National Heart Centre (NHC) recently recorded a few milestone firsts when it treated a foreign patient on holiday here in Singapore. The patient, 59-year-old Mr. Wolfgang Stocker Ernst Josef, was not only the first tourist-in-transit to be implanted with a life-saving left- and a right- heart assist device in Singapore, but also, the first patient supported by such a device to have been transported safely back to his country over 6000 miles away at a significantly high altitude.

Prior to his arrival in Singapore, Mr Wolfgang, whilst in Australia, suffered flu-like symptoms and complained of increasing weakness and lethargy. Upon arrival in Singapore, he became acutely short of breath and had to be admitted to CCU/MICU in Changi General Hospital (CGH).

He was diagnosed with fulminant myocarditis and was aggressively treated with inotropic drugs (intravenous drugs to support his blood pressure) and an intra-aortic balloon pump (catheter inserted into the aorta to support blood pressure) and mechanical ventilation.

When his condition did not improve and after discussion with the family and the cardiothoracic surgeons in NHC, a decision was made to transfer him for the implantation of a heart assist device, which has not been done for this condition in Singapore.

"Mr Wolfgang's symptoms were consistent with that of fulminant myocarditis, a very rare condition that affects the muscle of the heart. He was critically ill and he was aggressively supported medically and mechanically. This would have been sufficient in most cases. However, his condition did not improve and surgical options were explored with the cardiothoracic surgeons in NHC.

"Thereafter, we decided to transfer the patient for the implantation of a heart assist device," said Dr Tan Kok Soon, Head and Senior Consultant at the Division of Cardiology, CGH and Visiting Consultant, NHC.

That very night, doctors inserted an Abiomed mechanical heart assist device to support his heart in order to save Mr. Wolfgang's life. This device, which is a pump that resides outside the patient's body, is used for short-term support of up to 3 weeks. During this crucial period of mechanical support, the heart usually rests and has a 60-70% chance of recovery to have the device subsequently removed.

With the mechanical support, Mr. Wolfgang's liver and kidney function soon recovered to near normal levels, and he became more conscious and mentally alert. He was now able to communicate with his son and wife that had kept vigil at his bedside throughout his stay. In view of his nationality, cost considerations and expected 4 to 6 week period of recovery, his wife and son decided to complete his next phase of treatment in Germany once it was considered medically safe for evacuation. Through our collaboration with the world-renowned Berlin Heart Institute, plans were made for Mr. Wolfgang's flight back home.

Through careful coordination with Berlin and meticulous planning of logistics, Mr. Wolfgang was transported from our intensive care unit to Changi Airport on 16 December 2002 through the combined efforts of both teams from Singapore and Germany. Mr. Wolfgang then traveled more than 6000 miles and 15.5 hours at an altitude of 40,000 feet, ventilated and mechanically supported, back to Germany.

His flight was a medically historic one as the furthest transfer of a biventricular-supported patient ever recorded. The previous longest transport distance using the Abiomed system has been a 5-hour journey from Hawaii to San Diego.

Said Dr Michael Caleb, the attending surgeon of Mr. Wolfgang: "We are pleased firstly to have helped Mr. Wolfgang and his family and secondly to be part of this medically historic trip. We at the National Heart Centre will continue to provide this high-end specialised surgical care to both local and foreign patients who require these life-saving devices."

Mr. Wolfgang is currently recuperating after undergoing the next phase of treatment, which was switching to a longer-term device known as the Berlin Heart pump as they await the heart's recovery.