Born with congenital heart disease, underwent five open-heart surgeries... Regained healthy daily life through heart transplantation

A patient in his 60s who had undergone multiple open-heart surgeries due to congenital heart disease received a heart transplant and regained a healthy daily life without rejection.

The heart transplant team at Severance Hospital, led by Professor Shin Yu-rim of the Department of Cardiovascular Surgery and Professor Oh Jae-won of the Department of Cardiology, announced on the 7th that they successfully completed a heart transplant for Ms. Oh Mi-hye (62), who had undergone five open-heart surgeries due to congenital heart disease, and that she has maintained a healthy condition without rejection six months after the transplant.

O Mi-hye (center), who recovered her health after a heart transplant surgery, Shin Yu-rim, Professor of Cardiovascular Surgery at Severance Hospital (left), and Oh Jae-won, Professor of Cardiology. [Photo by Yonsei Medical Center]

Ms. Oh was diagnosed with a congenital heart disease called Tetralogy of Fallot and underwent the second Tetralogy of Fallot corrective surgery in Korea at Severance Hospital in 1972 when she was in the sixth grade of elementary school. Tetralogy of Fallot is a condition where four defects occur simultaneously: ventricular septal defect, right ventricular outflow tract obstruction, overriding aorta, and right ventricular hypertrophy. Without surgery, the mortality rate is high, and the surgical procedure is complex. This disease accounts for 5-7% of all congenital heart disease cases.

Even after the Tetralogy of Fallot surgery, Ms. Oh underwent four additional open-heart surgeries, including ventricular septal defect repair and pulmonary valve replacement, due to various heart problems until 2007. She maintained daily life without difficulty until October 2020, when she visited Severance Hospital due to worsening shortness of breath. Detailed examinations revealed significantly reduced function of both the left and right ventricles. Despite administration of cardiac stimulants, her breathlessness worsened, and edema increased. Eventually, Ms. Oh reached end-stage heart failure requiring a heart transplant, was registered on the transplant waiting list, and was hospitalized for treatment starting January 2021.

However, finding a suitable donor heart was difficult. Particularly, blood type O patients like Ms. Oh have relatively longer waiting times compared to other blood types. Moreover, pre-transplant tissue compatibility antibody screening showed that she had antibodies reacting to most antigens, placing her in a high-sensitization state with a high risk of transplant rejection. High sensitization means the patient’s antibodies are likely to cause acute rejection of the transplanted organ.

The medical team lowered the patient’s antibody levels through medication and plasmapheresis while waiting for a suitable donor heart. However, in December last year, her condition worsened, and extracorporeal membrane oxygenation (ECMO) treatment was initiated. ECMO is a treatment that mechanically supports a weakened heart by inserting a large cannula into a blood vessel, usually maintained under sedation with mechanical ventilation via leg vessels. However, due to prolonged hospitalization and severe heart failure, prolonged sedation could weaken Ms. Oh’s muscle strength, negatively affecting post-transplant recovery. Professor Shin Yu-rim, who performed the transplant surgery, maintained ECMO treatment using only the upper limb vessels without mechanical ventilation, keeping the patient awake to preserve muscle strength while waiting for a donor heart.

About a month after starting ECMO treatment, in January of this year, Ms. Oh underwent heart transplant surgery. Due to vascular adhesions from multiple previous open-heart surgeries and an unusual heart structure, the major surgery lasted over eight hours. She was discharged without significant complications and has been living a healthy daily life since. After a transplant, health status is checked at six months and one year to monitor for rejection of the transplanted heart. Recently, six months after the transplant, Ms. Oh underwent autoantibody testing and echocardiography. The antibody test showed no antibodies attacking the donor heart, and no rejection was detected.

Professor Oh Jae-won said, "This was a challenging patient with blood type O, who had undergone multiple heart surgeries and had reduced function in both ventricles, resulting in a long waiting period for a heart transplant and a high risk of rejection due to elevated autoantibody levels. Despite the difficult situation, the positive outcome was possible because the patient and her caregivers trusted and cooperated with the medical team."

This content was produced with the assistance of AI translation services.