From prenatal heart diagnosis to graduation

Ian Cadwallader has received care from before birth from Dr. Chandrakant Patel.

It’s a special time for 18-year-old Ian Cadwallader. He recently graduated from Cuyahoga Falls High School and will start college in the fall at The Ohio State University Mansfield Campus. While he’s focused on the future, he’s also taking time to look back on his life. That includes care he’s received from before birth at the Akron Children’s Heart Center.

A prenatal ultrasound showed Ian’s heart was on the wrong side of his body. “That particular finding sent his mother, Catherine Hofer, to us for fetal echocardiographic evaluation,” said Dr. Chandrakant Patel, pediatric cardiologist and director of Akron Children’s Maternal-Fetal Cardiology. “I diagnosed Ian’s underlying, complex heart defect during pregnancy.”

Diagnosis and surgery

Ian has dextrocardia with heterotaxy, a rare congenital heart defect. His heart is located on the right side of the chest (dextrocardia) instead of on the left – and other organs aren’t in their normal positions (heterotaxy). “We’ve been at Children’s since before I was born,” Ian said. “In addition to my heart being on the wrong side of my body, it is also a single ventricle.”

A single ventricle heart defect means a person is born with only one functional lower chamber, or ventricle, instead of two. In a normal heart, the right ventricle pumps blood to the lungs – and the left ventricle pumps blood to the rest of the body. In a patient like Ian with a single ventricle, the one ventricle must perform both functions. This can lead to complications including blood clots, irregular heart rhythms and heart failure.

Ian underwent heart surgery in 2007 and 2009. “We redirected the blue (deoxygenated) blood from the body to the lung arteries, bypassing the mixing that normally occurs inside the heart,” Dr. Patel explained. “This provides a more direct path for the blood to reach the lungs for oxygenation.”

Ian is one of many patients Dr. Patel has cared for before they were born.

Protecting his patients

Ian recovered well from his heart surgeries and had regular checkups with Dr. Patel – but Ian wasn’t out of the woods just yet. “Ian’s mom is a pediatric ICU nurse, and she sometimes ‘floats’ to different locations. One time, she was going out of the country for work – and a very complex surgery on Ian’s lung bronchus was being considered,” Dr. Patel shared. “I said we’d pray to the Lord that we don’t have to embark on any surgery on Ian’s airway. I had tears in my eyes as I told her I’d make sure Ian did OK until she came back. Fortunately, he improved and didn’t need the surgery.”

Ian has some physical restrictions, including no contact sports. He takes daily medicine to help his heart pump better and aspirin to thin his blood. “Of course, we want patients like Ian to have physical activity. But at the same token, we don’t want to have a sudden death situation,” Dr. Patel said. “It’s my responsibility to do the best thing for my patients and protect them. I tell them it’s perfectly fine to play tennis, ride a bicycle or other safe activities they enjoy.”

Ian sees Dr. Patel every 6-8 months, recently going in for an appointment about oxygen saturation. “Normal oxygen saturation in the blood is about 95, but Ian’s is in the mid-80s,” Dr. Patel said. “His stamina is going to be less, and he’s likely to get tired more easily when compared to other kids.”

Ian’s future

After high school graduation, Ian will spend the summer working at Giant Eagle Market District, writing stories and hanging out with friends and family. Once he leaves for college, he knows Dr. Patel is just a phone call away. “Dr. Patel has been the one who’s been here since the start, and we have a good relationship,” Ian said. “He knows I’m going to Ohio State to study engineering technology, and he takes time to talk to me about stuff like that. I can stay with him until I’m 21 or 22. I’ll then move to an Akron Children’s cardiologist who treats adult congenital heart patients.”

Dr. Patel said it’s been a “very rewarding journey” to take care of Ian. “I have cared for so many patients like Ian whom I have diagnosed prenatally – and I feel the ups and downs with the families,” he said. “Families like Ian’s rely on my guidance to have better quality of life for their kids, and it’s an important duty. Considering the complexity of Ian’s underlying heart defect, he has done remarkably well.”