CHLA Surgeons Perform First Hybrid Norwood Heart Surgery In Marion And John E. Anderson Pavilion
Octavio Hernandez, Jr. underwent pioneering heart surgery at Children’s Hospital Los Angeles. Pictured are the family (from left): mom Liliana Marquez; sisters Rebecca and Destiny Hernandez, and Octavio Hernandez, Sr., holding his infant son.
When 2-day-old Octavio Angel Hernandez Jr. arrived at Children’s Hospital Los Angeles (CHLA) last Christmas Eve, the 6.8-pound baby boy was fighting for his life. “He was in shock,” says Frank Ing, M.D., a pediatric interventional cardiologist at CHLA. “He was dying because not enough blood was getting to his body.”
Earlier in the day, little Octavio Jr. had been the center of attention as the Hernandez family gathered at his parents’ home to celebrate the holiday and their new family member’s arrival.
But as the afternoon wore on, Octavio Jr.’s breathing became labored and his voice disappeared. “He had cold feet and hands, a bluish face, purplish lips,” recalls his father, Octavio Sr. “He was crying; but only his mouth was moving; there was no sound coming out. I turned to my wife and said, let’s put him in the car seat and go.”
By the time they arrived at the CHLA’s emergency department, Octavio Jr. was in low output syndrome—his liver and kidneys were shutting down. The diagnosis: hypoplastic left heart syndrome, a congenital heart defect that shows up in about one in 2,500 births. The defect prevents the heart’s undersized left side—identified by underdeveloped mitral valve, left ventricle, aortic valve, and aorta— from pumping enough blood through the body. “Had we arrived 10 minutes later, we would have lost him,” his father says.
Though Octavio Jr.’s left ventricle was under developed, blood flow to the body could be still be pumped by the right ventricle through the ductus arteriosus.
The problem is this blood vessel normally closes within a couple of days after birth as left heart takes over the function of pumping the oxygenated blood from the lungs to the body.
In Octavio’s case, he didn’t have a normal left heart to do the work and as the ductus closed, his body did not get adequate blood flow. Doctors had to open the ductus just to keep him alive.
“We caught him early enough in the process and put him on prostaglandins (PGE ), a medicine that relaxes the ductus and opened it back up,” explains Ing. “So now there’s better blood flow to the body—but the body has taken a tremendous insult…and it doesn’t recover easily.”
Octavio Jr. hadn’t suffered brain damage, but his kidneys and liver were damaged and his body needed three weeks of recovery in the hospital’s cardiothoracic intensive care unit before CHLA Heart Institute surgeons could take the next step: open-heart surgery.
His doctors—Ing and Cardiothoracic Surgeon Cynthia Herrington, M.D., decided to perform the Hybrid Norwood, a less invasive surgery sometimes used in place of the Norwood surgery, a four-hour procedure that requires the use of heart-lung bypass machine. “The insult to his body was severe,” explains Herrington.
“His liver and kidneys came back, but they were not back to normal, so for Octavio, the Hybrid Norwood was a better alternative.”
It would be the first Hybrid Norwood performed in Children’s Marion and John E. Anderson Pavilion, which opened in 2011, and fourth overall at the hospital.
On Jan. 14, Octavio Jr. was brought to the hospital’s Catheterization Laboratory and the doctors went to work. Herrington opened up Octavio’s chest and began the delicate job of tying tiny bands, over Octavio Jr.’s left and right pulmonary artery branches to limit blood flow to over-circulated lungs.
The second step—Ing’s specialty—required the insertion of a stent—a tiny mesh tube—into the ductus that once in place, would keep the ductus open without medications and increase blood flow to Octavio Jr.’s body.
Before Ing could implant the stent, Herrington inserted a sheath, a small hollow tube, in Octavio Jr.’s pulmonary artery. As Herrington steadied the sheath, Ing used a tiny guide wire with the aid of X-ray to maneuver the stent through Octavio’s artery to the ductus arteriosis blood vessel. Expanding the stent, Ing secured the vessel, allowing blood to continue circulating through Octavio’s body. The surgery took less than an hour. “It went smoothly,” says Herrington. “Octavio did very well.”
Octavio will need another second, more complex surgery later on, but he will be bigger and stronger to endure the procedure, Ing says. “We have the expertise here to handle the next stages,” he says. That second surgery, called the Glenn procedure, will take place in four to six months and will involve the complex reconstruction of the aorta arch. The third stage, the Fontan operation, takes place later.
After the Jan. 14 surgery, Octavio, Jr. spent three more weeks in the hospital regaining his strength. His mom stayed by his side virtually the entire time, save for several days when she went home to see her daughters.
Octavio, Sr. visited on nights and weekends while extended family took turns watching their two girls, ages 4 and 6, who didn’t get to visit their baby brother because of the hospital’s restrictions during flu season. But on Feb. 7, Octavio, Jr. went home.
“He’s feeling good now,” says Octavio, Sr. “He’s nine-pounds, his voice is back, he’s feeding from his bottle and he’s breathing great. The sound of him crying is like music to our ears.”