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Hello i'm Dr. Steve Salvatore
the medical crises portrayed on television dramas make for great stories
but the dramas played out in rooms like this one
are very real.
In this program the main characters are too young to tell you about their
problems
that's because they're infants
battling crippling and even fatal diseases.
While every surgery involves some degree of risk
the stakes here are particularly high.
There is little, if any, room for error.
To save these precious tiny lives, surgeons must rely on a stunning array of
technology,
incredible skill and vision.
Join us for a story that truly defines the concept
of "Super Surgery".
Across the continent in Corpus Christi Texas
another baby has to have surgery
but for this child the future is much more perilous.
This will make it right Mammas
Daniella Reza is three months old.
She was born with a devastating heart defect.
She has never left
Driscoll Children's Hospital
and is being kept alive by medicine and machines.
Daniella's mom and dad Vincent and Angie are doing it tough.
They live sixty miles from the hospital
and have two other daughters back at home.
They've maintained a constant vigil by their new baby's side
waiting and hoping for the day Daniella is strong enough
for the surgery which might save her life.
I go to my room by myself and I pray
and start crying
you just don't know, I can't do it in front of her. I can't let her know that Mama is
upset, you know?
I have to show her that I'm strong for her
and she'll be okay.
Good morning, how are you? Good morning, we are all right.
I wanted to
go over some of the things of surgery
that you may not know.
When Daniella was born nine weeks premature Vincent and Angie already knew
that their baby had a score of health problems.
She's already been through a lot so
a lot of this is not new to you. Okay? Okay.
What they first diagnosed was that
she might have a hole in her stomach
like a hernia, that's what they first found out
and when they sent us over here to Corpus, that's when we really found out the
problem.
Her heart looked kinda different
it seemed that something was missing from it.
Daniella has a birth defect called Hypoplastic left heart syndrome.
She has only half a heart.
This is what a normal heart looks like; four chambers all pumping in sequence.
The left side of the heart receives blood from the lungs and pumps it to
the body.
the right side pumps blood from the body back to the lungs to be refueled
with oxygen.
No one knows why but Daniella's heart failed to grow properly in the womb.
The chambers on the left are undeveloped and don't work and her aorta
the major vessel meant to take blood to her body is stunted.
Daniella's lungs are getting too much blood
and her body is not receiving enough.
I'm just going to keep talking to her, right Mammas?
Her condition is rare
it affects about one in five thousand newborns and without dangerous surgery
Daniella will surely die.
Hi, how are we doing? Fine. Are we doing okay?
Vincent and Angie have asked Dr. Mark Morales to try and save their
daughter's life.
We are all ready to go on Friday morning.
He has a plan to rebuild Daniella's heart.
In which case we have to
enlarge the acsending aorta, the main artery that takes all the red blood
from the heart to the body
in second-place we have to
connect the main outlet of the heart or the pulmonary artery
directly to the reconstructed
ascending aorta
all those things put together make this operation
uh... very
risky operation.
However, I think
without the operation,
the baby is not going to make it. Be as strong as you can, baby. I'll be waiting.
Daniella Reza's heart operation will be incredibly complex.
Major arteries must be rerouted to make the two chambers of her heart which work
pump blood to her lungs and to the rest of her body
but for that to happen
Daniella's heart will be stopped from beating
and her blood was stopped flowing.
She has a fifty-fifty chance of surviving the operation
and even if she makes it
there's a real risk Daniella it could be brain damaged.
We had an option to say yes or an option to say no but like he told us
some of the families would say well there's no chance of doing if it's a
fifty-fifty chance. Let's just not do it
whatever happens is going to happen
but we do want her to go to surgery to see if she can survive
and which I hope she does.
Daniella Reza is on the edge of life
but as perilous as her condition is, she has a piece of good fortune.
Dr. Morales is is one of a growing number of cardiac surgeons
who are using a new method to protect the patient's brain during this kind of
heart reconstruction.
When he stops Daniella's is blood flow
Dr. Morales will try a number of techniques to combat brain damage.
The first thing he will do is cool down Daniella's body temperature by half
it will take her even closer to death
but cooling the body slows metabolism
and delays damage to the brain.
We've all heard stories of babies or kids
falling into a frozen lake and being brought up to life an hour later, 2 hours later
and that's really what we do. It's just to control our way of
freezing the body and bringing them back to life.
but Dr. Morales wants to go one step further.
He will try to perfuse Daniella's head
that is
to keep her brain alive and in intact
he will pump blood to it at all times.
It will make a difficult operation
even more complex.
We believe that if you can perfuse the head
or the brain
through the whole procedure
the neurological outcome should be better.
Okay so we run the shunt through the
one of the head vessels and we are going to put the aortic cannula
to perfuse the head
while we are doing the operation.
For any parent it doesn't get any harder than this
trying to cheat death from taking your child's life
but knowing the odds are stacked against you.
Losing her
and then them coming out and telling me that she's gone...
and that's what scares me the most and
I know I will be a wreck
and I will be crying a lot but
I will have family support and
my husband support to get me through it just the way he will have my support.
Even though the operation is so dangerous for Daniella
what her parents have decided to put her through is her only hope for life.
Her survival now all depends on the skills of Dr. Morales and his team.
Can we go on bypass, please?
We are on bypass now, we have full flow.
Daniella Reza is on the edge of life.
We are on bypass now, we have full flow.
Her surgeons are trying to reconstruct her malformed aorta.
It should be one big vessel to carry blood to her body
but Daniella's is aorta is a tangle of small and ineffective tubes which must
be severed and tied off.
The largest blood vessels will be stitched together to make one big one.
By the time we do the operation the heart will not be receiving any blood.
To work on her heart
Dr. Morales must attempt some dangerous maneuvers.
He has cooled Daniella's body temperature to sixty five degrees she's so cold her
heart is barely beating.
She is being kept alive by a heart-lung machine which puts oxygen in her blood
and pumps through her body.
Back it off, please.
Alright sir, ready to go on.
Okay stop.
but for a crucial period Dr. Morales must stop blood flowing in Daniella's
body.
That's when she could be brain damaged.
keeping Daniella's body temperature down will delay brain damage
but just cooling her will give Dr. Morales only thirty minutes to safely
complete the operation.
Lets perfuse to the head now
Ben, how are you?
Venous line is open
and good return. Coming up to speed.
To buy more time and to protect Daniella's brain
the heart-lung machine will pump small amounts of blood to her head. it's a
simple concept but difficult to do in such a small working space.
I guess one gets used to working with little babies.
but the problem is
there's a barrier
limited and reduce space between the
heart size and
six, seven little tubes coming out of heart in order to do this operation.
Ben, stop. Don't give her anything.
Okay.
Daniella's heart has stopped
there's no blood in her body and she's very cold.
Daniella is as close to death as she could be
but Dr. Morales is trying to keep her brain alive.
The flow of blood to Daniella's head will protect her brain but for how long
is still unknown.
Once you arrest the heart it becomes uh...just
the faster you do it the
better I think they do.
Down the hall Daniella's relatives know how tough things are right now for the
youngest member of their family.
Very scary,
very, very scary. The waiting
thinking she's going to be alright or not.
What Dr. Morales does next will reverse forever the way Daniella's heart
functions.
Her new aorta made of smaller blood vessels all stitched together
is being connected to the wrong side of her heart
but it's the side which works. Okay it looks good. Yeah, it looks alright.
if it all holds Daniella's new aorta will take a much needed blood to
her body.
So we have completed the repair as you can see.
You can rewarm now
Daniella is being brought back to life.
As her blood is warmed
her heart gives a beat.
The tube that was taking blood to her head is diverted to take blood to her
lungs.
Easy on the flow.
Alright, sir.
I believe that the most
crucial moment is
at the time that we separated the baby from the heart-lung machine
so that's moment of truth to see if everything we did is going to work.
This is the critical time.
Actually the pressure dropped, I think. Either that or the shunt is not working.
If Daniella's heart continues to beat
she will return to the ward.
Pressure is dropping.
but if it does not stabilize now it probably never will.
Daniella Reza's surgeons are having trouble restarting her heart.
Ben, you are going to have to keep perfusing.
Okay.
It's taking longer than Dr. Morales expected
but finally Daniella's heart gives one strong beat
then another.
Flow looks good. Pressure is good. We are all set.
We are now off of bypass.
Dr. Morale's is a satisfied Daniella's new aorta will hold
but the next forty-eight hours are the most crucial. There's a risk of infection
but Daniella's is chest must be left open to reduce pressure on her heart.
Okay well
I think we are
pretty much done.
As you can see, we are going to leave the chest open
until tomorrow or the the day after
and then we will close the chest in the ICU
but uh
I think overall she did pretty good so far
How are you doing? Fine. Everything went okay.
Sorry it took awhile
The operation went pretty good
was actually able to uh...
repair interruption
part and then hook up the
ascending aorta to the reconstruction. So I think it should be pretty good.
Okay? We appreciate it doctor, thank you! Thank you very much. You are welcome it was my pleasure.
Even though she survived surgery
Daniella's next forty-eight hours are critical
it's now that her heart has the highest chance of failing.
It's two days since Daniella's life-saving operation
and her reconstructed heart
is still beating.
She looks good. We closed her chest this morning
and everything looks good. Her stats are ok, her pressure is good. She's making good urine.
So I think we are going to start letting her wake up and maybe get her on a breathing machine
You can take her home!
Yup! Okay. Thank you. Alright.
This moment
marks the beginning of Daniella's long road to recovery
for Angie
the last few days have been the most difficult of her life.
I have faith and I knew she would make it through and I prayed
and prayed and sure enough she has made it through.
Daniella Reza
saved by the miracle of modern medicine