He's been on this earth only 19 years, but Scott Dolezal has already undergone four heart surgeries—one of which occurred when he was a newborn, and one when he suffered a near-fatal heart attack at age 17 and lost a leg as a consequence of the heroic efforts to save his heart and his life.
Remarkably, with all that Scott has been through, he doesn't see himself as a victim but a victor. He is staunchly committed to living a normal, teenage life—hanging out with friends, playing sports and going to the senior prom with his girlfriend Farah Sharis. Scott's attitude shouts, “Look out world, here I come!”
Scott was born with transposition of the great vessels, a rare heart defect in which the two major vessels that carry blood from the heart are switched so oxygenated blood goes back to the lungs instead of being pumped to the rest of the body [see sidebar on page 6]. About a week after he was born, Constantine Mavroudis, M.D., then a young cardiac surgeon at Children's Memorial Hospital of Chicago, corrected Scott's congenital defect. Years later, the Dolezal family would cross paths with Dr. Mavroudis again.
Scott's childhood was uneventful. He was like any other active kid, says his father, Craig Dolezal, until he was 13 years old and began having chest pain. Doctors performed cardiac catheterization but were unable to determine the cause of the pain. They did have good news, though: “The doctor said Scott was fine and was no more likely to have a heart attack than me,” recalls Scott's mother, Lucy Mueller. For this reason, “we never placed restrictions on him,” Craig adds. “His two older brothers were both good athletes, and Scott kept up with them.”
Brian, 24, played soccer at Williams College and Kevin, 21, captained the lacrosse team at the University of Texas-Austin. “I have always looked up to my older brothers, who are my role models,” Scott says.
Lacrosse was Scott's best sport, though he loved competitive diving and snowboarding, too. He was a star scorer on the junior varsity lacrosse team at Westminster High School, a prep school in Atlanta. To train for lacrosse he also ran cross country, just as his older brothers had. “I never held back,” says Scott. “In the back of my head I might think about my heart, but once the season got going, I never thought about it again.”
A SERIOUS SETBACK
What Scott didn't know was that he had developed another structural heart problem that decreased blood flow to his heart during vigorous physical activity like long-distance running. During the final lap of a varsity cross country time trial on August 1, 2009, Scott suffered a heart attack. A school groundskeeper saw him fall into a ravine and called for help. William Barber, M.D., the father of one of Scott's teammates, quickly started CPR. School trainers arrived with an automated external defibrillator to restore Scott's pulse. As he was being lifted into the ambulance, his cross country coach, Joe Tribble, urged him to “run the race of your life.”
Scott was rushed to Atlanta's Piedmont Hospital in critical condition. Upon arrival cardiologist Anna Kalynych, M.D., administered sedatives to keep Scott in a “twilight state” of semi-consciousness. The healthcare team rapidly cooled down his body with gel pads filled with icy water to slow his metabolism and delay the onset of brain damage caused by his floundering heart's inability to pump oxygenated blood to the organ.
Interventional cardiologist Vivek Rajagopal, M.D., then used a circulatory assist device to decrease the workload on Scott's heart so it could rest and heal. “We used the new TandemHeart™ percutaneous ventricular assist device (pVAD) for a day to deliver blood and oxygen for him until he could sustain himself,” explains Rajagopal.
Three days later, Scott awoke to find a roomful of family, friends and teammates. “It was freaky seeing all those people I knew,” Scott recalls. “My friends kept me up with gossip and what they had been doing every day.”
CONSEQUENCES AND COINCIDENCES
Although the pVAD saved Scott's life, a blood clot developed in his right leg at the knee that decreased circulation to the lower limb. Because Scott's arteries are relatively small, blood flow to his foot became obstructed soon after the pVAD was inserted—a complication that occurs in a small percentage of patients, Rajagopal explains. When blood thinners didn't do the trick, doctors surgically restored blood flow to his right thigh. Additional surgeries were unable to re-establish blood flow to his right foot, however, and an infection ultimately forced doctors to amputate his leg below the knee.
During this month-long ordeal, a computed tomography scan showed that a portion of one of Scott's coronary arteries had become imbedded in the muscle of his heart—a rare complication of the surgery he had as a baby—which was compressing the vessel and reducing blood flow to the heart. To prevent another heart attack, he would need corrective surgery.
Rajagopal recommended that the procedure be performed at the Cleveland Clinic, where he had trained. As luck would have it, Mavroudis was now chairman of pediatric and adult congenital heart surgery at the clinic. He operated on Scott on October 30, 2009. Scott's prognosis is good and Mavroudis expects him to “live a long life.”
Scott now takes a baby aspirin daily and a beta-blocker twice a day. Rajagopal notes that after a heart attack or coronary artery surgery, aspirin prevents blood clots from forming in the coronary artery, and a beta-blocker helps the heart promote regrowth of healthy heart tissue. “Scott has healed so quickly and so well he probably won't need these medications for long,” Rajagopal says.
A LEG UP ON LIFE
After he was released from the hospital, Scott was fitted for a prosthetic leg and quickly learned how to use it. “Once I could bear standing up, I got good at using the new leg,” he says. “The hard part was to act normal when I went back to school in January, because it was still extremely painful.”
Nonetheless, Scott was determined to follow in his brothers' footsteps and take the “Running through History” course taught by Tribble. The highlight of the course is a month-long excursion through Europe at the end of the school year that requires hiking an average of 10 miles a day.
“One of things that kept Scott going was to get healthy so he could go on that trip,” says Tribble. “When he's pushed, that's when Scott responds to a challenge.”
On the next-to-last day of the trip, Scott hiked with Tribble and 28 classmates to the base of the Matterhorn in Zermatt, Switzerland. “Mr. Tribble said I could wait in the hotel or just go half way,” says Scott. “It took me 5 hours, twice as long as the others, but when I got to the top everyone was clapping.”
Scott wasn't content to rest on his laurels, though, because there was still a bit of unfinished business he felt compelled to take care of. On August 2, 2010, Scott again ran the varsity cross country time trial that his heart attack prevented him from completing. “I had to wait a year, but I finally finished.”
Though Scott had hoped to play lacrosse during his senior year, “After two [recent] heart surgeries, heavy physical contact with blows to the chest from lacrosse made me nervous,” says Rajagopal. “I told him for the time being, let's not do that.”
Ever the athlete, Scott did go snowboarding this past March with his father and three friends. “I was really anxious the first day with my new leg, thinking I'd be left behind,” Scott says. “But after a few runs I was okay, and we ended up doing runs through the woods.” Adds Craig: “He's determined to prove to himself that his heart and his leg are not going to hold him back.”
In September, Scott will begin classes at the University of Michigan in Ann Arbor, where he plans to major in either biology or philosophy. He also hopes to play guitar in a rock band and go snowboarding whenever he can.
Whatever Scott does with his life, he will be guided by an important lesson he learned the hard way: “You never know how strong you are until being strong is the only choice you have left.”
TRANSPOSITION OF THE GREAT VESSELS
Scott Dolezal was a “blue baby”—born with a heart defect in which the pulmonary artery and the aorta are switched.
Normally, blood that has been circulated throughout the body returns to the right side of the heart and flows into the pulmonary artery leading to the lungs. Oxygenated blood flows to the left side of the heart and is pushed out by the aorta to the rest of the body. With transposition of the great vessels, instead of delivering blood from the lungs to the heart so it can be pumped throughout the body through the aorta, blood depleted of oxygen is pumped back to the body without ever passing through the lungs.
Transposition of the great vessels is usually detected within weeks of birth. The skin not only has a telltale bluish tint caused by circulation of oxygen-depleted blood, but the baby may have difficulty breathing, lack of appetite and poor weight gain.
This life-threatening defect is relatively rare, affecting just 1 in every 4,000 babies. In most cases the cause is unknown, but risk increases when a woman contracts rubella or another viral illness during pregnancy, develops gestational diabetes or becomes pregnant after age 40.
Transposition of the great vessels can be corrected with surgery. Scott's doctor performed a fairly new procedure called an arterial switch. The surgery returns the physiology and anatomy of the heart to the way it is supposed to be,” says cardiac surgeon Constantine Mavroudis, M.D., who operated on Scott shortly after he was born. The aorta is surgically removed from the right ventricle and the pulmonary artery from the left ventricle, and these vessels are put in their proper places in the heart. The coronary arteries are also transferred along with the aorta.
Most babies who undergo arterial switch don't have symptoms after surgery and live normal lives. However, complications, including arrhythmias, coronary artery problems, and heart valve problems, can arise. Careful monitoring by a cardiologist is needed for the rest of their lives.
© 2011 American Heart Association, Inc.