For preemie girl’s tiny heart, a huge life-saving miracle
Published: July 26, 2006 | 4493rd good news item since 2003
Texas Children’s shows creative, less invasive approach can fix even the smallest aortas
Kaylin Baker’s heart, no larger than a quarter, was soon to fail.
Born two months premature, and weighing just 2 pounds, 8 ounces, Kaylin had two defects in her aorta, the body’s largest artery, which carries blood from the heart to the body.
Two narrowings, one in a valve leading from the heart to the aorta and the other farther down the line, were forcing the heart to work overtime to deliver blood throughout her tiny body. Without surgery, her doctors said, the heart soon would pump itself to death.
Then, said first-time parents Nancy and Chris Baker of Austin, a miracle happened.
Instead of cutting her chest open — a difficult procedure from which Kaylin might never recover — physicians at Houston’s Texas Children’s Hospital devised a daring, almost certainly never-before-tried procedure in a baby so small.
They would snake a tube, or catheter, through her neck and down an artery the size of a spaghetti noodle into her heart. From there, the doctors said, they could fix Kaylin’s heart and narrowed aorta with a tiny balloon and a small, cylindrical cage, or stent.
Their plan worked. After Wednesday’s four-hour procedure, Kaylin’s tiny heart showed promising signs of recovery Thursday.
“It has been an extremely difficult month for us,” Nancy Baker said. “We have gone from such extremes of emotion, and we had prepared to never see our child alive again. Then, to have the operation go so well, with no complications, we can’t even explain it in words. We are just in awe as to what transpired in there. There’s not even a cut on my baby, and they fixed her heart.”
Trend extends to children
The procedure highlights a dramatic transformation in the medical treatment of hearts. In recent decades, cardiologists, who do not perform “open” surgery but rather approach problems by using catheters and other minimally invasive tools, have come to treat a majority of blocked arteries and failing hearts.
That trend gradually has been extended to children, whose smaller arteries make it more difficult to navigate inside the body with a catheter. Now, as the doctors as Texas Children’s have shown, the technique can be used in the smallest of babies.
“There has certainly been a trend around the world and in our center, as well, to try and do more and more procedures in a less invasive way,” said Dr. Henri Justino, an interventional cardiologist who led Kaylin’s operation.
Less invasive procedures typically mean minimal scarring, and more importantly for Kaylin, a shorter recovery time.
About 1,000 cardiac catheterizations are performed at Texas Children’s in a year, but only two or three are done in such small infants, Justino said. The real novelty of Kaylin’s case was in combining two intricate procedures into a single operation.
Through a sesame-seed-sized prick in Kaylin’s neck, the doctors inserted a tiny balloon in the valve leading from her heart to the aorta. The valve mediates the flow of blood into the aorta, which descends from the heart through the chest and abdomen, delivering blood to most of the body. By blowing up the balloon inside the valve, doctors opened the critically narrowed valve to a healthy position.
After removing the balloon, the doctors sought to address the second narrowing, farther down her aorta. For this task they used an adult stent, about one-tenth of an inch wide. The metal cage, which expands to restore blood vessels to their normal size, normally is used to open the small arteries on the surface of the heart.
But for Kaylin, the stent’s small size was perfect to expand the narrowed aorta just below her chest.
Perhaps in a few months, or maybe not until she is a teenager, Kaylin will need further surgery, probably to implant an artificial valve. By that time, however, doctors think her heart and body will be strong enough to withstand the rigor.
“This child will definitely need open-heart surgery eventually. It’s just a matter of what’s the best timing,” said Dr. Charles Fraser Jr., chief of cardiovascular surgery at Texas Children’s, who consulted with the Bakers.
Murmur detected at birth
The surgery capped a hectic month for the couple. Born June 21, Kaylin unexpectedly came 28 weeks into Nancy Baker’s pregnancy — the couple and their doctor had no reason to expect a premature child. They had not even taken childbirth classes.
After a heart murmur was discovered during routine testing following Kaylin’s birth, the Austin doctors decided the baby probably should undergo a catheterization procedure. However, they planned to enter her arteries through the groin, the normal area for such procedures in adults. Because Kaylin’s arteries were so small there, doctors feared she might lose a leg.
Then, as the operation was being scheduled in Austin last week, Chris and Nancy Baker reconsidered their options.
“My wife and I didn’t feel like we had done our due diligence, on who out there in the world has done something like this on a baby this small. The answer was nobody.”
Eventually, the Bakers and their Austin doctors consulted with Justino, who had more experience with catheterization in small children, and everyone agreed to transfer Kaylin to Houston. On Saturday, an ambulance transported Kaylin and her mom to Austin-Bergstrom International Airport, and they flew on a small Texas Children’s plane to Houston.
Chris Baker described the surgery as a “true miracle and act of God.” And although Kaylin will have a struggle on her hands, her doctors are optimistic about her chances after she survived a harrowing first month of life.
“Of all the hurdles she is going to have to face in her life, this is probably the biggest one,” Justino said Thursday.
Kaylin’s birth already has altered the couple’s lifestyle. Chris Baker will remain a real estate agent, but Nancy Baker, a kindergarten teacher, has submitted her resignation.
“I’ll be staying home to take care of my baby,” she said.