At just eight years old, Yemeni schoolboy Marwan Mohamed was one of the first patients at an Abu Dhabi hospital to undergo heart surgery through a small incision in the thigh.
The young boy was treated at NMC Royal Hospital earlier this year after receiving medical funding from a UAE health program.
He was not the typical heart patient seen by doctors, who typically treated men over 50 with a history of unhealthy lifestyles, smokers, and the obese.
On World Heart Day, doctors revealed details of the unusual surgery to show that heart problems can occur at any age.
In May, Marwan was taken to Sukatra Hospital in Yemen after his parents realized he was not growing up like his friends and was constantly ill.
A doctor heard abnormal sounds coming from the boy’s heart.
It turned out that he had a severe narrowing of the pulmonary valve and a large defect between two chambers of his heart, caused by a congenital disease.
The young boy’s father, a fisherman, did not want to be named but, due to the family’s poor financial situation, he was able to get help from NMC Healthcare as part of a sustained health program by the government of the United Arab Emirates.
Marwan was flown to Abu Dhabi in May 2021 and remained in the country for around 40 days.
“A plan was devised to perform balloon dilation of his pulmonary valve and closure of the defect in his heart without open heart surgery, but by cardiac catheterization with a very small needle prick in his thigh,” said the Dr Anas Abu-Hazeem, a consultant pediatric cardiologist at NMC Royal Hospital, Abu Dhabi.
“The child’s heart valve was dilated with a balloon catheter and the heart defect was closed using a 15mm device. Marwan was able to walk the same day.
The procedure was the first of its kind to be performed in a hospital, and due to its success, it led to other similar operations.
Marwan is now back in Yemen with his family and friends.
Cardiovascular disease (CVD) remains the leading cause of death worldwide, causing 18.6 million deaths per year.
It has many causes, mainly smoking, diabetes, high blood pressure, obesity and even air pollution, but sometimes genetic abnormalities from birth.
Young nurse struck down
Another younger patient was pediatric nurse Leena Susan Santhosh, 39, who was planning celebrations for her daughter’s second birthday when she suddenly felt ill in August.
Although she is diabetic, Ms. Santhosh had no previously diagnosed heart problems.
As she prepared to drop her daughter off at the nursery before a stint at Al Ain hospital, she began to experience sudden and unusual chest pain.
“I felt a heaviness in my chest after walking a short distance,” Ms. Santhosh said.
“My homework started at 9 am and my routine was to drop my daughter off at the babysitter before going to work.
“At first I ignored the pain assuming it was from my poor physical condition.”
The nurse went for a check-up, with blood tests and an EKG which came back with normal results.
At the end of the day, she felt a lot of pain and discomfort. After failing a routine treadmill test, doctors decided to perform an angiogram – the gold standard for detecting heart disease.
“Surprisingly, the test confirmed several blocks in the main blood vessel of his heart,” said Dr Syed Tanveer – a consultant cardiologist at NMC Specialty Hospital in Al Ain.
“Her left anterior descending artery – the largest coronary artery supplying blood to two-thirds of the heart, was also blocked.
“She was immediately taken care of for angioplasty and all three blocks were treated by placing two stents – mesh-like structures placed inside the blood vessel at the site of the heart blocks to facilitate blood flow. “
The procedure required an overnight stay, but on September 6, Ms Santhosh was allowed to return home to her daughter and resumed her work in the pediatric ward two weeks later.
“A typical symptom is similar to exercise-induced pain that improves when the patient is at rest,” said Dr. Austin Mohan Komranchat, specialist cardiologist.
“It was a clear sign and symptom of angina. But what scared me was her gender, her age and the fact that she doesn’t smoke.
“It is a known fact that premenopausal women her age protect against estrogen and rarely develop coronary heart disease.
“My advice to young women would be simple: maintain a healthy lifestyle, a balanced diet with regular physical activity, and perform preventive annual health checks. “
Critical rapid response
Doctors stressed the importance of calling an ambulance to take patients with chest pain to the hospital.
Dr Mahmoud Traina, interventional cardiologist at the Cleveland Clinic Abu Dhabi, reported a culture of friends or family members driving patients to hospitals themselves – sometimes with catastrophic consequences.
“People think they can go to a clinic on their own, but that clinic or that small hospital may not have the right resources,” said Dr Traina.
“What usually happens is that the clinic will then assess the patient, then call an ambulance itself and transfer the patient to a specialist hospital like ours.
“This causes a delay in their care.
“There is a culture of not using ambulances, but people don’t fully understand the type of service they can provide.
“They will sort the patient first, then transfer him to the appropriate place.”
Recent data from the hospital suggests that only 15% of severe heart attack cases have arrived at the Cleveland Clinic Abu Dhabi in an ambulance, with the vast majority arriving to the emergency room after being driven by a friend or family member.
There are three dedicated cardiac care hospitals in Abu Dhabi, including the Cleveland Clinic AD, which is also the main hub for emergency cardiac care.
Other specialized heart centers can be found in Sheikh Khalifa Medical City and Sheikh Shakhbout Medical City.
A major heart attack needs to be treated quickly and any minute of delay worsens the outcome for the patient.
Door-to-balloon times are internationally recognized measurements that determine the time elapsed between arrival at the hospital and opening of the patient during surgery. Ideally, this should be less than 90 minutes.
For every ten minute delay, there is an 8% increase in mortality, Dr Traina said.
“We are pre-notified by the ambulance via a signal to our emergency room so that the right team is notified before the patient arrives at the hospital,” he said.
Abu Dhabi doctors use 3D printed model of two-year-old’s heart to treat it – in pictures
Updated: September 29, 2021, 7:43 AM