Pregnancy & Baby Index: Pregnancy - Incredible Stories: Tiny baby has big heart surgery
Tiny baby has big heart surgery
Serena Brown is believed to be the youngest and smallest baby ever to
undergo open heart surgery. At two months of age, she was finally
healthy enough to leave Lucile Packard Children's Hospital at Stanford
in Palo Alto, California, to be reunited with her family in Sacramento.
Serena was one of a set of triplets born prematurely on December 27,
2001, after only 25 weeks of gestation. While one of her siblings died,
Serena and a sister survived.
Serena was diagnosed almost immediately after birth with a rare
congenital heart abnormality. Had she gone untreated, she would have
died. She was transferred to the Children's Heart Center at Packard
Children's Hospital, where she underwent surgery on January 11, 2002. At
the time of the surgery, she weighed only 640 grams, or 1.4 lbs. --
about the size of two cans of soda. Around 3,500 grams is normal weight
for a newborn.
"Her chest was smaller than my palm, and her heart was the size of the
tip of my thumb," said Packard physician V. Mohan Reddy, MD who
performed the surgery. "To the best of my knowledge, she is the youngest
baby ever to have open heart surgery, and the smallest."
Reddy, among the top surgeons in his field, has conducted a thorough
review of existing literature regarding pediatric cardiovascular surgery
and conferred with his colleagues across the country regarding Serena's
surgery. "Most surgeons don't do this operation before 1,000 grams,"
says Reddy, chief of pediatric cardiac surgery at Packard Children's
Hospital. "It's technically difficult, and, in infants this premature,
the risks are extremely high. But if you don't do anything, the baby
will not survive."
Serena suffered from a condition called total anomalous pulmonary venous
return, in which the veins connecting her lungs to her heart were
attached to the wrong side of the heart. This meant that oxygen-rich
blood from her lungs was not circulating efficiently to the rest of her
body. The condition was not related to her prematurity.
The only thing keeping her alive was a naturally occurring hole between
the two halves of the heart, which normally seals itself soon after
birth. To correct the condition, Reddy re-attached the veins to the
correct side of the heart and sealed the hole.
"The operation gives her a chance," Reddy said shortly after the
surgery. "Otherwise there is a 100 percent risk of death. Her prognosis
now should be like any other 25-week premature baby. There are a lot of
hoops she's going to have to jump through, and lung problems can be an
issue."
After some initial setbacks because of her lungs, Serena is healthy
enough to be transferred from Packard Children's Hospital to Sutter
Memorial Hospital in Sacramento, to join her sister Brianna. The third
baby, Jocelyn, died earlier this year of necrotizing enterocolitis, or
NEC, a severe inflammation of the infant's intestines in which tissue
begins to decompose.
Serena is now nearly 900 grams. She no longer needs a ventilator to
breathe, although she still receives oxygen. She is fed continuously --
about one milliliter of formula an hour through a feeding tube, says
Kirsten Braccia, RN, who cared for Serena at Packard Children's
Hospital.
"She's been through quite a bit," Braccia said Thursday. "She's really
turned the corner. She's doing really well. She truly is a
miracle...She's been very alert and very active."
Her parents, Joshua and Lori Brown, are delighted that Serena is alive,
improving and coming at least a little closer to home. "We'll be able to
see both of them more often, and I'll be able to hold Serena. I haven't
been able to hold her, yet. We'll be able to be closer to her
emotionally and physically. It feels strange not being able to hold your
child. It's against a mother's nature being so far from her child," Lori
Brown said Thursday.
The Children's Heart Center is one of six centers of excellence at
Packard Children's Hospital. The center brings together physicians,
nurses and support staff of many specialties to collaborate in the
treatment of congenital and acquired heart disease in children of all
ages from across the nation and around the world.
The Children's Heart Center is one of the largest programs in the
country performing such specialized pediatric cardiovascular surgery.
The more surgeries that are performed at an institution, the higher the
success rate, according to medical experts.
Reddy, Michael Black, MD, and Frank L. Hanley, MD, director of the
center, specialize in correcting the congenital cardiac defects that
affect approximately one percent of all newborns and are the leading
cause of death from congenital anomalies. Reddy's primary interest is
neonatal cardiac surgery on premature or low birth weight infants.
Serena's surgery, Reddy said, would not have been a success without
intensive preparation and a team of specialists. "This kind of operation
takes a lot of planning and teamwork," Reddy said. "We had very good
support and the team worked very well together. The neonatal respiratory
team did an excellent, outstanding job. Although I do the surgery, the
team has to be completely focused, because no one has done an infant
this small before."