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11/14/91

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LUNG TRANSPLANT IN INFANT WITH DIAPHRAGMATIC HERNIA IS FIRST OF ITS KIND

STANFORD--A 17-day-old infant with a diaphragmatic hernia has received a lung transplant at Stanford Medical Center in what is apparently the first successful operation of its kind.

The infant, Jacqueline Reed of San Jose, is recovering at Lucile Packard Children's Hospital at Stanford. Dr. Vaughn Starnes, who performed the operation, said she is breathing on her own and her airways are healing.

Starnes, head of Stanford's heart and heart-lung transplant program, did the surgery on Oct. 27. Starnes said as far as he knows it is the first transplant into an infant with a diaphragmatic hernia in which the patient has survived.

A diaphragmatic hernia is a breakdown in the muscle and tissue separating the chest and abdominal cavities. When Jacqueline was brought into Packard Hospital, her abdominal organs were pushing up into the lung area. "She had essentially no lung on the right side and a very small one on the left," said Starnes.

In addition, the baby had pulmonary hypertension, which results in constricted blood vessels and an inadequate supply of blood. Dr. William Rhine immediately put her on a lung- assisting device called ECMO, for extra corporeal membrane oxygenation. "She was our 100th ECMO baby," said Rhine.

The ECMO treatment eased the pulmonary hypertension and while the infant was still on the device, a team of surgeons headed by Dr. Stephen Shochat repaired the hernia. That was another example of the "unique, multidisciplinary approach" Stanford and Packard were able to bring to the case, Rhine said.

After she was taken off ECMO, Jacqueline was put on a ventilator that was keeping her alive. However, it was obvious she was not improving, and when a lung from an infant donor in Idaho became available for transplant, Starnes performed the operation.

The lung was from a six-week old infant and was too large for the recipient, so Starnes removed the middle lobe and used only the upper and lower lobes. Several factors complicated the operation, he said, including the poor condition of the recipient's arteries. "So we used the pulmonary artery from the donor," he said.

The transplanted lung was placed in the right side and the small, inadequate left lung remained in place. "The hope is the transplant will grow and so will the left lung," Rhine said. "Then even if she eventually rejects the transplant, if the left lung grows she'll be able to survive."

Jacqueline's parents are Chris and Teresa Reed of San Jose. "Having Jacqueline has changed how I look at things; it makes me realize how fragile life is," said Chris Reed. "I wish Jacqueline could have an easier life ahead of her. But she's alive."

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