RIYADH, 29 March 2004 — Seven weeks ago, 50-year-old Ali Al-Enazi suffered a massive heart attack and was rushed to the cardiac emergency room of Riyadh’s King Abdul Aziz Cardiac Center, where doctors declared his chances of survival very slight.
The residual function of the left ventricle of his heart was 15 percent, a state which required an immediate transplant if his life were to be saved.
Dr. Muhammad Balghith, consultant adult interventional cardiologist, took charge of Al-Enazi and at intervals applied five coronary stents to the damaged organ and monitored the situation.
Gradually, positive responses emerged. The patient was on the heart-lung machine, and since there was no donor immediately available, doctors decided to implant a bridge — the permanent mechanical heart.
According to Dr. Hani Al-Najam, head of cardiac surgery at the center, under whose supervision the surgery was carried out on Feb. 29, the device, made in Germany by the Incor group, is an axial rotary pump and is known as the Berlin Heart.
It produces a continuous flow of blood between three and eight liters a minute. Made of titanium, it has its impeller suspended between two magnets, a state which rules out any friction commonly produced in other systems available in the market today.
The device has replaced the recipient’s right ventricle and is supplying a constant blood stream to his left ventricle. “Al-Enazi’s heart has been stopped, giving it time for recovery,” said Dr. Al-Najam, adding that in case it recuperated enough to pump two liters of blood per minute, the artificial heart would be slowed down to work at three liters per minute.
Since their introduction two years ago, only one of the 20 devices used in Germany has failed. Having this continuously pumping mechanism in his chest, Al-Enazi now has no heartbeat.
He has neither systolic nor diastolic reading, and enjoys a mean arterial blood pressure of 70mm. He will be kept in the hospital for another four weeks to rule out any possibility of thromboembolism, a state in which blood clots cause a cerebrovascular accident commonly known as a stroke.
Al-Enazi will have to follow a strict anticoagulation program involving the regular use of medicines to help the artificial valve function.
This permanent mechanical device, costing about SR750,000, is the first of its kind to be installed in the Middle East and was a gift from Crown Prince Abdullah, deputy premier and commander of the National Guard.
Presently, there are 99 such hearts in the world, mostly in Germany. A small number have also been used in France, Belgium, Italy and Bulgaria.
“King Abdul Aziz Cardiac Center has a staff of about 40, consisting mainly of consultant cardiologists, surgeons and their assistants,” said Dr. Muayed Al-Zaibag, chairman of the center and a consultant cardiologist.
Last week in Dubai as a guest speaker in a symposium on advanced cardiology organized by the Mayo Clinic, Dr. Al-Zaibag gave presentations on two subjects.
One was on the history and development of the mitral balloon dilatation procedure while the other highlighted the cardiac vascular crisis in the Gulf states.
Al-Enazi’s own battered heart may or may not start beating again, but the permanent implant in his chest has arguably given hope to thousands, or may be hundreds of thousands in the Middle East and Asia.
This one step may give the men of medicine a lot to talk about and even more to work on.
