A heartfelt reunion

Azlan Othman

Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar met with a patient who underwent an artificial heart pump procedure for severe heart failure six years ago.

A device called a left ventricular assist device (LVAD) was implanted into Ramlee bin Haji Khamis at Gleneagles JPMC, Jerudong.

In describing the procedure, Dato Seri Setia Dr Haji Mohd Isham said the Government of His Majesty Sultan Haji Hassanal Bolkiah Mu’izzaddin Waddaulah ibni Al-Marhum Sultan Haji Omar ‘Ali Saifuddien Sa’adul Khairi Waddien, Sultan and Yang Di-Pertuan of Brunei Darussalam provides a service for those with severe heart failure.

“For some patients, it is a difficult task just to walk a short distance as the heart cannot pump blood throughout the body,” he said. “Since the programme started, five LVAD implants have been carried out including Ramlee, who has been doing well since his implant six years ago.

Ramlee was diagnosed with severe heart dysfunction in 2002. Since then, he had frequent admissions to the hospital due to heart failure. Despite optimum medical treatment, he continued to suffer from the symptoms of heart failure including difficulty in breathing and very limited physical activities.

Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar with his patient Ramlee bin Haji Khamis. PHOTO: AZLAN OTHMAN

On September 15, 2015, under the full support of His Majesty’s Government through the Ministry of Health, he received a LVAD, being one of the few eligible for the procedure.

For Ramlee, the implant was a type of LVAD called Heartmate II. Over the last five years, he has enjoyed a near-normal life with his family and friends.

Dato Seri Setia Dr Haji Mohd Isham said prior to implanting the LVAD, it must first be ascertained that there is sufficient electricity supply, wiring and house facilities as well as discipline, like taking medicine on time.

The candidate must also be aware of the risk of infection as the wire penetrates through the stomach.

“The surgery is quite technical as we have to align the tube parallel to the heart muscle. The tube should not deviate as it needs to pull the blood in a better manner or it would hit the heart muscle. We implanted this with the help of a professor from the Netherlands. But now, we are quite comfortable doing it ourselves,” the minister said.

Gleneagles JPMC said heart failure is one of the most common causes of death worldwide and in Brunei Darussalam. It usually develops because the organ has been damaged by a heart attack, or as a result of other conditions such as cardiomyopathy – a disease of the heart muscle. When patients progress to advanced heart failure, the risk of dying is very high.

The risk may exceed that of other terminal diseases such as certain cancers. In Brunei, patients who have very severe heart failure, which cannot be managed with medicines or other treatments, may be considered for a LVAD.

LVAD is an artificial heart pump. Normally, the left ventricle – one of the heart’s four chambers – pumps blood into the aorta and around the body.

In the event that someone has severe heart failure, the heart is too weak to pump enough blood around the body. The device helps the failing heart and aims to restore normal blood flow. An LVAD is life saving and allows a patient to live longer and resume an active lifestyle.

Most patients considered for an LVAD have a very limited quality of life before the operation. They feel tired, weak and are very breathless. Some have difficulty getting washed and dressed and they might not be able to leave the house.

As soon as the LVAD is implanted, the blood supply to the body returns to normal, so heart failure symptoms improve. Patients who have been too unwell to walk around are quickly able to get up and about. Many patients can soon return to other normal activities like driving and going on holiday and some of them even return to work.

On November 11, 2014, Brunei Darussalam became one of the first centres in ASEAN to initiate a LVAD programme and successfully perform an LVAD implantation. It remains one of the few centres in ASEAN where LVAD has been successfully implanted.

In some countries, it is used as a temporary support as a patient awaits heart transplantation. Brunei Darussalam is among the countries that use LVAD as a “destination therapy”.

Having this highly advanced mechanical heart device in the country is a testament of unwavering support and concern for the health and well-being of the people.