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Smallest baby to receive heart catheterization at BUMC

She weighed under five-pounds
Posted: 9:02 AM, Jun 24, 2019
Updated: 2019-06-24 13:05:09-04
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TUCSON, Ariz. — One baby is the smallest patient to undergo a specific heart procedure in Tucson. Banner University Medical Center operated on a neonatal intensive care unit patient who was just under five pounds.

Visiting the NICU every afternoon, Rachel Lara and Julienne Cordero watch their daughter, Ahriella Cordero, grow and recover. An ultrasound at 22 weeks showed Ahriella had heart defects.

When looking at the heart, doctors look for two pumping chambers, the pulmonary artery, and the aorta. A few things tipped Dr. Jamie Colombo off about Arhiella's heart during that 22-week ultrasound.

"One, that we saw a hole in between the two pumping chambers. That's called a ventricular subtle defect. And the second one, was that we saw that the pulmonary artery was having no blood flow going through it," said Colombo.

Because of her under-developed pulmonary artery, blood does not move to her lungs.

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Comparison of a normal heart to Ahriella's, before inserting stents

In an email explaining the two diagrams, Dr. Mike Seckeler, who performed the catheterization said:

"Normal – There are four chambers in the heart. The right atrium (RA) received venous blood from the body and sends it down to the right ventricle (RV) which pumps blood to the lungs through the pulmonary artery (PA). The blood returns from the lungs with oxygen to the left atrium (LA) which sends blood to the left ventricle (LV) which pumps blood to the body through the aorta (Ao).

Patient anatomy – The patient’s heart defect included a hole between the left and right atrium (ASD) and another between the left and right ventricles (VSD). She also did not completely form her pulmonary artery (*) so there was no direct connection from the heart to the lungs. Instead, blood is supplied to her lungs through the patent ductus arteriosus (PDA) – a normal structure in all infants that usually closes soon after birth."

Ahriella was born at 35 weeks and six days, at under five pounds. And two weeks after she was born, she had two stents inserted into her heart. She is the smallest patient to have undergone this procedure at BUMC.

"We didn't know what to do, because you never what that for your baby. And this is our first baby. So it was hard," said Lara.

"It's just a very large can of worm, I guess in a sense, of what to worry about when this type of thing happens," said Cordero.

Now that the family is over the initial hurdles, they say Ahriella is surpassing expectations, while also coming into her little personality.

"She's a little sassy. And its funny because before we would always joke about how she would be sassy," said Lara.

"Right after the procedure, her energy changed completely. I mean, like, she started crying a lot more. She was moving around a lot," said Cordero.

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X-ray captures of Ahriella's heart before and after stents were inserted

In explaining the above x-ray's, Seckeler said in an email:

"Pre-stents – The aorta is on the patient’s right side (left side of the picture) and the PDA is a large vessel on the patient’s left side that connects to the pulmonary arteries.

Post-stents – After placement of stents in the PDA, the vessel is straighter and will now stay open without medication to continue to supply blood flow to her lungs until her surgery."

Before Ahriella received the stents, Seckeler made a 3-D replica of her heart.

"The vessel we had to stent, was this log curved vessel here. Through heart catheterization, we can use minimally invasive methods and we can actually keep the vessel open with a stent instead of having to do open surgery," said Seckeler.

"This is something life-long we're going to have to follow, constantly seeing cardiologist and stuff. But I think that the best thing is to just take it a day at a time," said Lara.

Ahriella needs to be between 10 to 15 pounds before she can undergo heart surgery, where an artificial connection between her heart and lungs can be placed.

"This case really highlights the extensive team and expertise we have at BUMC. This includes my fellow cardiologists, the congenital cardiac surgeons, the pediatric and neonatal ICU physician’s and nurses, the cath lab staff and the radiologists. We are the only hospital that has all of these services and can perform these procedures in Southern Arizona," said Seckeler.