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Healing tiny hearts

When a baby has this heart defect, there are two ways to treat it. A bay area team helps determine if an experimental procedure is better than the way it has been done for years.

By LISA GREENE
Published May 18, 2006

	[Times photos: Melissa Lyttle]
	Five-month-old Darian Gibson looks toward his mom and dad while being transported in his crib to the operating room. He was born with an underdeveloped left side of his heart, and his doctors at St. Joseph’s Children’s Hospital are participating in a national study on how best to fix this defect. Darian got the experimental treatment.
	Surgeons work to remove the shunt from 5-month-old Darian Gibson’s heart during a surgery Wednesday at St. Joseph’s Children’s Hospital.

TAMPA - Darian Gibson was only a day old when his parents heard something was wrong.

The left side of his heart never developed, and it would take a series of surgeries to save him. The defect is so severe that it's the most common cause of cardiac death in the first week of life.

His parents, Seffner residents Derek Gibson, 26, and fiancee Christie Pelham, 31, were still reeling when doctors came to them again and asked if Darian could participate in a national study to see what type of surgery was the best way to save babies like him.

Although participating meant Darian might get a more experimental type of surgery, his parents didn't hesitate. "There was no question in our minds that we wanted to be part of it,'' Pelham said. "If it didn't help him, it would help someone else.''

Darian underwent the second of three planned surgeries at St. Joseph's Children's Hospital in Tampa on Wednesday. His doctors at Cardiac Surgical Associates - a team that works at St. Joseph's and at All Children's Hospital in St. Petersburg - are one of 14 groups across the country participating in the study, funded by the National Institutes of Health.

The study is designed to settle a debate among pediatric heart surgeons nationwide.

About half still favor a technique designed in the 1980s to correct the defect, said pediatric heart surgeon Dr. Paul Chai, one of Darian's doctors.

But a new variation, started in Japan about five years ago, is rapidly becoming more popular.

"There have been suspected advantages, but nobody really knows,'' Chai said.

Both techniques use the same three-step surgery. Because the left side of the heart never developed, it can't pump oxygen-rich blood to the body.

The surgery reroutes vessels around the heart to bypass the heart's left chambers.

It's not a perfect solution, but children who have the procedure usually can lead active, healthy lives, said Dr. James Quintessenza, the surgeon who led Darian's surgery Wednesday.

"They'll run around, play on the playground,'' he said. "They're not going to be marathon runners.''

Without surgery, babies with the defect usually die within a few weeks, if not days. The only other alternative is a heart transplant, but donor hearts are hard to find, and then the baby faces a life of antirejection drugs.

With the surgery being studied, the difference in the two techniques comes in the first step.

Both procedures use a shunt - a tiny artificial tube - to reroute blood around the heart.

But the traditional procedure uses a 3.5-millimeter shunt at the top of the heart to connect the aorta to the pulmonary artery, which takes blood to the lungs. The new procedure uses a shunt nearly twice as big to connect the heart's right ventricle to the pulmonary artery.

The shunt stays in place until the baby is old enough to have more surgery to reroute more blood vessels.

Advocates of the new technique say it helps keep babies' blood pressure more stable, so they're more likely to survive until the second surgery. Others say the old technique is better because it doesn't cut into the heart.

The 14 study centers are dividing babies at random, using the old way on half, the new on the other. Before enrolling in the study, surgeons at St. Joseph's generally used the older procedure, Chai said. But he had no qualms about switching to the new one.

"It's a method we're familiar with from other operations,'' he said.

So far, the Tampa group has performed about seven operations for the study.

As it happened, Darian was placed into the group getting the new shunt. His parents didn't see much of a difference.

"We felt that, regardless of which procedure, they would do the best for him,'' Pelham said. "With either one, we would be scared.''

Wednesday afternoon, Pelham and Gibson walked down St. Joseph's long hallways holding hands behind Darian's crib as he was wheeled into surgery. They said goodbye, and Quintessenza and Chai got ready to operate.

At 3:20 p.m., Quintessenza cut into Darian's chest. He moved carefully to remove the scar tissue that had already formed from the first operation.

Darian's heart beat large in the cavity, and the shunt clung tightly to it, at first barely visible. The tiny tube's ridges stood out against the heart's satiny smoothness.

"There's that shunt that's keeping this kid alive,'' Quintessenza said as he got ready to remove it.

He stitched carefully at one end, then the other. A few snips later, and Chai lifted it free. It was time to make Darian's body pump blood on its own.

By Wednesday evening, Darian was back in intensive care, listed in serious condition.

Everything went well, doctors said.

Darian will return to St. Joseph's for the final surgery when he's 2. By then, the study he became a part of should be complete.

[Last modified May 18, 2006, 05:45:42]