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To be considered a rarity once is a feat. Being placed in that category twice is truly remarkable. Even more so because Sally Fung skirted death along the way.
"When you're in your twenties, you think you're invincible," she explains.
All of that changed for Sally in May 2005, at the age of 23.
"It started with stomach and back pain," says Sally, recalling the initial onset of her pain. "It got to be so severe that I could barely breathe, even when lying motionless."
With her symptoms becoming progressively worse, Sally, accompanied by her husband Tim, rushed to Markham Stouffville Hospital in the early morning hours of May 1st, 2005.
"It was about 2:00 a.m. when I arrived at the hospital," recalls Sally. "The attending doctor performed an ultrasound on my stomach, as I was experiencing quite a bit of pain in this area. Thankfully, by chance, he ran the ultrasound over my heart, and commented that he'd never seen a heart that enlarged. He suspected it might be something called myocarditis, but wasn't entirely sure."
Enter the Peter Munk Cardiac Centre
The attending doctor sent the ultrasound images to physicians at the Peter Munk Cardiac Centre (PMCC), Canada's leading cardiac centre. As suspected, PMCC doctors told Sally her symptoms were in fact attributable to myocarditis, an inflammation of the myocardium --- the middle layer of the heart wall.
Myocarditis is a rare disease prevalent in approximately one to 10 cases per 100,000. In the most severe cases, the pumping action of the heart weakens, compromising the ability of one's own heart to supply the rest of the body with blood. Clots can also form in the heart, leading to a stroke or heart attack.
Without time to spare, and her breathing becoming more laboured, Sally was immediately transferred via ambulance to the PMCC in downtown Toronto. Her condition reached a critical stage when, during transfer from the ambulance to the Intensive Care Unit, Sally went into cardiac shock. Her heart stopped beating for almost a minute. Once stabilized, she was rushed into surgery.
"I had open heart surgery to place a bi-ventricle assist device (BiVAD) onto my heart to temporary help me pump," explains Sally. "Basically, the doctors wanted to wait and see if my heart would regain its natural pumping ability – otherwise, I would need a transplant."
Sally's surgery was performed by cardiovascular surgeon Dr. Viv Rao, an internationally renowned expert in mechanical assist devices for the heart. Under his leadership, the ventricular assist device program at the PMCC is now the largest and most diverse clinical program in the country, offering multiple leading-edge technologies suited to individual patient needs.
As a precautionary measure, doctors placed Sally on the priority donor list for a heart in Canada after her surgery.
"During emergent BiVAD support, there was no assurance that Sally's heart would recover," explains Dr. Rao, in making the decision to place Sally on the priority donor list. "Thus, the standard protocol would be to list her for transplant."
Fortunately, while waiting for a suitable donor heart, Sally exhibited signs of recovery to the point that Dr. Rao felt she may not require a transplant. After 11 days, she was removed from the bi-ventricular assist device, and her heart function maintained excellent output. During the month she spent in hospital, Sally was attended to by PMCC cardiologist Dr. Diego Delgado.
"Without BiVAD support, the best Sally could have hoped for was a high-risk transplant, facing the very real prospect of another transplant in the near future," says Dr. Delgado. "With the excellence of the technology at the PMCC, she now has a normal life expectancy with her own heart."
Another extraordinary twist
Very few women have given birth after a heart transplant. Even though Sally did not end up requiring a transplant, she did give birth to three children within three years, following her heart surgery, including a set of twins.
"Many myocarditis cases stabilize and heart function recovers," say Dr. Delgado, who now sees Sally once a year at the PMCC to ensure her heart is functioning normally. "However, Sally's case is especially unique because she was able to normalize her heart function and be off heart failure medication for years without recurrence and had three children. This is remarkably gratifying for the whole team that was involved in Sally's care."
A busy mom of three kids under four years old, Sally now reflects back on her journey and near-death experience.
"After my heart surgery, I made a concerted effort to eat healthier and go to the gym to continue cardio and strength training," says Sally. "Most importantly, I now pass this knowledge on to my children so they have the best line of defence for any sickness."
The harrowing moments are sprinkled with many positive memories.
"The care that I received at the Peter Munk Cardiac Centre was impeccable," recalls Sally. "The doctors and nurses really cared about me and my family. I was confident that any problem I encountered, they would have the necessary skill and expertise to treat. It left me with a feeling of assuredness and absolute confidence in the medical team."
"The PMCC team doesn't view what they do as just a job," says Sally. "So many people were involved in my care, but didn't have the chance to witness the quality of life they gave me after the fact. I married my high-school sweetheart in 2010, had a beautiful daughter in 2011, and welcomed twin boys into the family in 2013. I think they would be ecstatic to see all their hard work did not go to waste. They cared for me as if I was family, one of their own; and for that I am forever grateful."