A Man With Two Hearts Miraculously Survives Double Heart Attack

A man with two hearts was brought back to life after suffering a double heart attack.

The 71-year-old Italian was rushed to hospital in Verona, Italy, with chest pains when his two hearts started beating irregularly. The patient, who has not been named, had undergone a heterotopic - or double heart transplant - several years ago, according to the American emergency medical journal.

During the procedure, instead of his heart being removed and replaced with another one, the transplant paired a new organ with the diseased one according to a report in the Annals of Emergency Medicine. 

He had undergone a rare heart transplant seven years earlier in which a new organ was paired with the diseased one. The two hearts had developed independent rhythms and doctors attempted drug therapy to correct the problem. 

A The 71-year-old Italian arrived at the emergency room suffering from two irregular heart beats. His chest X-ray is pictured

While he was under the doctors' watch, both of the man's hearts stopped beating and he lost consciousness. 

After a jolt with a heart defibrillator miraculously brought him back to life doctors replaced his pacemaker but left both hearts intact, capping one of the most bizarre medical cases in recent memory.

Chambers and blood vessels of the two organs were connected so the new heart could support the old one. 

However, one of the hearts had become stronger than the other and had started beating at a different rate to the other.

'TWO HEARTS': THE PROCEDURE

People who undergo a heterotopic heart procedure survive for an average of 15 years after the procedure.

Like an ordinary heart transplant it is a prodedure performed on patients with end-stage heart failure or severe coronary artery disease.

In the heterotopic procedure the patient's own heart is now removed and the new organ is positioned so the chambers and blood vessels of both hearts can be joined to form a double heart.

This can give the original heart a chance to repair itself and if the donor heart fails it can be removed with the original heart still in place.

This procedure is only really used when the donor heart is not strong enough to function by itself.

Doctors tried to sync his two heart beats with drugs, but both organs stopped beating and he stopped breathing, Msnbc.com said. 

Amazingly the man was brought back to life by a heart defibrillator seconds later and surgeons replaced his pacemaker.

The man is alive and well following the emergency surgery in 2010 and still has two hearts. 

Dr Giacomo Mugnai, who helped treat the man, said in an email to the news website: 'We haven’t ever seen anything similar to this case before.'

Dr Rade Vukmir, professor of emergency medicine at America's Temple University, and a spokesman for the American College of Emergency Phsyicians, said he had seen the procedure carried out on kidney and cardiac patients before.

He said: 'Surgeons might leave a kidney in place if it’s too much trouble to take out, or if there is hope for recovery of a kidney, or a heart, after a period of time of being helped by the new organ.'

The heterotopic heart transplant is very rare nowadays as special devices to do the job of the second heart - called ventricular assist devices - which were large and expensive 20 years ago are now much smaller and portable. 

However, doctors are aware there are some patients - such as this man - still alive with two hearts and are trained to deal with the problem.

FIGURE 1: 

Left, Relationship between donor and recipient hearts shown by three-dimensional volume rendering reconstructed by cardiac computed tomography (Reproduced with permission from Lai et al., 2008). Right, Schematic diagram of heterotopic heart transplant that shows anastomoses between the right atrium, left atrium, aortas, and main pulmonary arteries with a tube graft. dAorta, Aorta of donor heart; dPA, main pulmonary arteries of donor heart; dRV, right ventricle of donor heart; dRA, right atrium of donor heart; rRA, right atrium of recipient heart; rRV, right ventricle of recipient heart; DG, polyester textile fiber (Dacron; DuPont, Wilmington, DE) tube graft. (Reproduced with permission from Lai et al, 2008.)

FIGURE 2: 

Left, Chest radiograph performed 1 year before, showing the site of the native and donor heart in the chest. This chest radiograph shows the biventricular pacemaker and its own electrocathethers. One is placed in the right atrium of the donor heart; the other 2 are visible in the right ventricle of the recipient heart (on the bottom, a pacing lead, and on the top, a defibrillation lead, already placed in anticipation of a possible and subsequent upgrade to an implantable cardioverter), and the last one is collocated in the left ventricle of the recipient heart. Right, Chest radiograph performed in our ED, showing right pleural effusion and pulmonary congestion and enlargement of the native heart.

FIGURE 3: 

Top, Standard 12-lead ECG at presentation. Left precordial leads V2 to V6 and aVL show an irregular and broad QRS complex tachycardia compatible with native heart ventricular fibrillation, whereas aVR, D1, D2, and precordial lead V1 show sinus tachycardia of the donor heart. Bottom, Standard 12-lead ECG after defibrillation. D1, D2, D3, aVR, aVF, and precordial lead V1 clearly show sinus rhythm of the donor heart. In all the limb leads (except aVR), it is clear that depolarizations of the 2 hearts occurred sequentially, as programmed by the biventricular pacemaker. Left precordial leads (V2 to V6) and aVL show biventricular stimulation of the native heart after a small QRS complex (depolarization of the donor heart). The native heart is affected by chronic atrial fibrillation; therefore, there are no P waves of the native heart.

FIGURE 4:

A, Example of a standard 12-lead ECG showing ventricular tachycardia of the native heart. B, A right-sided 12-lead ECG in which all precordial leads were switched from the left to the right. This right-sided ECG shows more stable sinus rhythm in V4R to V6R and smaller voltages of broad complexes, and it assists in making a correct diagnosis.

Source:[Annals journal of emergency medicine, AJEM, SciVerse ScienceDirect]

My comment: Heterotopic heart transplants are almost unheard of these days because of the development of small, portable devices that do the job of the second heart. Ten years ago, these machines, called ventricular assist devices, were extremely large and expensive.

Thanks for reading and please share your comments

Akshaya Srikanth,

Pharm.D Internee,

Hyderabad, India.