Heart pump device bridges teenager to her 2nd chance

Taft High School flutist was at risk to die before donor organ could be found

SAN ANTONIO (July 2, 2012) — Amber Munoz, 15, relishes the idea of playing her flute at football games this fall with the Taft High School Raider Band. “I love playing music for people; it makes me happy,” she says.

Band practice starts Aug. 1 but she still has a bit of recovery to do to get to the field. That’s because on April 4 surgeons at The Methodist Heart Hospital transplanted a new heart to replace her enlarged one. The six-hour implant procedure was performed by Jay Pal, M.D., Ph.D., and John Calhoon, M.D., of UT Medicine San Antonio.

This was among the first few cases in a new collaborative effort joining the forces of the Texas Transplant Physician Group of Michael Kwan, M.D., and Chandra Kunavarapu, M.D., with UT Medicine surgeons. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center at San Antonio.

A HeartMate® II left-ventricular assist device (LVAD) enabled Amber to stay alive for 48 days while surgeons and her family awaited the donor heart, which came from a young organ donor. The Methodist Heart Hospital team is the most experienced in the region with cardiac assist device implantations, having performed more than 130 implantations to date. Amber is one of the youngest patients in the world to be bridged to transplant in this manner.

“She was hospitalized on medication but then worsened,” Dr. Pal said. “We made the decision to move forward with the left-ventricular assist device. She would have died without it. I’ve seen patients die in similar situations.”

Dr. Pal implanted the pump Feb. 15, after which Amber’s condition stabilized. She was discharged from the hospital two weeks later. She handled the pump like a trooper — not a small task considering the device is implanted in the abdomen and is connected by a cable to an external monitor and power pack.

“There aren’t very many people this age who have had this pump,” Dr. Pal said. “We were concerned about children being able to manage these things, especially the emotional component of having a battery connected to the body. But she did a fabulous job. She is definitely one of the youngest in the world to have used this pump.”

Amber’s heart disease, called non-ischemic cardiomyopathy, was detected in an emergency room visit in January. A few weeks prior, on Dec. 27, she underwent bone spur removal and seemed to have an asthma attack under general anesthesia. “Looking back now, we think it was her heart,” said her mother, Valerie Munoz. In January the once-healthy teenager couldn’t eat or hold down food. During an emergency room visit, a chest X-ray revealed the heart issue.

“It was shocking news,” Valerie Munoz said. “There was no family history of what she had. They thought they might be able to give her medicine and she would get better. It took about a week to learn that she needed a transplant.”

Because undetected cardiomyopathy may result in sudden death, the foot surgery and complications likely saved Amber’s life. “They think the surgery pushed her heart,” Valerie said. “If she had not had the surgery, we wouldn’t have known. While the news was difficult, in a way, yes, I’m grateful we did find this out.”

Amber’s outlook is good and she started a Facebook group to encourage youngsters who are facing heart transplants. “She’s a great story,” Dr. Pal said. Dr. Kwan, medical director of the Heart Failure and Heart Transplant Program and member of the medical team that took care of Amber, added: “She was so sick that almost weekly her plan would change. She went from broken ankle to ‘asthma’ to heart failure to HeartMate II LVAD to transplant. But not only did she keep a positive attitude during an up-and-down hospital stay, with her Facebook support group she’s inspiring others whom she’s never even met that they can do it, too.”

“The last few heart biopsies are looking good,” Valerie Munoz said. “She’s not healed yet, but she’s walking and being active. She’s more and more herself as the days go by. Her friends are starting to come over again.”

Amber, whose favorite subjects are biology and English, will repeat her freshman year at Taft. “I’m pretty sure I can march this fall,” she said. “I am going to feel very happy and proud to be out there.”

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 100 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship location, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the website at www.UTMedicine.org for a complete listing of clinics and phone numbers.

Methodist Heart Hospital was established in 2001, offering the most comprehensive cardiology services in South Texas. In 2008, the heart transplant program moved to Methodist Heart Hospital from Methodist Specialty and Transplant Hospital. The program is the largest heart transplant program in Central and South Texas, having performed over 360 heart transplants and over 130 cardiac assist device implantations to date. It is also the most experienced program in the region that offers percutaneous and surgical ventricular assist devices. Earlier this year, the program was the first in South Texas to be recognized by the Heart Failure Institute of the Healthcare Accreditation Colloquium for its outstanding high-quality services and results. The physician transplant team includes Michael Kwan, M.D., Chandra Kunavarapu, M.D., and surgeons Charles Christian, M.D., Jay Pal, M.D., Ph.D., Lawrence Hamner, M.D. and Leopoldo Zorrilla, M.D.. Visit www.SAHealth.com to learn more.

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