UMH Cardiac Team Makes Ultimate House Call to Save N.C.I.S. Agent in Panama

The request from cardiologist Alan Heldman, M.D., came on a Tuesday, March 19, just after 3 p.m., as Carlos E. Alfonso, M.D., was rounding at the VA: Could Alfonso mobilize a team and get to Panama right away? A 42-year-old diplomat at the U.S. Embassy had suffered a massive heart attack the day before, and without the mechanical pump UM doctors had helped prove effective in the U.S., he would likely die.

Arriving at Hospital Nacional in Panama City about six hours later, Alfonso, assistant professor of medicine, wasted little time threading a thin catheter with a tiny mechanical pump into the failing heart of Noel Zuniga. Rotating 60,000 times a minute, the pump took over the job of Zuniga’s heart and set the Naval Criminal Investigative Service’s Resident Agent in Charge in Panama on his long road to recovery, which culminated May 17 with a news conference at University of Miami Hospital. After nearly two months living at UMH, he and his wife wanted to express their gratitude for UM’s extraordinary response to the U.S. State Department’s urgent call for the equipment and expertise that had saved his life.

“The staff here has been nothing short of miraculous,” Zuniga said, looking remarkably fit and happy to be heading back to Panama and his three children. “They not only treat the human condition, they treat the human spirit.”

“We had no family here in Miami,” Diana Zuniga added. “The University of Miami became our family.”

The couple’s frightening ordeal began before nightfall on Monday, March 18, when Noel Zuniga finished running sprints at the embassy compound, where he is responsible for ensuring the safety of U.S. military personnel in Panama. Suddenly, excruciating pain gripped his chest. “Never have I felt such pain in my life,” he recalled.

In the midst of an acute heart attack, Zuniga was rushed to Hospital Nacional, where doctors performed a balloon angioplasty and inserted a stent to reopen his blocked artery. They also placed him on a mechanical intraaortic pump and on multiple medications to maintain his blood pressure and keep his blood circulating. But as the night wore on his condition worsened. His heart was barely pumping. His organs were failing. He needed a more advanced ventricular assist device not available in Panama, but he could not survive a flight to the U.S. where one could be implanted.

Awakened around 4 a.m. on Tuesday, March 19, his wife was told her husband’s life was slipping away. “They gave him about a 20 percent chance to live because they did not have the equipment,” she said.

Panama’s U.S. Ambassador Jonathan D. Farrar began searching for a U.S. hospital that could send a cardiac team on the ultimate house call. Fortunately, Heldman, professor of medicine, was the first to respond. Not only was UMH relatively close to Panama, the hospital’s interventional cardiologists were intimately familiar and experienced with the Impella 2.5 pump, a minimally invasive cardiac assist device for the left ventricle. After all, UMH had been one of the sites and Heldman among the investigators who tested it in clinical trials before it was approved by the FDA.

“We were very active investigators in its use so we had a tremendous amount of experience and confidence that this was the right thing to do – to put in a pump that would take over the heart, maintain blood flow and allow the heart a bit of rest to recover,” Heldman said.

When Alfonso and cardiac perfusionist Pedro Tages arrived in Panama on a private jet from Miami just after 9 that Tuesday night, more than 24 hours after Zuniga’s heart attack, they knew his condition was dire, but they also counted him lucky. “More than 500,000 patients like him die at home of sudden cardiac death every year without ever making it to the hospital,” Alfonso said. “His would turn out to be the perfect situation, especially because we could give him another option. Not all of them turn out this way.”

Delivering Zuniga to UMH early Wednesday morning, the tiny mechanical pump still spinning in his chest, Alfonso and Tages’ work was done. But for many on UMH’s extensive cardiac team, the work had just begun. With Robert C. Hendel, M.D., professor of medicine, guiding Zuniga’s initial intensive care in the cardiac care unit (CCU), where he spent a month, Kymberlee Manni, Ph.D., R.C.I.S., Associate Vice President of Cardiology Clinics and Outreach Programs and the CCU staff were like angels, always at his side. Sandra Chaparro, M.D., assistant professor of medicine and Director of the Heart Failure Clinic, and her team guided him through his cardiac rehabilitation.

They were on hand last week to bid Noel and Diana Zuniga farewell, and send them home to their children, the youngest of whom began walking while visiting her father in the ICU.

“She’s running now,” Zuniga said of 13-month old Alessandra. “She’s going to give Daddy a little exercise when he gets home.”

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