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Newborn has heart attack, thrives after heart transplant

May 24, 2011

EDMONTON — Today, 10-week old Kaleb Busch looks like any other bouncing baby boy. But at birth he suffered a massive heart attack that caused the left side of his heart to fail.

Thanks to a donor family and successful heart transplant surgery at the Stollery Children’s Hospital, and to the amazement of his parents and healthcare team, Kaleb has defied the odds.

On March 15, Kaleb was delivered by emergency C-section at Lloydminster Hospital after his mother noticed he had stopped moving. When staff determined he had experienced heart failure, he was flown to the Stollery Children’s Hospital.

Kaleb’s heart failure — known as congenital myocardial infarction — is rare in infants, with only one previously documented case in Canada, that happened in Winnipeg in 2009.

“I’d never seen a case like Kaleb’s before,” says Dr. Simon Urschel, a pediatric cardiologist, “He experienced the equivalent of a massive adult heart attack when he was born. From what’s published in medical literature, about 90 per cent of newborns with this condition do not survive.”

The cardiology team performed interventions to keep Kaleb alive, but none were long-term solutions. A team led by Dr. Jennifer Rutledge did a heart catheterization, which sees a catheter inserted into the heart and aorta. This confirmed a blood clot in the left artery of the heart. Medication was injected into the clot which led to mild improvement in blood flow. Unfortunately, this did not lead to improvement in Kaleb’s heart function. Kaleb was supported with extracorporeal membrane oxygenation (ECMO); a machine circulated his blood through tubes to add oxygen and remove carbon dioxide. Later, he was attached to a device that relied upon a mechanical pump to replace his left-heart function.

Kaleb would not survive without a heart transplant, doctors determined.

Dr. Urschel cautioned Kaleb’s parents, Terry-Lynn and Owen, that the chances of finding a heart in time were slim. Even if a heart did become available, the surgery would be risky. Despite the fact that Edmonton transplant teams performed nine pediatric heart transplants in 2010, eight children died on the waiting list; five of them infants.

Ten days after Kaleb’s birth, however, his parents got word that a heart was available.

Although the heart — about the size of a walnut — did not match Kaleb’s blood type, he was still able to undergo a heart transplant. This type of transplant, called an ABO-incompatible transplant, can only be performed on very young children, whose immune systems haven’t yet developed the capability to reject other blood types. Kaleb is only the 17th pediatric patient at the Stollery to undergo a heart transplant from another blood type.

On May 2, Kaleb was discharged; his family went home to Lloydminster to enjoy their life together. His grateful parents thank the healthcare team for the care their son received, and the donor family for believing in the gift of organ donation.

As for how Terry-Lynn will explain the scars to her son when he’s older, her answer is simple: “I will tell him he has the heart of an angel.”

As the only specialized pediatric emergency in Alberta, as well as being a Western Canadian referral centre for complex pediatric heart surgeries and transplants, the Stollery Children’s Hospital has the expertise and resources that were needed to save Kaleb’s life and help other infants.

“It’s amazing to see how the seamless collaboration of all involved teams helped to stabilize Kaleb and gave him the chance to survive until, and through, heart transplantation,” adds Dr. Urschel. “Kaleb’s story is also a reminder of the importance of organ donation. Thanks to the decision made by a donor family, we get to see Kaleb now as a nearly healthy baby.”

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.7 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.