SINGAPORE - A patient with a cavity the size of a golf ball in his heart was saved after doctors operated in the nick of time.
The 52-year-old was just minutes from death due to a rare infection that was last recorded in 1981. Bacteria had invaded his heart, triggering a chain of events that created the ballooning cavity.
This left a team of specialists at the National University Heart Centre facing a problem that would test their knowledge and expertise to the limit.
While one misstep could easily lead to the patient bleeding to death, doing nothing was simply not an option.
"It was like tossing a coin; we do not know what will happen," said Associate Professor Theodoros Kofidis, who heads adult cardiac surgery at the centre. "But if we don't do anything, he is 100 per cent dead."
To add to their difficulties, little information was available on the infection - which had been recorded only twice, both times in the United States.
Yet despite the challenges, the operation was a success. The patient, who wanted to be known only as Mr Tan, was able to sit up and talk normally the next day. Doctors said he is "extremely healthy" and will be able to live a regular life.
Mr Tan first came to the hospital in May, complaining of chest pain and dizziness following a trip to Bangkok. At first, doctors thought he had suffered a regular heart attack. But tests showed they were dealing with something far more serious.
Bacteria in the heart had caused pus to accumulate inside. Even when wiped out by antibiotics, it left an "empty shell" the size of a golf ball at the centre of the heart. Every time the organ pumped, blood filled the space. Soon, the wall of the heart around the cavity became stretched, reducing its thickness to mere millimetres.
"It became like a balloon within the heart muscle," said Prof Kofidis.
"It was threatening to burst. If this happened, he would have bled out in three minutes."
However, figuring out how to save Mr Tan's life was no easy task. Not much was known about the condition, said cardiologist Pipin Kojodjojo.
With the only two recorded cases happening back in 1977 and 1981, the doctors had little international research to fall back on. The cavity was also difficult to reach, flanked by key heart structures such as valves.
This meant the team was sailing into "uncharted waters", said Dr Kojodjojo.
Despite the dangers, it decided to press ahead with the 21/2-hour operation. During the surgery, doctors reached into the empty space from the right side of Mr Tan's heart. The cavity was cut apart, flattened and forged together. It was only then that doctors made their most surprising discovery. Mr Tan's heart had already burst.
Prof Kofidis said there was a "crater" at the back of the organ that was leaking blood. Thankfully, a very thin membrane had yet to give way, preventing him from bleeding to death. If not for this, the effect would have been like a knife stabbing into the heart, said cardiologist William Kong.
Doctors then stitched a piece of cow heart tissue over the hole to patch the leak. Mr Tan was discharged in July after making a full recovery.
Only one mystery remains: How did the bacteria, called streptococcus agalactiae, find its way into his heart? National University Hospital's infectious diseases specialist Nares Smitasin said the patient might have eaten food that was contaminated with the bacteria, which are found in the gut.
"It is strange," he admitted. "And we may never know why."
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