A seven-year-old boy whose heart failure had left him facing a bleak prognosis has been saved after becoming the first child in the United Kingdom to undergo an angioplasty procedure for the condition. The intervention, carried out at Great Ormond Street Hospital (GOSH), reversed Elliot Atkins’ heart failure – a situation previously considered irreversible – and made it possible for him to receive the life-saving surgery that has now allowed him to run around with his friends and train for his school sports day.
Elliot’s parents, Amy Govier and Thomas Atkins, both 29, were told that without action he was unlikely to survive his diagnosis with heart failure and a “one in a million” condition called middle aortic syndrome. Medics at GOSH made the decision to give him an angioplasty to help make him fit enough for the major operation he needed. Doctors confirmed that the angioplasty reversed Elliot’s heart failure, a development previously not seen in such cases, and that he is the first child in the UK to be given an angioplasty for heart failure. With no other documented cases, the hospital believes Elliot could be the first child worldwide to receive the intervention for his particular condition.
Middle aortic syndrome is a rare vascular disorder in which the aorta – the body’s main blood vessel – and the vessels supplying blood to the kidneys become severely narrowed. This significantly reduces blood flow, raises blood pressure, and places extreme strain on the heart, kidneys, brain and eyes. In severe cases it can lead to life-threatening complications including myocardial infarction, heart failure, aortic rupture and intracranial haemorrhage. While the condition can be caused by genetic disorders such as neurofibromatosis type I or acquired inflammatory diseases like Takayasu arteritis, many cases are idiopathic, meaning the cause is unknown.
Elliot’s journey began when he was 11 months old. Born healthy at Musgrove Park Hospital in Taunton, Somerset, he became seriously unwell following a chest infection. He was struggling to breathe and a scan revealed his heart was enlarged. He was taken to the Bristol Royal Hospital for Children, where further tests concluded he was in heart failure, that his blood pressure was dangerously high, and that his aorta was narrowed. “They couldn’t work out why, because his symptoms weren’t adding up,” Ms Govier told the Press Association. Elliot was referred to Great Ormond Street, where he received the additional diagnosis of middle aortic syndrome.
With such advanced heart failure, major surgery was initially considered too risky. Doctors from different specialties across the world-renowned children’s hospital discussed giving Elliot an angioplasty to widen his blood vessels and improve his blood pressure control, helping his heart grow strong enough to eventually have surgery. While angioplasty is a routine treatment in adults, it has not traditionally been considered possible for children with severe heart failure. The technique involves guiding a small balloon into narrowed blood vessels and inflating it to widen them, improving blood flow. Mr Atkins, a military medic, told the Press Association that because the procedure had not been performed in a child with heart failure before, “there was nothing that we could go and look at and read”. He added: “It meant we couldn’t Google anything to reassure ourselves that this was going to be okay. There was stuff on angioplasty, sure, but the patient pool was much, much older, so we knew that the procedure itself was fairly routine, but the fact that it was on a child in Elliot’s condition… we were at a loss really.” Ms Govier said: “I think a lot of it was just pure horror and shock.”
A series of angioplasty procedures – six by the age of two – helped Elliot become strong enough to withstand a long and complex operation: an aortic bypass graft with a transplant of a single kidney. The surgery, performed last July, created a new route for blood flow around the narrowed section of Elliot’s aorta using a specially designed synthetic graft, while relocating his kidney to improve its blood supply and help control his blood pressure.
Now seven and living with his parents and sister Miya in Colchester, Essex, Elliot is thriving. “He just knows he’s got this scar on his tummy, and that’s it,” Ms Govier said. “He is very excited for sports day – they do a class race, which he’s very excited for, and there’s some ball skills, and there’s some throwing that he’s just really excited for all of it. He’s just a bundle of joy, he always tries to make people laugh.”
Since Elliot’s first angioplasty in 2020, the teams at GOSH have gone on to perform angioplasty procedures for other children in heart failure. Dr Jelena Stojanovic, Elliot’s clinician and lead for the kidney transplant and renovascular service, said: “Following Elliot’s intervention, we have successfully performed this intervention over several other children who will refer to us not from other centres in the UK but also from abroad. This is a very rare condition, and the numbers on its own will be small, but what is important is… that the children can be offered the chance to survive. When we as a team look at him today, we see a child who has been given an opportunity that simply would have not existed without the treatment and the extraordinary efforts of the teams involved in his care. He’s doing remarkably well, he’s taking fewer medications, his quality of life has improved significantly, and he’s actually back to doing the activities that every child of his age should be able to enjoy.”