Boy, 3, Dies After Two Heart Transplants

Nicky Carrizales, the 3-year-old Texas boy who underwent two heart transplants within 24 hours at Loma Linda University Medical Center here two weeks ago, died Wednesday morning of respiratory difficulty that developed only hours earlier. Hospital officials said the child’s family was at his side.

Although the exact cause of death is awaiting completion of an autopsy report, Dr. Leonard E. Bailey, the pediatric surgeon who performed the two operations, told a news conference that a major factor was the exceptionally long time that the child was forced to remain on a heart-lung machine during and in between the two operations--about 18 hours.

Bailey said the prolonged period on the life-sustaining device “raised havoc with all the cells of his body.”

“His loss of lung function was the ultimate coup de grace,” he said. “He couldn’t take on another (organ) system being out . . . but we sense no defeat from this experience.” Part of Nicky’s unsuitability was related to birth defects that affected a heart valve and a major artery. The child also suffered from cardiomyopathy, a deteriorating condition in which the left side of the heart pumps inadequately.

Nicky had been on continuous kidney dialysis since the surgeries, and his liver and nervous system also showed signs of deterioration, the Loma Linda University Medical Center surgeon said.

Sandra Nehlsen-Cannarella, director of immunology, ruled out rejection as the cause of death. She said that from the day of the double transplant, Nicky showed no signs of rejection of the transplanted heart.

Rejection, Bailey said, is “the least likely” of the possible causes of Nicky’s sudden loss of ability to supply his body with sufficient oxygen. An infection, heart failure or a blood clot in his lungs are among the more likely immediate causes, he said.

Bailey said he now realizes that Nicky was not a good candidate for a transplant--an admission that underlines the experimental nature of transplanting hearts in young children.

But Dr. Bruce Branson, chairman of surgery at Loma Linda, near San Bernardino, said the center is committed to continuing its support of Bailey’s experimental heart transplant program on children and newborns.

“In every war there are casualties,” Branson said, “and sometimes they are innocent children. There may be even more (casualties) in our future . . . but we are not discouraged nor deterred from exploring better ways to help children.”

Nicky’s death is the first among six young children, including three who were only days old at the time of surgery, who have undergone heart transplants at Loma Linda in the last seven months. According to Bailey, all are doing well except Baby Rachel, who was operated on in April and has had “a recalcitrant rejection episode which we have not been able to fully suppress.”