Minimally invasive cardiac procedure

November 04, 2010

A trip to the Children's Emergency Center in July led to a diagnosis of two heart defects for Haylee Allen, then 5 months old. Once diagnosed, Haylee underwent a life-saving, but minimally invasive procedure that offers a quicker recovery and less scarring for patients requiring intracardiac repair.

Haylee Allen behaves like a typical 8-month-old, scooting around the house, getting into things she shouldn't and keeping her parents on their toes at all times. The daily routine now belies the hidden heart complications that led to a small scar on her chest where doctors on the medical staff at Children's performed life-saving open heart surgery in October.

"Until July, we had no idea Haley was sick," said her mother Jennefer Grygorczuk. "We noticed she grunted a lot and was even diagnosed with asthma by a local pediatrician."

It took a fateful trip to the Children's Emergency Center for Haylee to be diagnosed with two holes in her heart, which had evaded all previous inspection.

Haley received an echocardiogram at Children's, and Dr. Claudio Ramaciotti, a cardiologist on the medical/dental staff at the hospital, confirmed she had one ventricular and one atrial septal defect that most likely would require surgical repair.

Symptoms of septal defects sometimes remain dormant until several weeks after birth. Without surgery, the development of babies with large defects quickly tapers, usually due to undernourishment. Babies with septal defects also may develop respiratory symptoms such as grunting or rapid breathing due to an increased workload on the heart and lungs. Over time, this may cause permanent damage to vessels in the lungs.

Comprehensive care

"When I learned about Haylee's condition, it was very scary; and I wanted to know why it was happening to my little baby," Grygorczuk said. "My whole world stopped, and I wouldn't have made it through without the support of the hospital's Pastoral Care staff."

Following the initial diagnosis, Dr. Ramaciotti prescribed medications such as Digoxin to help the heart beat more strongly and regularly and Lasix to reduce retention of fluids and improve her breathing. The medications succeeded in helping Haylee breath more easily, but open heart surgery still loomed on the horizon.

A day before Haylee was admitted, Grygorczuk met with Dr. Joseph Forbess, chief of cardiothoracic surgery, to discuss her daughter's procedure.

"Dr. Forbess couldn't have been better. He spent about an hour with me and answered every possible question I had and even and a few more I didn't think of," Grygorczuk said. "He seemed like he genuinely cared about Haylee, which put me at ease."

Mini-sternotomy

On Oct. 27, Dr. Forbess performed a mini-sternotomy on Haylee to repair her septal defects. The surgery is noteworthy for being part of a growing trend of similar minimally invasive techniques now offered to children who need cardiothoracic surgery. The procedure left Haylee with only a two-inch scar on her chest.

According to Dr. Forbess, several potential functional and cosmetic advantages to the minimally invasive approach include a shorter stay in the hospital, lower requirements of postoperative narcotics, a lower incidence of loss of skin sensation and a smaller scar. The primary difference between the mini-sternotomy and the full-sternotomy is the mini involves about a two inch incision instead of a four to six inch one with a full-sternotomy.

"Several studies examining this surgical strategy in greater than 200 patients have confirmed comparable safety and accuracy of intracardiac repair," Dr. Forbess said. "Recent experience has shown that a significant number of congenital heart defects can be safely and accurately repaired with incisions offering superior cosmetic results for our young patients."

Following the four-hour surgery, Haylee remained briefly in the cardiac intensive care unit at Children's for evaluation before being transferred to a regular recovery room. Three days later, she was discharged.

Now at home, Haylee enjoys hugging her Care Bears, eating sweet potatoes and being the center of attention for her parents and three siblings.

"I can't say enough good things about Children's," Grygorczuk said. "They helped my baby become just like every other kid her age, which doesn't sound like much, but to us, it means the world."

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