At just eight years old, Yemeni schoolboy Marwan Mohamed was one of the first patients at an Abu Dhabi hospital to undergo heart surgery via a tiny incision in his thigh.
The young boy was treated at the NMC Royal Hospital earlier this year after securing medical financial assistance from a UAE health programme.
He was not the typical heart patient seen by doctors, who would usually treat men over 50 with a history of poor lifestyle, smokers and the obese.
Marking World Heart Day, doctors revealed details of the unusual surgery to show heart problems can strike at any age.
In May, Marwan was taken to Sukatra Hospital in Yemen after his parents realised he was not growing like his friends and was persistently unwell.
A doctor heard abnormal sounds coming from the boy’s heart.
He was found to have severe narrowing of the pulmonary valve and a big defect between two chambers of his heart, caused by a congenital condition.
The young boy’s father, a fisherman, did not want to be named but because of the family’s poor financial situation, qualified for assistance from NMC Healthcare under a UAE government assisted health programme.
Marwan was flown in to Abu Dhabi in May 2021 and stayed in the country for around 40 days.
“A plan was developed to perform balloon dilation of his pulmonary valve and closure of the defect in his heart without open-heart surgery, but through cardiac catheterisation with a very small needle prick in his thigh,” said Dr Anas Abu-Hazeem, a consultant paediatric cardiologist at NMC Royal Hospital, Abu Dhabi.
“The child’s heart valve was expanded with a balloon catheter and the heart defect was closed using a 15mm device. Marwan was able to walk the same day.”
The procedure was the first of its kind to be performed at the hospital, and because of its success it has led to other similar operations.
Marwan is now back in Yemen with his family and friends.
Cardiovascular disease (CVD) remains the world’s number one killer, resulting in 18.6 million deaths a year.
It has many causes, mainly from smoking, diabetes, high blood pressure, obesity and even air pollution but occasionally genetic defects from birth.
Young nurse struck down
Another younger patient was paediatric nurse Leena Susan Santhosh, 39, who was preparing celebrations for her daughter’s second birthday when she suddenly felt ill in August.
Although she was a diabetic, Ms Santhosh had no previously diagnosed heart conditions.
As she was about to drop her daughter off at crèche before a hospital shift in Al Ain, she began to experience sudden, unusual chest pains.
“I experienced chest heaviness after walking just a short distance,” Ms Santhosh said.
“My duty started at 9am and my routine was to drop my daughter to the babysitter before I went to work.
“Initially, I ignored the pain assuming it was because of my poor fitness levels.”
The nurse went for a check-up, with blood tests and an electrocardiogram that came back with normal results.
By the end of the day, she was in a lot of pain and discomfort. After she failed to complete a routine treadmill test, doctors decided to run an angiography - the gold standard in detecting heart disease.
“Shockingly, the test confirmed multiple blocks in her heart’s major blood vessel,” said Dr Syed Tanveer - a consultant cardiologist at NMC Speciality Hospital, Al Ain.
“Her left anterior descending artery - the largest coronary artery supplying blood to two thirds of the heart, was also blocked.
“She was immediately taken up for the angioplasty and the three blocks were treated by placing two stents — mesh-like structures placed inside the blood vessel at the site of the heart blocks to provide for an easy blood flow.”
The procedure required an overnight stay, but on September 6, Ms Santhosh was allowed to go home to her daughter and was back at work in the paediatric ward just two weeks later.
“A typical symptom is similar to exercised induced pain that gets better when the patient is at rest,” said Dr Austin Mohan Komranchat, a specialist cardiologist.
“This was a clear sign and symptom of angina. But what anguished me was her gender, age and her being a non-smoker.
“It is a known fact that premenopausal females of her age have oestrogen protection and rarely become a coronary heart patient.
“My advice to young females would be simple — maintain a healthy lifestyle of balanced diet with regular exercise and take preventive annual health check-ups.”
Rapid response critical
Doctors have stressed the importance of calling for an ambulance to take patients with chest pain to hospital.
Dr Mahmoud Traina, an interventional cardiologist at Cleveland Clinic Abu Dhabi, reported a culture of friends or family members driving patients into hospitals themselves - sometimes with catastrophic consequences.
“People think they can just drive to a clinic themselves, but that clinic or small hospital may not have the right resources,” Dr Traina said.
“What typically happens is that clinic will then evaluate the patient and then call for an ambulance themselves and have the patient transferred to a specialist hospital like ours.
“This causes a delay in their care.
“There is a culture of not using ambulances but people do not fully understand the kind of service they can provide.
“They will first triage the patient and then transfer them to the appropriate place.”
Recent data from the hospital suggested just 15 per cent of severe heart attack cases arrived at Cleveland Clinic Abu Dhabi in an ambulance, with the vast majority arriving at the emergency department after being driven by a friend or family member.
There are three hospitals dedicated or cardiac care in Abu Dhabi, including Cleveland Clinic AD, which is also the main hub for emergency cardiac care.
Other specialist cardiac centres are at Sheikh Khalifa Medical City and Sheikh Shakhbout Medical City.
A major heart attack needs to be treated quickly and any minute of delay worsens patient outcome.
Door-to-balloon times are internationally recognised metrics that determine the time from hospital arrival to getting the patient opened up in a surgical procedure. Ideally, this should be under 90 minutes.
For every ten minute delay, there is an 8 per cent increase in mortality, Dr Traina said.
“We get pre-notified by the ambulance via a signal to our emergency room so the right team is notified before the patient arrives at the hospital,” he said.