Ian: Living with Heart
By Diane Yohe
Tammy Quinones was driving to work last December when she received a call from her son’s school, where she had just left her 13-year-old, Ian. There had been an accident, the school said. Her son was involved.
Tammy turned around, and on her way back to Rincon Middle School in Escondido, she passed an ambulance, and she knew Ian was inside. “At the school, they told me he was taken to Palomar Hospital,” Tammy said.
At Palomar Medical Center, a nurse and chaplain told Tammy what had happened. Ian had collapsed during gym class. He was given CPR. Someone used a defibrillator to restart his heart.
Ian’s team at Palomar then called for emergency transport to Rady Children’s Hospital-San Diego. “Physicians couldn’t get a pulse for him in the emergency room,” Tammy said. Rady Children’s Hospital Emergency Transport (CHET) Team stabilized Ian and delivered him to Rady Children’s. CHET provides immediate response to hospitals, clinics or doctor’s offices in San Diego, Imperial and Riverside counties.
“When Ian was admitted to the ICU, he was as critical as they come,” said Matthew Wilder, M.D., a pediatric critical care fellow at Rady Children’s. “He was in full cardiac arrest and getting CPR by the support team.”
Tammy called Ian’s father to tell him the news. Ian was in the intensive care unit in very critical condition. “It was very frightening,” Tammy said. “He was put into a drug-induced coma, and a surgeon put him on an ECMO machine to stabilize his heart.” ECMO, or extracorporeal membrane oxygenation, is advanced technology that circulates blood so that oxygen can be supplied to the body. Similar to a cardiopulmonary bypass performed in operating rooms, it can be used to support heart and lung function in children.
Bradley Peterson, M.D., director of the Ernest Hahn Critical Care Center, examined Ian and prescribed medications to help stabilize him. Dr. Wilder noted that Ian was given massive amounts of medications to try to regain pulses and a normal heart rhythm.
James C. Perry, M.D., director of Electrophysiology and the Adult Congenital Heart Program at Rady Children’s and professor of pediatrics, the University of California, San Diego School of Medicine, examined Ian as well, and determined he had Wolff-Parkinson-White syndrome, a rare heart condition.
The congenital (present at birth) disorder has the presence of an extra abnormal pathway to the heart that causes periods of very fast heartbeat.
“Only one percent of patients who have this congenital condition go into cardiac arrest as Ian did,” Dr. Perry said.
“The condition often doesn’t show up until later in life. That’s why Ian didn’t have any symptoms until he collapsed at school. The instant CPR he received and the defibrillator at the school definitely saved his life.”
When Ian was stable enough, Dr. Perry took him to the electrophysiology lab and found he had several dangerous extra pathways on the left side of his heart. Dr. Perry and his staff prepared for a radiofrequency catheter ablation procedure to destroy the extra pathways. The procedure would take six hours, Tammy learned. “They told us they would have to re-enact a cardiac arrest to find the electrical currents that ran down into the bottom part of the heart so Dr. Perry could ablate them,” she said.
Ian was asleep during the procedure in the cardiac catheterization laboratory.
A catheter was threaded up through his leg into the heart, and radiofrequency energy (low-voltage, high-frequency electricity) targeted the pathways causing the abnormal heart rhythm, and destroyed them.
“Ian will only need to see us one more time,” Dr. Perry said. “He is doing great and is cured from a heart standpoint. We have one of the most active cardiac catheterization programs in the country and have first-class results in the nation for doing this catheter-ablation procedure.”
Said Tammy, “Dr. Perry cured Ian’s heart condition, and we’re so grateful he practices at Rady Children’s.”
The ECMO treatment caused some damage to Ian’s right leg. Due to oxygen loss from the knee down, physicians had to remove 60 percent of the muscle from his lower leg. Ian has had five surgeries on his leg, followed by physical therapy to help in his recovery. He might have one more surgery on his leg to minimize the scar.
In February, Ian was released from the hospital, and he returned to school.
Now 14 and in ninth grade, Ian is grateful to be alive, and for the care he received at Rady Children’s.
“The one thing I’ll remember most about the nurses and doctors is that they were nice and that they saved my life,” Ian said.
Tammy still can’t believe Ian survived everything so well. “Ian is such a miracle boy,” she said.
The San Diego Union-Tribune Kids’ NewsDay, October 2011