Surgeon Performs Heart Autotransplant in Guatemala

Dr. Rafael Espada, a surgeon at the Methodist DeBakey Heart Center and a professor of surgery at Baylor College of Medicine, has performed a rare cardiac autotransplant in Guatemala.

Dr. Espada recently performed the surgery on 36-year-old Arely Salguero, a Guatemalan schoolteacher. He removed the patient's heart, excised a tumor that was affecting the organ's mitral valve, then repaired and reattached the heart.

Salguero and her doctors have known about the tumor for 12 years. Although it had steadily grown, it didn't affect the woman until a few years ago.

"It had grown to the size of a tennis ball, inside the left atrium of her heart," Dr. Espada explained. "It had become heavy enough to pull open the mitral valve, causing it to leak."

This blood leakage caused severe fatigue, forcing Salguero to quit her job two years ago.

"Her husband, who is also a schoolteacher, only makes about $500 a month so it has been tough on the family," Dr. Espada said. "Over the years, they've spent their life savings trying to find a cure."

Physicians first thought the woman might have an aneurysm, but Dr. Espada recognized the mass as a cardiac sarcoma, or tumor. To treat it, he consulted a colleague in the next office - Dr. Michael Reardon.

"We looked at the data and Salguero's information, and we believed that this surgery would help her," Dr. Espada said.

He performed the surgery for free, at Roosevelt Hospital in Guatemala City. The Methodist Hospital donated the pericardial patch that was used to patch the hole in her heart left by excising the tumor. When the tumor was removed, it was biopsied and found to be benign.

"That is very good news, because she is totally cured," Dr. Espada said. "Ms. Salguero has recovered well from the surgery and in a few weeks she should be able to go back to work."

For years, Dr. Espada has traveled to Guatemala on a monthly basis to perform cardiovascular surgeries. He has also organized the AMEGESO foundation which helped to create the first heart care center in Guatemala.

The foundation raised enough donations to open the heart care center in 1994. It is now building a new unit in a three-story building that will have 50 beds, 25 ICU beds and three operating rooms. The new unit should open this fall, Dr. Espada said.

Each month, Dr. Espada performs six to eight surgeries in Guatemala. He operates on difficult, high-risk patients and helps to train surgeons so they can operate when Dr. Espada is not in the country.

"One of the three surgeons trained here in Houston with me," he said. "With that expertise, our unit is practically an extension of Methodist and Baylor."

Over the past three years, Dr. Reardon has performed the first three autotransplant procedures, believed to be the first ever successfully accomplished. He performed yet another successful autotransplant on April 4 on a 22-year-old man from New York.

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©2006 Texas Medical Center

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