LOS ANGELES (February 09, 2000) - “I was in shock,” stated Santa Maria resident Jill Martin about the day she learned her four-month-old baby, Alyson, had patent ductus arteriosus (PDA). The condition -- the third most common congenital heart disorder -- results when the ductus arteriosus, a large blood vessel that joins the pulmonary artery to the aorta during fetal development, does not close after birth, leading to potentially life-threatening problems. While open-heart surgery has long been a standard course of treatment, Cedars-Sinai Medical Center is instead utilizing a minimally invasive procedure for patients like Alyson. The result: shorter hospitalization, less scarring and speedier recovery.
“Unfortunately, many people don’t realize there is an effective option to open heart surgery that offers unique advantages,” explained cardiothoracic surgeon Gregory Fontana, M.D., co-director of pediatric cardiac surgery at Cedars-Sinai Medical Center. The medical center was the first in the Western U.S. to offer minimally invasive procedures -- using scopes and fine instruments -- to treat such conditions as PDA and atrial septal defect. Since 1994, Cedars-Sinai has been the only hospital in the Southwest U.S. providing these procedures on a routine basis, performing more than 200 in the last five years.
For Jill Martin, it was the answer to a prayer...and a lesson in why patients need knowledge to make informed health care decisions.
“I had taken Alyson to her pediatrician for a cold,” said Jill, who is a nurse. “The doctor kept listening to her chest. I thought, ‘Enough already...something must be wrong!’ Then the pediatrician explained that he heard a heart murmur. I was mortified.”
A subsequent ultrasound confirmed a diagnosis of PDA, though the “opening” was relatively small. The ductus arteriosus allows blood to flow around the lungs during fetal development (since the infant does not breathe on its own), and then typically closes during the first few hours or days after birth. PDA is particularly prevalent in premature babies with low birth weight, and sometimes occurs along with other congenital heart conditions. When the ductus arteriosus remains open, blood does not flow normally into the body, and can result in breathing difficulties, strain on the heart and lungs, build up of fluid in the lungs and right heart enlargement.
There were several options, Jill recalled: 1) monitor the condition, delaying treatment when, and if, serious symptoms developed, 2) elect closure via thoracotomy, involving a sizeable chest incision, or 3) choose a less invasive approach -- utilizing a miniature video camera and three or four small incisions -- called Video Assisted Thoracoscopic Surgery (VATS). At first, Jill and her husband, Duke, leaned toward the more conventional thoracotomy, but quickly changed their minds when they learned the pros and cons associated with the various surgical approaches.
“The thoracotomy was going to displace more breast tissue, which could lead to greater scarring, and the recovery time was much longer,” she said. “As we learned more about the minimally invasive procedure, we became convinced that was the best option.”
Scarring is a serious concern when thoracotomies are performed on infants and young children, explained Dr. Fontana. Over time, the growth of scar tissue can result in shoulder problems, scoliosis and breast abnormalities. There are also the psychological considerations, he stated. “Kids are very self-conscious about scars -- a big incision left on the chest could be very traumatic to a child.”
Palmdale parents Gertie Kellogg and Dwayne Scott were also concerned about the surgical approach necessary to repair daughter Molly’s atrial septal defect, discovered when the twin was one year old. Ironically, a routine exam uncovered a murmur in sister Molly -- not Megan -- but their pediatrician decided it would be wise to refer both girls to a cardiologist for examination. An echocardiogram revealed that Megan had a small hole in heart, though Molly was fine.
“I just broke down and started crying, thinking about Megan having to undergo surgery,” recalls Gertie.
Both Megan’s and Alyson’s parents were referred to Dr. Fontana, who spent time with each couple to thoroughly explain the approach and what to expect. This helped to allay their fears, said Jill, “As a parent, you’re scared to death about your child, and a lot of the fear is from not knowing what’s going on.”
Gertie remembers the same feeling of reassurance, “Dr. Fontana put us totally at ease -- he answered every question before we even asked.” She and her husband were relieved to learn, however, that a relatively new approach -- minimally invasive surgery -- could effectively correct the problem without requiring a major incision. Instead, her procedure could be performed through an incision just 1 1/2 inches in length.
In Alyson’s case, the procedure was done at four months of age. During the first few months of life, she also developed asthma problems which are sometimes associated with this disorder.
“It was heart wrenching to watch her go into surgery that morning, but she was out in 40 minutes, and doing well,” Jill remembered. “The next morning, Alyson was awake, feeling great and in no pain. We left the hospital at noon.”
She was amazed at the miniscule size of the three tiny “puncture holes” that served as the entryways for the instruments used to secure the metal clip that closes the PDA.
Megan Kellogg, whose minimally invasive procedure was performed in January 2000 at age three and a half, was old enough for her parents to talk to about the upcoming surgery. Two months before the surgery, they started telling her that she would be going the hospital, where the doctor would make a little cut in order to fix her heart.
“Megan likes Brittney Spears, and associated what we told her to the song ‘From the Bottom of My Broken Heart,’ says Gertie. “She even started telling people, ‘I have a broken heart, Molly doesn’t have a broken heart.’”
Her interest in this new-found “individuality” waned as the procedure approached, “I don’t want to have cut,” Megan told her mother. But she sailed through surgery -- about an 1 1/2 hours -- on Tuesday and was ready to go home on Friday. “I missed you Megan,” said her twin upon return home, where the two promptly fell into their normal play.
“If you looked at her today (a week after surgery), you would never know that she’d had heart surgery,” explains Gertie the day of their return.
Once back home, Alyson’s parents tried to keep their daughter relatively quiet the first week of the healing process, though she was a typically active one-year-old. Since the procedure, now nearly three years ago, Alyson is “doing great,” said her mother, though the youngster is still troubled by asthma.
“It’s amazing what the medical profession can do these days -- and we were shocked to go home in just 24 hours,” Jill stated adding, “Cedars-Sinai was one of the few hospitals (in the country) experienced with this procedure -- it was a real blessing that we found them. You really have to take control of your health care these days in order to make the best choices.”
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