Rare Double Heart Transplant

When Clarence Fontenot was in junior high, he wanted badly to play football. But when his mother took him to the local physician in Baytown for his required physical, he immediately failed to get clearance to join the team.

“The doctor said that he felt a gap in my chest bone and it worried him, so my life as an athlete ended before it even started,” Fontenot said. “I’d never had any problems, so it was frustrating to hear I couldn’t play.”

As it turns out, however, that physician’s vigilance may have saved Fontenot’s life. Just a few months later, Fontenot collapsed after running into a store to pick up a forgotten receipt. He was rushed to the local hospital where he was diagnosed with having suffered a Sudden Cardiac Death attack, brought on by irregular heart rhythms and ventricular fibrillation. Treatment required inserting an implantable cardioverter-defibrillator (ICD) into Fontenot’s chest. The ICD works by detecting and stopping abnormal heartbeats by continuously monitoring the heart and delivering electrical shocks to restore normal rhythm when necessary.

Fontenot lived with that defibrillator through high school, receiving periodic shocks to reset his weakening heart. Unfortunately, ICDs last between just three and six years, and Fontenot’s condition wasn’t improving, so his physicians decided to place him on the transplant list. He was given a pager to keep with him at all times and told to resume normal activity. Then, on Dec. 16, 1994, he got the call.

The First Transplant

“I remember they said they had a heart for me and that I had to get to the hospital,” Fontenot recalled. “I was definitely scared. I remember hoping that the pager would go off, but also not really wanting it to – I was walking around fine and then all it took was that one phone call and I’d be heading into major surgery.”

Fontenot had just turned 18 years old at the time of his first heart transplant, a procedure that couldn’t have gone better. In just three days, he was walking a mile throughout the hospital. His physicians told him that the donor was a 15-year-old and that the heart would last approximately nine years. No heart lasts forever, and transplanted hearts have an even shorter prognosis due to the plaque buildups caused by the required rejection medication. So in the meantime, Fontenot planned on living. He traveled the country, vacationed in Canada, had two children, raised horses, built custom-made motorcycles for local rap artists, worked at NASA, and partnered in a bakery, piping and decorating cookies and cakes. He would try not to think about what would happen nine years later.

“What would happen,” however, didn’t occur for another 19 years.

“I remember it was a Sunday night and I felt like I was drowning every time I tried to lie down, I couldn’t breathe,” Fontenot said. “So I took a Benadryl® and called in sick to work. I thought it was allergies.”

Fontenot returned to work that following Tuesday, but continued to have trouble sleeping, breathing, and ultimately walking. He finally visited an urgent care facility where they determined that not only were his lungs filled with fluid, but that he was having a heart attack there in the examination room. Once again, Fontenot was rushed to the local hospital where his primary cardiologist, Patrick Cook, MD, stabilized him. Tests revealed that two of his arteries were 100% blocked, and a blood clot was sitting behind one of them.

But Fontenot was ready to keep fighting, and so were his physicians. His doctors decided the best place for him was the Center for Advanced Heart Failure at Larry D. Johnson Heart & Vascular Institute at Memorial Hermann-Texas Medical Center. He was transported and placed under the care of Pranav Loyalka, MD, associate chief of the Medical division at the Center, Igor Gregoric, MD, chief of the Surgical division, Biswajit Kar, MD, chief of the Medical division, Indranee Rajapreyar, MD, Sriram Nathan, MD, and Farshad Raissi, MD The team inserted a pump to stabilize his heart and once again he was placed on the transplant list, but this time he wasn’t allowed to leave with a pager.

“I watched a lot of Netflix,” Fontenot recalled, laughing. “Thirteen weeks’ worth. In fact, that’s what I was doing when Dr. Loyalka called and said they might have a heart for me.”

Beating the Odds

Fontenot was the 25^th person on the priority list for that heart, which meant the 24 people before him would have to not be a match in order for him to receive it.

“I remember Dr. Loyalka saying, ‘Just be prepared.’”

Despite the odds, one by one the individuals before him declined, so in the early hours of July 1, 2013, Dr. Gregoric made an incision in Fontenot’s chest along the scars from that same surgery nearly two decades earlier. With the help of Manish K. Patel, MD, associate professor of the Surgical division at the Center, who was the procuring surgeon of the donor heart, Mr. Fontenot’s breastbone was spread apart, tubes were inserted into his chest and his blood began pumping through a cardiopulmonary bypass machine. His failing heart was removed and his now-third heart was sewn into place. After all the blood vessels were securely connected, the physicians shocked Fontenot’s new heart into beating.

“His heart was in really bad shape,” Dr. Loyalka said. “Another transplant was really his only option, and although it is rare, it can be very successful.”

Recovery

Fontenot is now back to living his life – keeping himself busy with work, building bikes and spending time with his family. The night before this interview, he had been up late modeling Rice Krispies treats into the shape of an 18-wheeler for his uncle’s upcoming birthday.

“The key to recovery, the key to longevity, is to just keep going,” Fontenot said. “Don’t let things stop you. You’ve got to want it, you’ve got to go and just take it. Get in the sun, live your life. If I’ve got to go, I’m going to go happy.”

According to Dr. Nathan, however, Fontenot isn’t going anywhere – not for a while. “He’s recovered very well from his second transplant and his new heart is in great shape. He’s doing his part to take care of it through diet and medication, and we’re all confident that he’s going to continue to do well for many years to come. He’s truly a transplant success story.”