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Show u dri The Sail Lake Tribune, Sunday . April (i 9, lx x Babies Like Tizzy Now Likely to Survive Heart Surgery t By B. D cardiovascular surgery at Children's, "no matter who, what or where they are unless there's a second coming of Christ There's just a certain baseline of things you " just cant (leal with Coli-- n Washington Post Writer WASHINGTON Mary Jane Frje, mother of three, sat in room 3105 of Childrens Hospital National Medical Center in Washington, glancing toward an empty stainless steel cnb near the door, a crib that had been occupied by her daughter. "This morning, when they came to give her the shot she was just laughwas ing like nothing going to hapiK'n tixiay, Frje thought "Ive got to keep a cool head I can't go hysterical or anything imagination. Surgeons operating on hearts the size of golf balls can repair valves, stitch or patch holes between chambers, save babies with transposition of the great vessels, a condition in which the chambers of the heart are, in effect, in exactly the opposite position from the one they should be, and thus close the patent ductus, a natural connection between the aorta and pulmonary artery that is supposed to close itself off at birth. 1,000 Gram Baby Going Smoothly At that same moment, thiee stories below m operating room 1, the operation to close a hole and repair a defective valve in Kizzy Frye's heart was going smootlJy. Eleven years ago. 01 (lercent of the 18 infants who underwent cardiovascular surgery at Last Children's died year 80 percent of the 88 cardiovascular patients younger than one year survived Frank Surgeon But weve had a dramatic increase in the number of patients and the percentage of mortalities has dramatically lessened. "This baseline (or mortalities) probably cant get below 10 percent, said Midgley, chief of cusps were partially stuck together, not unlike pages of a book that never were separated at the bindery. Midgley S job was to finish separating the cusps. Even two or three years ago we didnt have the facility, the dexterity, the good pumping and postoperative care to be able to offer an operation like this to a child this age, said Midgley. "We used to put it off a year or two. But then they got all these progressive, and sometimes irreversible, apparatus that changesof the heart. in chamber" Kizzy was in the operating room by 7:45, and anesthetized by 8 a.m. By 9:24, when Midgley entered the room, she lay on the operating table, her tiny body eom- - mitted unoxygenated blood returning from the Z O IVI I careful irboiit monitoring (blood) temperatures in kids than we are in he explained. adults, "The oxygenator, which carries out the function of the lungs, "is smaller, sion " its a baby ver- Another Difference Another difference between working with chll-die- u and working with adults, said OConnel, is that our blood (testing) is all done by microtechnique. Everything we do is designed not to use up any of the childs blood Id use 2 ccs to do the tests that would take 5 CCs in an adult Ai 9 24, in a scene from . a thousand movies, Frank Midgley strides into the operating room, bright blue gown covering his surgical green scrub suit, flapping open behind him. He extends his hands, freshly scrubbed and "to estimate the amount that the patient will use on cardiopulmonary bypass, explained nurse Lydia who drapes perfusionist John OCon-ne- l, the man who runs the a clean towel over them, machine, "We perfuse helps with drying and (oxygenate) 2,400 cubic then holds the surgical centimeters (of blood) gloves in which Midgley per minute for every seals his hands. meter of body surface Shall We Begin? area squared. So in her The gown properly case he took the body tied, he steps up to the surface area, 32 multitable and is' plied it times 2,400, and operating that comes out to the handed a pair of forceps estimated flow of 775 containing a cotton swab drenched in Betadine, a CCS." soluWhen the patient is an brownish anesthetic He solution rubs the tion. of size infant the Kizzy, rather than an adult, all over the childs torso. OConnel uses the pump The body is draped differently. The pump with surgical toweling, is the same but we empand at 9:30 Midgley asks loy it differently. The shall we begin? What tubing (which carries the time is it? And then blood from the patient to draws a gleaming scalpel the pump, where it is 4.75 inches along the mid- oxygenated, and back into the body) is smaller because were using less blood volume its quarter12-DIG- of flow ing back In Kizzys case the edges of the three hands to indicate the size of the baby . . . And weve done 60 of those without an operating room mortality. Kizzy Frye needed what is commonlyknown as open heart surgery, like 44 other infants who underwent the surgery at Childrens from July 1974 through December of last year. She was born with both an atrial septal defect, a hole between the right and left atria, and a blockage in the pulmonary artery caused by a valve that was not opening wide enough. The septal defect per- Pts. Up Deaths Down tion. The body surface area measurement is needed allow blood to flow out of the heart, and then c lose to prevent it from seep- pounds, no bigger than . . The valve normally has three leaflets, or cusps, which open to said Midgley, that, barely separating his mortality rate in 17 a "sign of the basic newness of our specialty . and a manifestation of a lot of things; a lack of proper equipment, expertise and experience. g ly die. Just yesterday I did patent ductus) on a little 1,000 gram baby, which is under two Midgley calls the awful . . one (a M. pletely umoveied, adhetape covering her eyes and mouth Information Posted On an observation window across the room from the child size table was taped a large, hand lettered jxister with the name FRYE, KIZZY. her age. weight, height, body surface area, percentage red of solid material in her and white cells bkxxl, the estimated flow of the pump, the heart-lunmachine, her estimated blood volume, the amount of Heparin that would be used to keep her blood from clotting on the machine and the amount of Protamine that would be used to counteract the Heparin at the end of the operasive from the lungs, and the failure of the valve to function properly causes the heart to work harder than usual, building up muscle, further narrowing and eventually clos ing off the opening to the pulmonary artery. Operate Early "The kid isnt desperately ill and desperately Midgley symptomatic, said of Kizzy a few minutes pprior to surgery on March 8. "but we know from dealing with these children in the last several years that if you dont operate on the child early enough they can have progressive problems and eventual- But what can be dealt with tixiay, and in babies no more than five days old, staggers the She had nothing to lie hysterical about. body to mix with oxygenated blood returning -inch rather than three-eight- or IT half- SEIKO inch. "Were probably more 15 up the heart-lunmachine, the pump. are Purse strings sewn into the heart. They will be used to attach the g lines from the pump. At 10:07 Midgley calls to OConnel, Go on bypass and cool to 30 85 degrees (centigrade fahrenheit) slowly. "Okay," replies O'Con-ne- l, "Im ready to go on bypass." Now! Flow Rates Adjusted The flow rates are adjusted, the pursestrings checked, and the machine has temporarily taken over the work of Kizzys heart. Midgley begins his repair work. The hole is easy to close. Two stitches and its done. The valve is very thick. No. 11 blade please, he says, reaching for a surgical knife. The entire valve structure is not much larger than the eraser at the end pencil. The surgeon makes three incisions between the cusps and the work on the valve is done. It is 10.26 The repair work itself has taken about 15 minutes. Midgley gives the, order to "fully rewarm the blood prior to turning the pump off. Own Heart Beats The lines are disconnected one by one and the flow from the pump is reduced. At 10:37 Midgley tells OConnel to turn off the pump and Kizzy' s heart again is on its own. of a It is all pro forma from here: checking the heart for any leakage, cleaning the area, removing some of the remaining lines, closing the chest cavity, muscle, fat and skin. It will all be over by 1 1 : 50. on the Meanwhile, third floor, primary care nurse Marilyn Clare walks into a playroom where Mary Jane Frye is talking to a reporter. "Hi! she begins with a smile. "I just wanted to let you know she's doing fine. Theyre starting to close and there were no problems. Dr. Midgley will probably be up to see you within an hour and then well go with the rest of our procedure from there. He said to tell you it w'ent fine. He didnt have to put a patch in to cover the hole. Like to take a deep breath? Yeah, responds Frye, who breaks into a wide grin. suivived long enough to know if they may need further surgery m middle or old age. two days after the oera-- t ion kizzy was already back in the rixim she was sharing with her mother in keeping with Children's policy of encouraging parents to room-i- The Bills Asked about the Frye said, "Medicaid will have to pay for those Aint no way in the world I can pay for it. Not here anyway. It's expensive The entire procedure, including surgeons fees, the room, intensive care and medication will probably cost about $8, (k io, Shell spring right back, she said of her daughter, and indeed she with their n Despite the increasing of such operations, there is still one major unans- wered question: What will happen to these children over the long run? While they can lead normal lives as children and adults, there is not yet a large enough group of such children who have did rAUCTION 10:30 a.m., TUESDAY, APRIL 18, on Mary SI, of Roundup Junction, BILLINGS, MONTANA. east 2nd ANNUAL MONTANA CONTRACTORS ASSOCIATION EQUIPMENT AUCTION! In association with Max Rouse I Sons, Auctioneers Inspect from April Tremendous Inventory Includes. 11 Gratters Cat lhG & 12G articu'ated Cat 14E 14C. 12T, D (6) Wheel Loaders. Cat 9S0 B & 988 at'icu Allis Chalmers lated Hough H30CV Mich 174A Crawler Loaders ID 495 Inti Tere 82 40 Motor D9G, D8. 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Wash 98199 (206) 284 5040 Toll 361 So Couldnt Be Better Things could not have gone better, Midgley said PRINTING DISPLAY 310 IMPACT PRINTING HEAD this week only brentwood pros men & boys action footgear IUOO(TITOHf hue of Ki7)'s chest and abdomen A pencil-lm- e thick of blood springs up in its wake Through the skin, fat, muscle, breastbone its mostly cartilage" and into the chest cavity. The entire opening is so small it looks more like an oral surgical procedure on an adult than cardiovascular surgery. By 9:44 Midgley calls for dissecting scissors to oxn the pericardial sac, the membrane that surrounds the heart, and the heart is completely visible For 23 minutes the surgeon and his staff work preparing to hook jlffl off A. Reg. 9.99, Now 8.49 white vinyl with blue sweep stripes to carry you along on a job, a bikeride or just for looking good. 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