Just four days earlier, Beau had made Texas state medical history of sorts when the fingertip-sized hole in his tiny heart was closed with the help of a highly specialized and minimally-invasive surgical technique at Children’s Heart Center at Children’s Memorial Hermann Hospital.
Beau’s congenital heart defect (CHD) had put undue stress on his body, tiring him quickly and inhibiting his ability to eat and nourish himself. His parents shouldered an emotionally equivalent burden in the months leading up to his surgery.
But all Jessica and Andrew Wyble had to worry about now was satisfying their son’s new appetite. Not pain medication, or a heart problem, or a telltale scar on Beau’s chest that would grow with him into adulthood.
“Now we can focus on those normal milestones and Beau just being a baby,” Jessica Wyble said.
And that’s exactly what pediatric cardiothoracic surgeon Ali Dodge-Khatami, M.D., PhD, wants.
“The goal with heart defects that are curable through surgical repair is to fix the problem with one operation and help the child return to normal activities as soon as possible,” Dr. Dodge-Khatami said.
A hole is found in Beau’s heart
A hole in the muscle that separates the two ventricles of Beau’s heart was discovered when he was one week old. The hole, called a ventricular septal defect (VSD), disrupted the ability of the ventricles in Beau’s heart to efficiently pump blood to other parts of his body.
“We were told that some VSDs close on their own, but Beau’s likely would require surgery,” Jessica Wyble said. “We also learned it was a relatively common condition, so that reassured us a little bit and we tried to keep perspective.”
VSDs indeed are the most common CHD, occurring nationally in 1 in every 240 children born. While many VSDs do close on their own, it became apparent Beau needed surgery.
Beau’s VSD measured 9 millimeters in diameter and stressed his body to the point he was burning more calories than he could consume while attempting to breastfeed.
His cardiologist referred him to Children’s Heart Center for surgical repair.
Finding the window to the heart
Dr. Dodge-Khatami has pioneered the repair of CHD in the United States in a novel way, by accessing the heart through an incision under the right arm. The cosmetic benefit of the innovative approach, called a right axillary thoracotomy, is the absence of the large vertical scar on the chest that is characteristic of traditional open heart surgery.
The approach spares muscles from being severed, requires less pain medication in recovery and a shorter hospital stay than traditional open heart surgery. For female patients, it removes the risk of damaging tissue that could lead to uneven breast growth.
Most important, the approach has produced excellent outcomes among infants, children and adolescents, who are able to return to normal activity after open heart surgery within days instead of weeks.
“There is no disadvantage to this approach for the patient,” Dr. Dodge-Khatami said. “The holes and valves we want to repair are best accessed through the right chest. It’s a window to the heart for a surgeon.”
Introducing an innovative approach to CHD repair
Since 2005, Dr. Dodge-Khatami has performed more than 200 right axillary thoracotomies to repair CHD in Europe and the U.S. The right axillary approach can be used to repair all atrial septal defects, a vast majority of VSD and several other types of CHD.
Dr. Dodge-Khatami brought the approach to the U.S. in 2013, and to Texas in July 2018 as the director of pediatric cardiac surgery at Children’s Memorial Hermann Hospital and a professor of surgery at McGovern Medical School at UTHealth.
Beau’s surgery is followed by a quick recovery
Beau was Dr. Dodge-Khatami’s first patient in Texas, and he became the first child in the state to undergo right axillary thoracotomy for CHD repair on the morning of July 9.
After the incision was made under Beau’s right arm, surgical instruments were placed to push apart the muscles, blood vessels and nerves covering Beau’s ribs, creating an opening to his chest cavity without severing any further tissue. This created access to the heart and allowed Dr. Dodge-Khatami to begin the process of permanently repairing the VSD with synthetic material. Beau was also given an epidural under anesthesia to assist with post-surgical pain management.
The surgery lasted approximately three hours.
One day after open heart surgery, Beau had enough energy to successfully breastfeed for the first time since he was three weeks old. The following day, he no longer needed pain medication.
On the morning of Friday, July 13, Beau effortlessly lifted his arms and legs off his hospital bed. His gaze shifted from his parents at his bedside to the visitors in his room before a toothless smile emerged from behind the pacifier in his mouth.
That afternoon, the Wybles took Beau home.
Thriving and healthy at home
The day after Beau returned home, he showed no signs of discomfort or pain from his surgical wound. His parents could pick him up under his arms, as they did before surgery.
Beau returned to Children’s Heart Center the Monday after he was discharged for his only scheduled follow-up appointment to remove one last stitch from his surgical incision.
“Unless something looks bad or out of the ordinary, we won’t need to go back to the hospital at all,” Andrew Wyble said. “We only need to check in with his cardiologist.”
The Wybles quipped their only worry now is keeping up with Beau’s newfound appetite.
It’s a good problem to have.
“Beau’s recovery was wonderful and we couldn’t be more pleased with the results,” Jessica Wyble said.
Children’s Heart Center at Children’s Memorial Hermann Hospital has earned a distinguished three-star rating from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in congenital heart surgery. Visit http://childrens.memorialhermann.org/heart/ to learn more.