A 5-pound newborn with a life-threatening heart defect has received the world’s first partial heart transplant using living tissue that may never need to be replaced.
North Carolina child Owen Monroe, now four months old, was born with his two main arteries – the aorta and the pulmonary artery – fused together in a condition called the arterial trunk.
Doctors separated them and replaced the ‘leaky’ heart valves shortly after birth using them with living tissue that will grow with him, avoiding further surgery. In fused valve repair operations, dead tissue is usually used – but it must be replaced in extensive surgery up to three times before adulthood, and every 10 years thereafter.
Today, four months after the operation at Duke University in North Carolina, the baby is “thriving” and reaching every stage of his development.
His mother, Tayler Monroe, called the procedure a “miracle” and said it saved her son’s life.
The arterial trunk is normally a death sentence for infants without surgery, as the heart overwork as it struggles to deliver nutrients to all corners of the body. It’s also rare, with less than 1 in 10,000 American babies born with it.
Owen Monroe was born weighing 5 pounds in North Carolina. His parents listed him for partial heart surgery after being told they would have to wait six months for the full transplant, which might be too long for their son.
Pictured above, the operation takes place, where Owen’s fused arteries have been separated and his heart valves replaced
Pictured is Owen a few months after surgery, with the scar visible on his chest
Mother Tayler said it was ‘miraculous’ that her son survived. He is “fulfilling” and reaches every stage of development in line with his peers
NORMAL HEART AND OWEN’S HEART: Above, a normal heart (left) and Owen’s (right). He had a rare disease called truncus arteriosus. It’s normally a death sentence without surgery
Parents Tayler and Nicholas Monroe said their son’s diagnosis left them with “few options” as he was already at risk of heart failure shortly after birth.
They were told the waiting list for a full transplant was around six months, which their son was unlikely to achieve.
So they signed up for experimental surgery at Duke University, which would use living tissue to separate the fused arteries.
What is the arterial trunk?
This rare defect is where the two main arteries of the heart – the aorta and the pulmonary artery – merge.
The condition is normally a death sentence for infants without surgery.
But children usually need several operations in their lifetime to replace the valves as they grow, because the valves don’t grow with them.
What are the symptoms?
These appear in the first week of life and include.
- Bluish color of lips and nails;
- Rapid breathing or difficulty breathing;
- Bad nutrition.
How is it treated?
Babies are treated early after birth to prevent congestive heart failure, when muscle stops working because it can’t pump enough blood to meet the body’s energy needs.
They are then offered surgery to separate the two arteries.
What is the survival rate?
About 90% of infants operated on live to be over 40 years old.
The disease is rare, with less than one in 10,000 American babies being diagnosed with it.
Source: Cincinnati Children’s Hospital
About 90% of infants who have surgery using tissue from a cadaver – the standard procedure – survive past 40 years.
But they will need at least three more operations in their lifetime to replace the tissue as they grow, according to the American Heart Association. It may also need to be replaced every ten years as an adult.
When Owen was born, doctors discovered that as well as having fused arteries, he also suffered from a ‘leaky’ heart valve – which would also need to be replaced.
It is essential to have good heart valves because they prevent blood from flowing back in the wrong direction, thus interrupting circulation.
During the operation, he received living tissue and valves from another infant’s heart.
The heart had strong valves but was too weak to be used for a full transplant. Doctors said that without Owen’s operation he would not have been used.
After recovering and showing no ill effects from the surgery, Owen was discharged and returned home.
Doctors say the youngster is now developing normally and his parents couldn’t be more delighted.
Speaking before the birth, mum Tayler said: ‘It was like something happened [at birth] we would like to resurrect it and hope for the best, which is really hard and scary to hear.
“Nick and I had the conversation about whether Owen is here to be a donor for other babies, which is probably the hardest conversation you can have as a parent.”
But after the surgery and her son’s recovery, Tayler said it was “miraculous”.
“The fact that he is not only doing well, but really thriving gives a lot of hope for future babies who have to go through this.
“All of his doctors are delighted with the way he is doing. He’s not at all backward in development, something like that.
Dr Joseph Turek, a cardiologist who led the operation, said: “This procedure potentially solves the problem of a valve growing out.”
“If we can eliminate the need for multiple open-heart surgeries each time a child outgrows an old valve, we could extend that child’s life by decades or more.”
During surgery, doctors started by cutting the single blood vessel (pictured above)
They then used living tissue to replace the missing area of the aorta and the missing area of the pulmonary artery. New valves were also added from the donor heart to control blood flow
Owen’s heart has since functioned normally. Doctors hope the living tissue will grow with it, avoiding the need for future heart surgeries
Dr Michael Carboni, a cardiologist also at the university who consulted for the baby, added: “What is particularly remarkable about this procedure is that not only can this innovation extend the lives of children, but it uses a donated heart that otherwise would not be transplantable.
“The valves for this procedure were taken from a donor heart that had too weak muscle tissue to make it viable for a full transplant, but had strong valves that were well suited to Owen’s needs.”
The father, Mr Monroe, said: ‘As heartbreaking as it was for our family, we knew from the start that Owen was in good hands.
“Our greatest hope is that Owen’s success will change the way organ donations and transplants are handled not just for babies with congenital heart disease, but for all patients.”
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