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Stanford Report, February 27, 2002

Packard Hospital discharges smallest open-heart patient


Last Thursday, the smallest and youngest infant ever to undergo open-heart surgery was well enough to be released from Lucile Packard Children's Hospital, moving closer to her family in Sacramento.

Serena Brown weighed about as much as two cans of soda when she was born nearly four months early on Dec. 27, along with her two sisters. But for her doctors, keeping Serena alive meant more than just helping her gain weight and overcoming other obstacles infants often face when born prematurely. That's because Serena was born with a congenital heart defect -- unrelated to her premature birth -- that needed to be surgically repaired or she would die.

Whether she's part of medical history or not, Serena's parents, Lori and Joshua Brown, said Thursday they are just grateful their daughter is alive and closer to home. "I haven't been able to hold her yet," Lori Brown said. "Now we'll be able to be closer to her emotionally and physically."

When she underwent open-heart surgery early in 2002, Serena Brown weighed as much as two cans of soda and her heart was the size of the tip of her surgeon's thumb. She has since rejoined her family in Sacramento.

Upon leaving Packard, Serena joined her twin sister, Brianna, at a Sacramento hospital. The third sister, Jocelyn, died of necrotizing enterocoloitis, a severe inflammation of the intestines common in premature infants. "It was hard to lose one. I was really attached to her," Brown said.

Hard, too, was the decision to allow doctors to operate on Serena. Even cardiologist V. Mohan Reddy, MD, said only the fact that Serena's chances of survival without surgery -- near zero -- prompted him to consider the technically difficult surgery.

"Her chest was smaller than my palm, and her heart was the size of the tip of my thumb," said Reddy, chief of pediatric cardiac surgery at Packard Children's Hospital. He performed the procedure Jan. 11 along with a team of other surgeons. "Most surgeons don't do this operation on a patient under 1,000 grams," he added, noting that Serena weighed only 640 grams, or 1.4 pounds, which is about one-fifth of normal for a newborn.

Reddy, among the top surgeons in his field, has conducted a thorough review of existing literature regarding pediatric cardiovascular surgery and conferred with his colleagues across the country regarding Serena's operation. "To the best of my knowledge, she is the youngest baby ever to have open-heart surgery, and the smallest," he said.

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 only thing keeping Serena alive was a naturally occurring hole between the two halves of the heart. Normally, that hole seals itself soon after birth. To correct the condition, Reddy re-attached the veins to the correct side of the heart and closed the hole.

"The operation gives her a chance," Reddy said shortly after the surgery. Her prognosis now should be like any other 25-week premature baby, but "there are a lot of hoops she's going to have to jump through," he added.

Serena's weight has climbed to nearly 900 grams since surgery. She no longer needs a ventilator to breathe, although she continues to receive oxygen. She is also fed tiny amounts of baby formula continuously through a feeding tube, said Kirsten Braccia, a Packard nurse who cared for Serena. Given all she's been through, Braccia commented, Serena is "very alert and very active."

The entire Brown family has gone through a trying time. Recovering from his own heart surgery a year ago, Joshua Brown has just received the go-ahead from doctors to return to his job in sales. Lori, an apartment manager, has been on disability leave since early in her pregnancy. The Browns said they have coped with the help of their 20-month-old son Dylan, and the kindness of family, friends, nurses and doctors.

Despite the emotional and financial struggle, Serena's progress has been inspiring for her mother. "I am not a religious person, but lately I have been praying a lot," she said.

New pediatric team is good news for kids with severe heart defects at Packard (11/7/01)

Lucile Packard Children's Hospital