Annette Malocco, from the West Midlands, had the pioneering operation two weeks ago
It
sounds like a scene from a horror movie. As almost every drop of blood
was drained from Annette Malocco’s body, for 20 minutes she ‘died’ on
the operating table at Papworth Hospital.
Yet
surgeons were saving her life. Annette was undergoing a pulmonary
endarterectomy, a pioneering operation which put her into a corpse-like
state as a heart-lung machine took over the work of these vital organs
and her blood was removed.
Although
her brain continued to function normally, with no oxygenated blood
being circulated in her body, surgeons had just 20 minutes to remove
clots from her lungs that were severely affecting her ability to
breathe, before her organs would begin to shut down.
Thankfully,
the procedure was a success, and less than a week later the 40-year-old
housewife was on her way home. While the seven-hour operation might
seem like the stuff of nightmares, Annette admits she had few nerves as
she became one of the 160 patients who undergo the surgery each year at
Papworth.
The
hospital in Cambridgeshire is one of only four centres in the world,
and the only one in the UK, able to carry out the highly complex
procedure.
Her operation features in an episode of the BBC documentary series Trust Me I’m A Doctor later this month.
Annette,
of Sutton Coldfield, West Midlands, had her surgery just two weeks ago.
She first began having problems in June last year when she had trouble
breathing while walking her dogs. ‘I’m asthmatic so I initially put it
down to that and thought my inhaler wasn’t working properly,’ she says.
‘But within months I found I couldn’t walk across the living room
without being breathless, and then I began to get chest and shoulder
pains as well.’
An
X-ray revealed that Annette had blood clots in her lungs. She was
suffering from chronic thromboembolic pulmonary hypertension (CTEPH) –
blockages in the blood vessels to the lungs as a result of scar tissue.
The
body naturally dissolves blood clots but in rare cases they become
fibrous, block the arteries and prevent normal blood flow.
Annette
was referred to Papworth and consultant cardiothoracic surgeon David
Jenkins had to determine if she would benefit from the operation. When
they decided she was a suitable candidate, Annette was undaunted.
‘My
quality of life had gone. I’d got to the stage where I thought, “What
is the point?” I was existing, not living, so I jumped at the chance of
surgery,’ she says.
Surgeons perform a pulmonary
endarterectomy at Papworth Hospital - which involves putting the patient
into a corpse-like state as a heart-lung machine takes over the work of
these vital organs
First,
the patient is connected to a heart-lung bypass machine that diverts
the circulation. The same machine is used to cool the body from 37C to
20C to prevent damage to vital organs. This also reduces the blood
circulation so that for about 20 minutes there is no blood in the body
at all.
The
heart stops beating, meaning the body is effectively lifeless. Five
litres of blood a minute are usually pumped into the pulmonary arteries,
which is why it is vital that there is no blood to obstruct the
surgeons’ view as they open the blood vessels and then remove the artery
lining to clear the clots.
Once
this has been done, the patient is warmed up to a normal body
temperature and taken off the bypass machine, a process that can take
two hours.
The hospital in Cambridgeshire is one
of only four centres in the world, and the only one in the UK, able to
carry out the highly complex procedure
Mr
Jenkins says: ‘To anyone watching the operation, the patient has
flatlined, nothing is working, there is no blood going to the brain.
They are put into a suspended state called deep hypothermic circulatory
arrest.
‘We
did a complex trial at Papworth and discovered that after this
operation, patients’ cognitive skills were not impaired – in fact in
many cases they improved.’
The
condition affects both men and women, and Mr Jenkins has operated on
sufferers aged between 14 and 89. Patients usually spend at least two
days in intensive care but generally return home after two weeks. They
must take blood-thinning drugs for the rest of their life to prevent
further clots.
‘I
feel as if I’ve been given a new lease of life,’ Annette says. ‘Within
days of the operation I could breathe properly and without pain. I’m
having a bit of physiotherapy to help with the healing where the
surgeons made an incision in my sternum, but apart from that I feel
amazing.
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‘I
think in some ways it has been tougher for my husband Trevor because
he’s had to put a brave face on things to support me, but now we feel we
have a future to look forward to.’
lTrust Me I’m A Doctor will be screened on BBC2 on October 29.
Ask a stupid question
Do some people never cry?
Dr
Adam Perkins, lecturer in the neurobiology of personality at The
Institute of Psychiatry, Psychology & Neuroscience, King’s College
London, says: ‘Our emotional reactions are influenced by two structures
near the base of our brain known as the amygdala.
'Damage
to this area causes impaired emotional reactions. However, there is
naturally variance in amygdalar reactivity between individuals. People
at the low end of the scale would have relatively flat, unemotional
personality profiles.’
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