Cape Town - A year ago, Philasande Dladla, 10, was an active hockey player and a budding swimmer who used to represent his primary school at competitions.
But within a few months after contracting a “flu virus”, his world changed and his future became uncertain after doctors diagnosed him with cardiomyopathy. It is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently.
His mother, Sindi, recalled how tired Philasande would get.
“Initially we thought it was just flu, but we suspected that something was wrong when the flu wouldn’t go away. Instead of getting better, it escalated into stomach cramps, and he would get tired easily. The strangest thing was the rate at which he was gaining weight.”
But it turned out that the weight gain, was his body retaining water because of heart failure. Last month, Philasande, who only had 10 percent functionality of his heart, became the first African child to undergo a lifesaving operation at Netcare Christiaan Barnard Memorial Hospital, where a “mechanical heart” was implanted to enable his damaged heart to continue functioning.
The heart is known as a HeartWare Ventricular Assist Device (HVAD).
The pump, which is about the size of a golf ball, is implanted into the heart and is designed to restore a normal blood flow into and out of the heart. It keeps the patient well while awaiting a heart transplant.
It draws the oxygenated blood from the left ventricle of the heart and propels it into the aorta for distribution into the body. The right ventricle of the heart is responsible for pumping deoxygenated blood into the lungs, where it is oxygenated.
While the technology is widely used in Europe and the US, the city hospital became the first in Africa to do it. The first device was implanted about four years ago, and up until now it’s only been performed on adults.
Philasande, of Newcastle in KwaZulu-Natal, who has since temporarily suspended his studies at Drakensberg Primary School, was admitted to Netcare Christiaan Barnard Memorial Hospital at the beginning of last month. The implantation of HVAD follows another mechanical heart procedure at Netcare Milpark Hospital, where he had a temporary tandem mechanical heart device implanted six months ago.
This temporary device was to allow the repair of his damaged heart valves.
Dr Willie Koen, who is head of the transplant programme at the hospital and who operated on Philasande, said the device took on the full function of the heart once inserted, and helped to “restore normal blood flow by enabling the left ventricle of the heart to operate properly”.
The device worked only if the right ventricle of the heart remained operational. If not, the artificial heart, known as Berlin Heart, was used. But this required full-time hospitalisation.
Inserted during open-heart surgery, the device is surgically implanted directly next to the heart. A cable of the battery-powered controller then exits the patient’s skin through the diaphragm and connects the implanted pump to the externally worn controller.
Koen said the four-hour procedure was challenging in Philasande’s case due to the small frame of his body. “Because he is a child we had to improvise on everything. His femoral arteries, where we had to do a bypass, were very small, and his chest as well so we had to be extra careful with everything. Due to the small size of his chest, we had to place the device more to the lung area instead of the heart sac to give it more space in the chest,” he said.
Koen said the device enabled patients to wait safely for a new heart, without further deterioration of their health. The device can stay inside the body up to eight years.
“Philasande’s journey has been a most remarkable one and we are delighted that he has recovered so well that he is being discharged from hospital with renewed vigour and a smile on his face. Where Philasande’s future was uncertain before, he has now been given a completely new lease on life,” said Koen.
“However, these procedures were not a long-term solution and were designed to win Philasande time, as his heart had been damaged to such an extent that he needed a transplant. Unfortunately, although Philasande is on the transplant list, a suitable matching donor heart for a child is extremely difficult to come by and, as a result, another solution had to be found.
His mother, who described Philasande’s health problems as the “most taxing experience for our family”, said she was delighted and surprised at her son’s rapid recovery. Previously he had completely lacked energy but is now his old self again, she said.
Dr Cassel, who practises at Netcare Milpark Hospital, says that the groundbreaking procedures that were performed on Philasande had been made possible by years of international and local collaboration, and important advancements in cardiovascular medicine on the continent.
“Many South Africans are not aware that we have such active heart transplantation and repair programmes in place, nor that South Africa remains a leader in heart medicine. Philasande’s case once again highlights this fact,” he said.
Cape Argus