Texas Boy, 3, in Critical but Stable Condition : Child Gets 2nd Heart Implant

A 3-year-old Texas boy was in critical but stable condition Thursday after receiving his second transplanted heart within 24 hours at Loma Linda University Medical Center.

After what Dr. Bruce Branson, chairman of Loma Linda’s surgical department, called the most “complicated surgery we’ve ever had to do,” Nicky Carrizales was described as “warm and pink” and “showing signs of recovery.”

Branson added, however, that “there has been minimal kidney output” and that Nicky may have to be placed on dialysis.

First Heart Fails

A second transplant was performed on Nicky, who suffers from cardiomyopathy, a degenerative heart condition, after the first heart he was given early Wednesday morning failed, Branson said.

“It took over an hour for the first heart to start beating after suturing. This was unusual,” Branson said. “By comparison, the second heart started to beat within five minutes after suturing was completed.”

At a press conference, Branson said a tissue examination of the first heart would be conducted to determine why it failed. Dr. Leonard L. Bailey, chief of cardiac pediatric surgery and leader of the team of physicians who performed both heart transplants, did not attend the press conference. “He has had two hours’ sleep in the last two days,” Branson said.

Bailey began the second transplant operation at midnight Wednesday with the donor heart of a 6-year-old Denver boy who was killed in a shooting accident earlier in the afternoon, officials said.

Progression of Case

“At 1:05 a.m. Thursday, the heart was in place, the heart began to beat and looked good,” said hospital spokeswoman Anita Rockwell. Seven hours later, Nicky was transferred to an intensive care unit.

Nicky is the sixth and oldest child to receive a new heart at Loma Linda and the first to suffer an immediate failure, officials said.

Branson suggested that some of the problems with the first transplant may have been related to the fact that the donor--a 2-year-old Fullerton girl who died from injuries sustained in a hit-and-run traffic accident 13 days ago--had been on life-support systems for more than a week.

Surgeons were unable to sustain a heartbeat in the new donor organ, which “couldn’t keep up with the demand,” Branson said.

Loma Linda officials decided to make an urgent request for another heart with the Regional Organ Procurement Agency at UCLA, which coordinates organ donations throughout Southern California.

Aided by Machine

Meanwhile, Nicky clung to life for 13 hours with the help of a heart-lung machine, the use of which also increased the risk of damage to the boy’s red blood cells and other organs, Branson said.

On Wednesday afternoon Loma Linda learned of another potential donor, Jason Lars Kendrick, 6, who was declared brain-dead after he was accidentally shot by a playmate at the home of a baby sitter in the Denver area, officials said.

Jason’s parents, John, a city employee in nearby Aurora, and his mother, Paula, a nurse at Humana Hospital in Aurora, made the decision to volunteer their son’s organs to Loma Linda, according to a friend of the Kendrick family.

“The parents said Jason was always a giving child and would have wanted it that way,” said Bonnie Wenners, a close friend of the family and a nurse at Humana Hospital.

Aurora Police Department Sgt. Jim Hale said the shooting accident occurred at 12:45 p.m.

Jason and four other children were playing in his baby sitter’s home when a 10-year-old boy took what he thought was an unloaded .22-caliber rifle from a gun rack and pointed it at Jason, Hale said.

The gun discharged hitting the 6-year-old in the head, Hale said.

“It was an antique gun, an heirloom--no one had any idea there was ammunition in it,” Wenners said. “It was a complete accident.” The wounded boy was airlifted to Swedish Medical Center in the Denver suburb of Englewood where he was pronounced brain-dead at 1:45 p.m., said Debbie Felker, a spokeswoman for the medical center.

Paul Taylor, transplant coordinator at the University of Colorado Health Services Center, contacted Loma Linda officials about the case and then arranged to have the brain-dead child flown to Norton Air Force Base in San Bernardino on Wednesday evening, Felker said.

His heart kept beating by a life-support system, the donor arrived at Loma Linda about 11 p.m., officials said.

Tissue Typing

Nicky went into the operating room at 11:30 a.m. after physicians had completed compatibility tests on blood and tissue and concluded that the heart from the older, larger donor could be fitted into Nicky’s chest cavity.

“It was largely a matter of size matching,” Branson said. “This 3-year-old already had an enlarged heart because of disease.” As a result, he said, “by the time of surgery, the diseased heart was almost the size of the second heart.”

Nicky arrived at Loma Linda with his father, Rudy Carrizales, an X-ray technician at Kelley Air Force Base near San Antonio, and his mother, Mary Lou, on June 9 with funds raised by Project Any Baby Can, a child support service for children with chronic diseases.

Dr. Marian Sokol, spokeswoman for the service, said additional funds were raised to have Nicky’s sisters, Jeanine, 11, Melissa, 9, and Celeste, 7, flown to Loma Linda on Friday morning.

Jesse Progressing

Bailey’s most recent infant-to-infant heart transplant was June 10 on Jesse Dean Sepulveda, who was 16 days old at the time.

On Thursday, Branson described Jesse as progressing “reasonably well.” Branson said the boy had a mild fungus infection in the mouth, but that his kidneys, neurological system and lungs showed no complications.