http://blog.al.com/spotnews/2011/06/uab_is_first_in_us_to_use_exp...

http://blog.al.com/spotnews/2011/06/uab_is_first_in_us_to_use_expe.html UAB is first in US to use experimental cardiac care device on child .
One Tuesday back in February, Greer Underwood's parents were told she had a sinus infection and she could go back to school the next day. By the end of the week, the 9-year-old was at UAB Hospital having a massive stroke and at the edge of heart failure.

Greer's fast decline was a surprise, but the little girl got lucky on a lot of levels.

Because she ended up at UAB -- Children's of Alabama sends some critical cardiac cases there -- doctors handled her stroke the same way they do for adults, quickly catheterizing her to remove the dangerous blood clot and avoid paralysis. As she stabilized, however, her medical team was faced with a new dilemma: what to do with her failing heart.

She needed a transplant, but there was no telling how long that would take. The doctors wanted to give her a ventricular assistive device, or VAD, a mechanical pump to keep heart patients alive. But the only one available for children, called the Berlin Heart, carries with it a high risk of stroke, something Greer just couldn't handle.

"To be honest, we didn't have a lot of options," said Greer's father, Greg Underwood.

So Greer's doctor, James Kirklin, the head of cardiothoracic surgery at UAB, decided to try something new: a VAD that's still awaiting federal approval called the HeartWare. It's made for adults, but at about 3 inches long, it's small enough to fit in Greer's heart cavity. With special emergency permission from the Food and Drug Administration, she became the first child in the United States to have the device installed.

"This is the way in which you push the limits a little bit and increase awareness for the potential for this kind of pump in a child," Kirklin said.

Greer seems like a guinea pig, but she's also a preview of how pediatric heart patients may be treated in the future. Doctors say that a new wave of tiny heart pumps could help keep children alive as they wait for transplants and may also help an ever-growing group of adults with heart failure.

Shrinking technology
As recently as a decade ago, the standard treatment for kids with failing hearts -- and still the main option for newborns -- was a machine called an ECMO, for extracorporeal membrane oxygenation. It's much like the heart-lung machine used on patients during open-heart surgery; blood is drained from the neck or groin, pumped through an artificial lung to get new oxygen and then filtered back into the patient.

The ECMO's a lifesaver, but it requires children to be temporarily paralyzed with medication and hooked up to wires and tubes in intensive care. It also wears out quickly and has a high risk of infection.

VADs have been available for adults for years, but the industry has been slow to make models for pediatric patients. The earlier forms, which pulse blood like a pump, are too big for most children. And though the newer, continuous-flow VADs are getting smaller, only one -- the Berlin Heart that wouldn't work for Greer because of the stroke risk -- was specifically designed for children.

The problem is, there isn't a big market for new heart devices for children, because as few as 100 may need them in the United States each year. That means private companies, which spend huge sums developing new devices, aren't that interested, said Tim Baldwin, a biotechnologist who works with heart devices at the National Heart, Lung and Blood Institute at the National Institutes of Health.

"You don't turn your back on these children, but I can understand from a business standpoint why they'd make these decisions," he said.

So Baldwin's institute funded two programs to the tune of $50 million to encourage the development of pediatric heart machines, one that ran from 2004 until 2009 and one that kicked off last year. The latest, called PumpKIN -- Pumps for Kids, Infants and Neonates -- is focusing on four devices: two small VADs and two that are basically streamlined, more durable ECMOs.

The goal, Baldwin said, is to make technology like the VAD that saved Greer available for more children.

Back to Muscle Shoals

Greer, meanwhile, received her heart transplant on Mother's Day. She's recovering well and headed back home to Muscle Shoals last week. Physical and occupational therapy are helping her regain the use of her right leg and arm, which were damaged by the stroke.

She hopes to learn to write left-handed before she starts fifth grade this fall and plans to play basketball again come winter. She needs regular blood tests and biopsies to monitor her new heart, but she loves the iPad she got in the hospital.

Her doctors still don't know what caused her heart to fail. Kirklin said such sudden-onset cardiomyopathy, which can be caused by a virus, often goes undiagnosed, sometimes with lethal results.

Greer's parents say they're thankful not just that she made it but that her ordeal might help others. It was scary saying yes when the doctors told them she'd be breaking new ground -- Greg Underwood joked that they signed so many forms they weren't sure they still had custody of her -- but someone has to be first, Dawn Underwood said.

Meanwhile, don't try to tell them they just got lucky.

"We like to think of the Lord blessing us instead of luck," Dawn Underwood said. "I don't think we were just necessarily in the right place at the right time. It's too good to be luck."

HOW IT WORKS
The HeartWare VAD is built around a 3-inch-long blood pump that looks like a tiny, shiny hairdryer.

The pump sits inside a patient's chest and is attached to the heart. A cable comes out through the skin and connects the pump to a controller, which is powered by a battery pack and can be plugged into the wall.

The pump has one moving part, an impeller that spins like a fan more than 2,400 times a minute, taking blood from a lower chamber of the heart and pumping it to the aorta so it can be sent out into the body.



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