"Broken heart - rare repair"

Just about a month ago, Haitham Masri, a 19-year old from Kfar Kara, came to Hillel Yaffe Medical Center after falling 20 meters from a cliff at Michmoret beach. "He was shattered completely when he arrived," said Dr. Boris Kassel, Trauma Unit Director, who was called to the hospital when they received notice of Masri's impending arrival. "He had a brain hemorrhage, spinal fractures, fractured ribs and pelvis, and very serious fractures in his lower limbs, bleeding in the chest and stomach, tears in the intestines and spleen and mainly - what was diagnosed at a very early stage - bleeding around the heart."

Masri was quickly transferred to the operating room, where they discovered that the bleeding in the heart was critical, because it was due to an extensive tear in the left atrium. It's important to emphasize the professional medical literature describes only isolated cases of these types of trauma injuries - in other words, as a result of all of the reported blunt traumas to the chest, the risk of injury to the heart is less than 0.50%, and when looking at all heart injuries, the frequency of the injury Masri suffered is 2%. Furthermore, the mortality rate for such injuries is over 80%.

"To stop the bleeding, which was in the back of the heart, we needed to move the heart from its natural place so that we could reach the tear," said Dr. Kassel. "All the attempts to move the heart to reach the injured area were unsuccessful, because they led to a sharp drop in blood pressure and extreme arrhythmia, and the bleeding continued, with no end in sight," he recalled. 

Dr. Kessel's creative solution was to use clips actually designed for use in intestinal surgery - an improvised solution that saved Masri's life. The ability to stop the bleeding also made it possible to perform other additional surgical procedures necessary to save his life. Masri was in the General ICU, and his family was with him the entire time. He also received dedicated, multidisciplinary and multisystem care. All in all, Masri underwent four surgeries, all of which were necessary to stabilize him. Some were orthopedic procedures. In all of the surgeries, he received numerous units of blood, equal to replacing all of the blood in his body five times. About a week ago, all of these tremendous efforts led to the best possible result his parents and doctors could have hoped for - he opened his eyes, regained full consciousness, was transferred for continued care in the Surgery Department and is now beginning rehabilitation.

"A day after the procedure to repair the heart, I asked our Heart Institute Director to check if additional heart surgery would be necessary," said Dr. Kassel. "We performed an echocardiogram, which showed normal heart function and we consulted with a heart surgeon from a large hospital in the center of the country. The two doctors decided that the clips that were inserted by a device designed for intestinal surgery 'did the trick' exceptionally well and that there was no need for any other procedure. The two of them were also surprised and said that they had never encountered this kind of situation."

As previously mentioned, this is a very rare and extremely lethal injury. The literature describes isolated cases in which a patient survived the condition that Masri's heart was in - blunt trauma to the heart, the location of which causes massive bleeding, extreme drop in blood pressure, arrhythmia that cannot be treated with medication. The end is generally death. "Obviously, the solution was an improvised one," said Dr. Kassel, "But it saved his life, and that's what's important."

Dr. Boris Kassel, Haitham Masri and his father, Nazam in the Surgery Department