At Stanford Children’s Health, Groundbreaking Treatment Leads to New Heart and Lungs for Thankful Oregon Teen

PALO ALTO, Calif.–(BUSINESS WIRE)–2016 is starting off a whole lot better than last year for 14-year-old
Oswaldo Jimenez of Salem, Oregon.


Last year at this time, he was sick. Life-threateningly sick. Diagnosed
with pulmonary
arterial hypertension
at age 9, his heart and lungs were failing,
and a heart-lung transplant seemed to be his only real hope for survival.

Oswaldo was referred to doctors at Lucile
Packard Children’s Hospital Stanford and Stanford Children’s Health
,
one of America’s leading centers for organ transplant. His doctors at
Packard Children’s determined that Oswaldo would indeed need a
transplant, but that he could return home to Oregon and await the call
for transplant there. But in the spring, Oswaldo’s condition rapidly
worsened, and he was admitted to a local hospital and emergency
airlifted to Packard Children’s in May.

What happened? The pulmonary arterial hypertension made it hard for
blood to flow properly through Oswaldo’s lungs, where blood picks up
oxygen for the rest of the body. “The high blood pressure in his lungs
was requiring his heart to pump harder and harder,” explained pediatric
cardiologist Jeffrey
Feinstein, MD
, director of the Vera Moulton Wall Center for
Pulmonary Vascular Disease, and head of the hospital’s pediatric
pulmonary hypertension program. “This eventually caused his heart to
fail.”

“When we initially evaluated him a few months earlier, he had very few
symptoms; when he returned, he could only walk a short distance before
getting breathless,” added Feinstein, who is also a professor of
pediatrics at the Stanford School of Medicine and the Dunlevie Family
Professor of Pulmonary Vascular Disease. “The pressure in his lungs also
caused two episodes of pulmonary hemorrhage. This bleeding into the
lungs can be fatal.”

Combined heart and lung transplants are so rare that only
24 were performed in the United States in 2014
. Stanford has long
been a national leader in multi-organ transplantation, performing the
world’s first successful combined heart-lung transplant
, on an
adult, at Stanford Hospital in 1981.

Listing Oswaldo for transplant was just the beginning. Care teams wanted
to ensure his failing heart and lungs could keep going until donor
organs were available. They needed to establish what is referred to as a
“bridge-to-transplant” solution, one that would sustain Oswaldo’s organs
until transplant could occur.

A creative but risky way to keep Oswaldo moving

“An integral element to success for children awaiting lung transplants
is to keep them moving around,” said pediatric pulmonologist Carol
Conrad, MD
, director of the pediatric lung and heart-lung transplant
program at the hospital and an associate professor of pediatrics at the
School of Medicine. “Being in good shape helps to make them good
candidates for the transplant operation. Pre-operative debilitation
leads to prolonged recovery period post-op and a poorer outcome in the
long run.”

It was then that doctors decided to try a novel procedure, one that
would enable Oswaldo to be mobile. Called a pulmonary artery to left
atrial shunt,
it was a surgery that had been used only a dozen times in patients
nationwide. The surgery would reduce the workload on his failing heart,
and allow Oswaldo to stay mobile and help oxygenate his blood while
awaiting transplant.

“He was so critically ill and it was a very risky procedure; he was at
high risk of cardiac arrest when being put to sleep for the surgery,”
said Katsuhide
Maeda, MD
, surgical director of lung and heart-lung transplant
program and a clinical assistant professor of cardiothoracic surgery at
the School of Medicine. “But essentially, this shunt established a
‘lung’ that served to oxygenate his blood as it flowed through a box
outside of his body. Since the device was reasonably small, it allowed
him to stay awake and mobile while awaiting transplant.”

For parents Carmen Hernandez and Martin Jimenez, it was a difficult
decision to go forward with this novel procedure, but there were no
other options — and they trusted the team.

“We weren’t given any hope until we came here,” said Oswaldo’s mother,
Carmen Hernandez, via a translator. “This seemed to give him the best
chance to live.”

How it’s done

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.

“We are so, so thankful for organ donation,” said mom, Carmen. “During
another family’s time of incredible grief, they gave my son the ultimate
gift of life.”

Looking Ahead

The post-operative period was complicated, but now Oswaldo and his
family just recently returned home to Oregon in late December. “He’s
steadily improving,” said Conrad, “he’s been weaned off his ventilator
and so we removed the trach (breathing tube). We expect to see
him return to many of his normal activities over the next few months.”

“There are no words to express our gratitude and we can’t say enough
about our medical team,” said dad, Martin. “Once we arrived here, we
knew we had the best and most experienced care possible.” Added Carmen,
“Now, the doctors can use this therapy to treat other patients. Maybe
the next family faced with this won’t have such a hard decision to make,
because it certainly worked for Oswaldo.”

Conrad says they will likely use this bridge-to-transplant treatment
again, adding yet another option to the Stanford
Medicine therapies
and innovations for kids with failing hearts and
lungs.

For Oswaldo, he is simply looking forward to being a kid again. “I want
to run and play, and get my life back,” he said, proud that he made
history as the first kid on the West Coast to receive this treatment. As
far as what the future holds?

“I just know I want to do something big in life.” We think he already
has.

About Stanford Children’s Health and Lucile
Packard Children’s Hospital Stanford

Stanford Children’s Health, with Lucile Packard Children’s Hospital at
its core, is the largest Bay Area health care enterprise exclusively
dedicated to children and expectant mothers. Long recognized by U.S.
News & World Report
as one of America’s best, we are a leader in
world-class, nurturing care and extraordinary outcomes in every
pediatric and obstetric specialty, with care ranging from the routine to
rare, regardless of a family’s ability to pay. Together with our Stanford
Medicine
physicians, nurses, and staff, we can be accessed through
partnerships, collaborations, outreach, specialty clinics and primary
care practices at more than 60 locations in Northern California and 100
locations in the U.S. western region. As a non-profit, we are committed
to supporting our community – from caring for uninsured or underinsured
kids, homeless teens and pregnant moms, to helping re-establish school
nurse positions in local schools. Learn more at stanfordchildrens.org
and on our Healthier,
Happy Lives blog
. You can also discover how we are Building
the Hospital of the Future
. Join us on Facebook,
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and YouTube.

Contacts

Lucile Packard Children’s Hospital Stanford
Samantha Dorman, media
relations manager
650-498-7056 office
650-384-5826 cell