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Advancing heart surgery for the most fragile babies

January 11, 2002 was a red-letter day in the history of the Children's Heart Center at Lucile Packard Children's Hospital. That was the day pediatric cardiac surgeon Mohan Reddy, MD, repaired a congenital heart defect in an infant younger and smaller than any previous open-heart surgery patient.

Serena Brown had been born 15 weeks early on December 27, 2001. One of a set of triplets, Serena was diagnosed soon after birth with a rare congenital heart abnormality. Gone untreated, she would have died.

Yet the repair presented an enormous challenge. At the time of the operation, Serena weighed only 640 grams - about the size of two cans of soda. A normal newborn weighs around 3,500 grams.

"Her chest was smaller than my palm, and her heart was the size of the tip of my thumb," said Reddy, chief of the division of pediatric cardiac surgery at Packard Children's. "Most surgeons don't do this operation before 1,000 grams. It's technically difficult, and, in infants this premature, the risks are extremely high. But if you don't do anything, the baby will not survive."

Serena suffered from a condition called total anomalous pulmonary venous return, in which the veins connecting her lungs to her heart were attached to the wrong side of the heart. This meant that oxygen-rich blood from her lungs was not circulating efficiently to the rest of her body. The condition was not related to her prematurity.

The only thing keeping her alive was a naturally occurring hole between the two halves of the heart, which normally seals itself soon after birth. To correct the condition, Reddy re-attached the veins to the correct side of the heart and sealed the hole.

"The operation gives her a chance," Reddy said shortly after the surgery. "Otherwise there is a 100 percent risk of death." The surgery improved her odds to those of a preemie her age and size with a normal heart, he added.

Though she faced some initial setbacks because of her premature lungs, after about a month at Packard, Serena was healthy enough to be transferred back to Sutter Memorial Hospital in Sacramento to be closer to her family and continue her recovery.

And Reddy could take satisfaction in knowing he'd been able to save an incredibly fragile life - a feat he repeated three years later for a similar patient.

This month marks the 20th anniversary of Lucile Packard Children's Hospital, which opened its doors on June 10, 1991. Each Friday in June, we'll take a look at the hospital's first two decades.

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