatment. By then, his heart function had dipped to just 13 per cent.

His blood pressure had sunk to dangerous levels and he fell into a coma for close to a week. Realising that Mr Wong’s life was in danger, the National Heart Centre Singapore (NHCS) medical team suggested implanting Heartmate II, which would help his heart pump better. The device, also known as a left ventricular assist device (LVAD), is commonly used as a bridge to a heart transplant.

Mr Wong’s heart surgeon, Adjunct Assistant Professor Tan Teing Ee, said: “As we do not have many donor hearts available in Singapore, we used to have patients who were not able to survive the wait for a heart. “Ever since the newer generation LVADs were introduced here in 2009, not only have patients on the heart transplant waiting list survived many years longer, their quality of life has vastly improved as well.”

Mr Wong’s parents had to consent to the implantation because he was in a coma. He found out about his mechanical heart, and the changes he would have to make to his lifestyle as a result of having the device, after he regained consciousness post-surgery. “My mind was a blank. I didn’t register what the coordinator told me. What to do? I can’t change things, so I can only accept,” he said, resignedly.

Mr Wong was discharged with a cocktail of drugs to stabilise his condition and to allow his body to accept the LVAD. A wire now snakes out from an open wound in his abdomen and links to a controller powered by two batteries. The controller, which weighs 2kg and is kept in a sling bag, keeps his mechanical heart running.

He has to take it everywhere with him and make sure it does not get wet when he takes a shower. “I just tape it up so that water can’t get in. I used to think it was very troublesome. “But after three years, I’m used to it,” he said with a shrug. 

He no longer feels breathless when he walks and although he has regained a near-normal life, there are times when he feels like he is missing out. As he cannot do contact sports, he had to give up his weekly basketball games. But he makes it a point to shoot some hoops about once a month so that he can “feel like a normal person again”, he said.

Even though he was exempted from national service, his condition also hampered his job search. “I was rejected by five companies,” Mr Wong said quietly. He finally landed his job with Transmedic in April. It was at an NHCS fund-raising gala and Mr Wong, a beneficiary, was seated beside a Transmedic employee, who told him of a vacancy that might suit him. Mr Wong applied for the job and was accepted.

Now, his best hope for a normal life is a heart transplant, which he is already on the waiting list for. According to a report in The Straits Times, the average waiting time for a new heart is 1 1/2 years. Having lived with his heart ailment for three years, Mr Wong said that he has fully come to terms with it. “I have learnt to be zen about it. No point being upset. My mind was a blank. I didn’t register what the coordinator told me. What to do? I can’t change things, so I can only accept.” 

23 People On The Waiting List

The mechanical heart assist device, also known as the left ventricular assist device (LVAD), is implanted as a bridge to heart transplantation. It is usually used as a last resort for heart failure patients and it keeps them alive until a suitable heart comes along. According to Thoratec, the company that manufactures the Heartmate II, there are patients who have lived for more than eight years with the device.

One of the risks, however, is blood clotting and, when that happens, the device will have to be replaced. To date, only 65 heart transplants have been performed at the National Heart Centre Singapore (NHCS), the only place in Singapore that does heart and lung transplant surgeries. There are 23 people on the waiting list for a new heart, including Mr Kevin Wong.

NHCS’ senior consultant of cardiothoracic surgery Tan Teing Ee said: “Patients who were incapacitated by the symptoms and recurrent hospitalisations due to advanced heart failure have gone on to lead almost normal lives, and some have even gone back to work.

“To date, NHCS has performed 67 implantations for the newer generation LVADs and Kevin is just one of many who have done well.” The newer generation LVAD, called the Heartmate II, is a golf ball-size device that works like a jet engine. It is implanted under the heart with a connector drawing blood from the left ventricle (pumping chamber) of the heart and pumping it into the aorta continuously via a conduit.

Although the device is small, it can pump six to 10 litres of blood a minute, more than the average requirement of four to five litres for a healthy adult. The pump and its connections are implanted during open heart surgery. A computer controller, a battery pack and a reserve battery pack remain outside the body.

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Published on 30 Jan 2016

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