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Unusual bridge-to-transplant method helps teen get new heart and lungs

bridge-to-transplant device
Earlier this year, Oswaldo Jimenez's heart and lungs were failing. He needed a combined heart-lung transplant, but his doctors at Lucile Packard Children's Hospital Stanford were worried that the 14-year-old from Salem, Oregon might not survive the wait for donor organs.

Stanford physicians have lots of experience with using external and implanted pumps that can support a patient's failing heart. A few years ago, for instance, an 8-year-old patient spent 229 days with a Berlin Heart pump that moved blood through her body while she awaited a heart transplant.

Oswaldo's case was different. Although his heart failure was significant, his failing lungs posed the biggest risk to his health. His doctors were concerned that his poor lung function would immobilize him - yet to benefit from transplanted lungs, he needed to stay fairly fit and mobile while he waited.

So the doctors decided to try an unusual bridge-to-transplant procedure called a "pulmonary to left atrial shunt," which connected Oswaldo's heart to a portable box outside his body that oxygenated his blood. Essentially, the team gave Oswaldo a temporary, artificial lung.

A press release from the hospital explains how it worked:

The procedure involved the insertion of a tube that redirected blood away from Oswaldo’s lungs into the oxygenator. This, in turn, provided oxygen to the blood and then returned it to his body, with his own heart providing the pump. Reports on this shunt device being able to sustain patients’ lives range from several weeks to six months, depending mostly on being able to prevent the blood from clotting while avoiding complications such as bleeding or stroke.

On July 12, Oswaldo made history by becoming the first child in the western United States to undergo this treatment — it saved his life and bought him time. Then, just one week after receiving the shunt, donor organs became available. Oswaldo received his heart and lung transplant on July 19.

Oswaldo is still recovering at the Ronald McDonald House, and his doctors think he'll be able to go home close to the New Year. He's looking forward to being a kid again, and his grateful family is thinking about how his case might benefit other kids in similar situations. "Now the doctors can use this therapy to treat other patients," said Oswaldo's mom, Carmen Hernandez.

Previously: Stem cell medicine for hearts? Yes please, says one amazing family, "Liberated from LVAD support": One patient's story and Image of the Week: First heart-lung transplant
Image of pulmonary to left atrial shunt courtesy of Lucile Packard Children's Hospital Stanford

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