First person in Asia with a complex ailment called 'Takayasu' to get a heart transplant

(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, shares experiences that touched his heart. Click here to read previous columns in the series.)

It was in 2005 that Shruthi first came to Lisie Hospital in Ernakulam. She was only 16 years of age then with a heart whose functioning had greatly reduced.

A team led by Dr Ronnie Mathew conducted an angioplasty to remove a blockage in her coronary artery.

Several tests were done on Shruti which revealed that was suffering from a disease called Takayasu. She also had excessive blood pressure, lacked a kidney, and the blood vessel to her left arm had narrowed.

In later years, Shruthi had to be hospitalised several times due to breathing problems, leaving her and her loving parents perplexed about what the life ahead had in store for them.

It took them days to come to terms with the fact that the heart's functioning was in its final stages and that a heart transplant surgery was the only option to cure the problem.

Heart transplants are rare in patients who have suffered heart failure due to the complex condition called 'Takayasu' that constricts blood vessels in various parts of the body.

Poor condition of the arteries and renal malfunction generally deter medical science from proceeding with such a surgery. Yet, that smiling face and benevolent look and the loving disposition of her parents and family that gave so much importance to her life inspired us to take on the responsibility of planning the surgery.

Shruthi was admitted to the hospital for completing the initial steps and tests required for the heart transplant surgery. She had only 18 per cent heart function. Also, she had only one kidney since birth and the blood pressure in the kidney was higher than expected. However, we went ahead with the preparations for the first ever heart transplant surgery in Asia on a patient suffering from Takayasu.

Her name was registered in 'Mrithasanjeevani', a network for organ sharing in Kerala, and we waited for a heart to become available for her.

On September 23, 2013, Shruthi received the heart of a 44-year-old native of Chingavanam who was pronounced brain dead at the Kottayam Medical College Hospital.

With the help of Dr T K Jayakumar, the head of the cardiac surgery department at the Kottayam Medical College, Lalichan's heart was removed and it was rushed from Kottayam to Ernakulam with a police escort.

It was 4 pm. We reached Lisie Hospital in 53 minutes through the rush hour when students step out of schools. By the time we arrived, the operation theatre was ready.

As we removed Shruthi's failed heart and a new heart was sewn to replace it, we had strong doubts about how the other organs of her body would accept the new heart. The most troubling was the functioning of the kidney.

Attempts to remove the heart from the heart-lung machine after the new heart was sewn failed. Her heart and lungs were again put under the control of that machine. It was a situation where the right ventricle of the heart expanded like a balloon and stopped functioning. Those muscles were tense, unable to withstand the excessive pressure of the lungs.

We often receive a heart without knowing if there was any narrowing of arteries in the donor. This is especially the case if the donor is young. As if on cue, a thought came to my mind that the right artery of the heart might be constricted. An artery was taken from the leg and a bypass was performed on the right artery of the heart.

Call it a miracle, the heart began to beat again; the rhythm in Shruthi's chest was back and powerful, it gave her a new lease of life.

But the real challenges were only about to begin. The functioning of her kidney came to a standstill within 48 hours after the surgery. It took a lot of effort to keep the blood pressure normal.

It was a situation where the balloon pump that is commonly deployed to improve the functioning of the kidney could not be used due to the side effects of the medication given to prevent the body from rejecting a transplanted heart.

We had to tell Shruthi's parents that she needed dialysis. We were aware that the kidney not functioning after a heart transplant surgery and the subsequent need for dialysis were major causes for an operation's failure.

In the days that followed, she had to undergo dialysis several times in the intensive care unit. Her condition was critical — anything could have happened at any moment. We could not bear to see the changed expression on that ever-smiling face.

Some improvements in her condition became visible after four days of dialysis. The functioning of her kidney resumed slowly. After a week of treatment in the intensive care unit, her body began to accept the new heart.

She was then shifted to the ward, tests were done to ascertain the effectiveness of the medicines given to her, the biopsy of the muscles of the heart was performed... all this happened one after the other.

On October 21, 2013, when she was discharged from the hospital almost a month after the surgery, Shruthi became the first person in Asia with 'Takayasu' to have had a successful heart transplant.

When Shruthi, who worked as a clerk in a real estate bureau, left the hospital, she was seen off by actor Dulquer Salmaan and director Ranjith. Dulquer gifted her a laptop for her to do her work from home.

Many incidents disrupted Shruti's life when she returned home with a new heart after the operation, posing lot of difficulties for her.

About a year later, when Shruthi was admitted to the hospital with a toothache, we got frightened. Her face was so swollen that it couldn't be recognised. We wondered how she would cope with this condition when the medication she was taking to keep her heart from being rejected was weakening the body's immune system.

Her life and health were again in the hands of fate. This time the person who came to her rescue was ENT surgeon Dr Reena Varghese.

Shruthi again underwent a timely surgery after which she was put on strong antibiotics. In about two weeks, we were able to bring Shruthi back to normal. It was such a big relief.

But her difficult journey did not end there. Biopsy reports indicated that the body was rejecting the heart. She was again admitted to hospital and she needed intensive medication. Shruthi faced everything with a smile and she was greatly supported by her mother Shanta, father Sashi and sister Shalu.

The angiogram done as part of routine examination surprised us. Although the bypass on the right artery done during the heart transplant surgery had no problem, she had a 90 per cent block in the most important left artery.

We felt that it was perhaps with that block that Shruthi had been leading a life for three years. On August 17, 2016, another angioplasty was performed on Shruthi under the direction of Dr Ronnie Mathews for the narrowing of blood vessels in her transplanted heart.

Later, an angiogram done in 2019 showed that the right artery bypass and the left artery angioplasty were working perfectly. All that one could say was that this was miraculous!

In 2013 and then in 2019, she had swelling in her legs that forced her to spend weeks at home without being able to walk or go to work. She had to take medicines for days because of the disease and swelling that afflicted the muscles. In the meantime, she also received Dr Latha Mathew's treatment in 2015 to correct a problem with her vision.

My colleagues and I again entered her life recently when Shruthi was admitted to the hospital for treatment of an ailment behind her ear. Her surgery was completed in six hours by Dr Reena Varghese and colleagues. We were all very happy with the decision of the hospital director, Fr Paul Karedan, to not charge Shruthi's family for the operation.

It would probably be rare to see individuals and families who have faced a very serious illness so bravely. It was their confidence and extreme passion for life that inspired our team members to perform this heart transplant surgery that many would have considered impossible.

The journey that Shruthi has gone through and the way she has overcome obstacles should be an inspiration to all of us.

There are many organisations and individuals who have been a part of this incredible journey. How great is the message that the real estate bureau in which she worked for years after the heart transplant surgery; Nithi Laboratory in Mulanthuruthy where she worked in a technical role; Dreams Studio in Arakkunnam where she now works as a photographer; Jesse Santhosh, also a ward member, who came forward to raise money for the heart transplant surgery; activists Benny Ponnankuzhi and B B Paulose; SNDP office-bearers Shaji, Nandanan and Sivaraman; and the Heart Care Foundation are giving to the community!