Patient Story:
Jennifer Shih, M.D.
VAD and Transplant
A Tricky Diagnosis
"This is one of the more dramatic stories of how a pump and transplant can truly save a life."
Robert E. Hobbs, MD.
Wiped out. That's how Jennifer Shih, MD, felt. Twenty-nine years old and in training to become a pediatric cardiologist, Dr. Shih had been on call at her Cincinnati hospital for five of the previous six days. But this exhaustion was beyond anything that could be accounted for by hard work alone. Dr. Shih wondered if it could be her heart.
"I was short of breath after walking up one flight of stairs," she says. "That was strange."
A month earlier, she had learned how to do an echocardiogram, an ultrasound imaging procedure like those that show a new baby in a mother's womb. Dr. Shih did an "echo" of her own heart and saw that it was surrounded by fluid. She took her blood pressure and discovered it was dropping rapidly. Dr. Shih wasted no time in getting to the emergency department. The doctors were unable to stabilize her or diagnose her condition. Her heart was failing, her blood pressure was plummeting and the lower chambers of her heart were beating crazily.
"She was," says one of the doctors who treated her, "plunging into death."
The Cincinnati doctors called Miller Family Heart & Vascular Institute and arranged to transfer her there. A special plane was summoned.
Almost as soon as Dr. Shih reached Cleveland Clinic, she went into cardiac arrest. Robert E. Hobbs, MD, was the cardiologist on call that night. He quickly diagnosed her condition: giant cell myocarditis– a rare disease that affects mostly young people and causes the body's immune system to attack the heart itself.
"I was impressed by the fact that even before the biopsy, Cleveland Clinic doctors suspected giant cell myocarditis," says Dr. Shih.
Dr. Hobbs confirms that it is "a tricky diagnosis. If you haven't seen it before, you won't suspect it." The enormous number of cardiac cases seen by Cleveland Clinic specialists enables them to diagnose rare conditions based on previous experience with the disease. There is only one treatment for giant cell myocarditis: rapid heart transplant.
But there was no donor heart at hand, and Dr. Shih's heart was going under fast.
Fortunately, the Miller Family Heart & Vascular Institute had an alternative: ventricular assist devices (VADs). These implantable artificial hearts can take over for the real heart and perform its pumping function for days, weeks or months until a donor heart can be found. Dr. Shih was rushed to an operating room. At the very door, she once again went into cardiac arrest and was again revived. Heart surgeon Nicholas Smedira, MD, was able to implant two ventricular assist devices, one for each lower chamber of her heart.
After surgery, Dr. Shih was taken to intensive care, in pain and weakening quickly. The VADs helped her heart continue to beat while she was placed on the transplant list under the highest priority. (In 2005, 27 patients were implanted with one or another of six different ventricular assist devices at Cleveland Clinic.)
The tragic fact is that too many people in Dr. Shih's position never get a heart transplant. If a donor heart does not become available in time, the patient dies (that's why it's important to be an organ donor).
But providence was on Dr. Shih's side. Twelve days after being admitted to Cleveland Clinic, a donor heart had become available. But Dr. Shih knew that it was too soon for jubilation. First, it needed to be seen if the donor heart was a match for her own tissue type. If it didn't match, her body would reject it.
For five hours, she and her friends and family waited for the results of the lab test. Then she was told the good news: The heart was a match.
"A nurse held my hand as I was put under anesthesia and held my hand all the way into the operating room," says Dr. Shih. Six hours later, she had a new heart.
"This is one of the more dramatic stories of how a pump and transplant can truly save a life," says Dr. Hobbs. "It was a close call. If it weren't for an aggressive team approach with mechanical support, she may have died."
Today, Dr. Shih is in the midst of a long recovery, which includes some ups and downs and returns to the hospital. On the whole, however, she is progressing well.
"The outcome has been great," she says. "I was so lucky to come to Cleveland Clinic. Everybody was so considerate. They'd do little things to make me feel better. Even washing my hair. That's a big deal when you've been in a bed for two weeks and can't wash it on your own."
Because she will need to take immunosuppressant drugs for the rest of her life, Dr. Shih has had to let go of plans to become a pediatric cardiologist. But an enormous network of friends in several cities is helping to keep her spirits up, and Dr. Shih is even keeping an on-line diary of her recovery so friends and supporters can check up on her. On her 30th birthday, she celebrated her first six months of her new heart. "The survival rate at 3 years is 75 percent," she writes, "and since I am a bettin' woman, I'll take those odds!" Her most recent entry is the happiest yet: a surprise marriage proposal. She writes, "I am a fiancée!"