A Boy Full of Heart
Born with a life-threatening defect, 4-year-old Kellan Klingman now thrives
By Bonnie Ward
For the expecting parents of Kellan Klingman, the bad news came in waves.
“At about 18 weeks [into my pregnancy], a routine ultrasound showed our baby had a hole in the heart,” recalls Kellan’s mom, Christina Meehan. “About two weeks later, we found out he also had a small aortic valve.”
Just a few weeks later, Christina and her husband, Terrance, received the most distressing news of all. Their baby would be born with an interrupted aortic arch, a complex and life-threatening heart problem.
“I was in a fog,” says Christina. “You never think your baby is going to have such a severe defect that he might not live.”
After discovering the three major heart issues, Christina’s obstetrician referred the couple to the Cardiology Division at Rady Children’s Hospital-San Diego, where they learned that Kellan would need open heart surgery shortly afterbirth. Terrance says it was scary to hear their newborn would require surgery but was comforted knowing he would be cared for by top doctors.
The cardiology team at Rady Children’s prepared a post-birth plan, which called for Kellan to be whisked from the delivery room at Sharp Mary Birch Hospital to Rady Children’s cardiovascular intensive care unit immediately after birth. The two hospitals, which are adjacent, are connected by a hallway to enable rapid transfers.
Making the Connection
Kellan arrived at Rady Children’s as planned and was placed on medication to maintain blood flow throughout his body in preparation for surgery.
With an interrupted aortic arch, the aorta—the main blood vessel carrying oxygen-rich blood from the heart to the body—has a small section missing. The interruption allows relatively normal blood flow to the head and brain but deprives the lower body of normal blood circulation. While medication can temporarily sustain blood flow, surgical repair of the aorta is required for survival.
Kellan also had not one, but two holes in his heart that needed repair.
“This combination of abnormalities meant that Kellan needed open heart surgery in the first week of life to restore continuity of the aorta and to close the holes,” says Kellan’s cardiologist Christopher Davis, M.D., Ph.D., director of the cardiology outpatient clinic and exercise laboratory and an associate professor of pediatrics at UC San Diego.
John Lamberti, M.D., a renowned cardiac surgeon and director of Rady Children’s Heart Institute, performed the delicate and complex operation to mend the interrupted aortic arch, a relatively rare condition occurring in about 1 in 350,000 births.
“Repair of an interrupted aortic arch involves mobilizing the separate segments of the aorta and then sewing them together in a manner that allows for subsequent growth of the connection, since the aorta must grow along with the child,” says Dr. Lamberti, also a professor of surgery at UC San Diego.
Dr. Lamberti notes that the repair also requires a more complicated setup for the heart-lung bypass machine, which takes over the work of these organs during complex cardiac surgeries. “Since the aorta is discontinuous, we must utilize two inflow tubes in order to provide blood flow to both the upper and lower parts of the body until the repair is complete,” explains Dr. Lamberti. “This is in contrast to conventional bypass surgeries where only one inflow tube is necessary.”
The stress of not knowing how the surgery would turn out and waiting for it to be over was almost unbearable for Christina and Terrance, but they had faith in Dr. Lamberti. “If, as a father, I couldn’t be in there with my son, I felt good knowing that Dr. Lamberti was doing the surgery,” Terrance says. “Just knowing that he’s so respected and has saved so many lives, we knew we could trust him to do the best for Kellan.”
Dr. Lamberti successfully repaired Kellan’s aortic arch and the holes in his heart, and Kellan was soon recovering in the cardiovascular intensive care unit, where he spent the next two months. “We went to see him every day,” says Christina. “Sometimes we would spend the night. The people at Rady Children’s, especially the [cardiovascular intensive care unit] nurses, became like a second family.”
While the most dangerous of the surgeries was over, Kellan still needed two more operations to have optimal heart function. When he was six weeks old, a pacemaker was implanted to ensure his heart maintained proper rhythm. At 18 months old, Dr. Lamberti enlarged the aortic valve opening and removed an area of obstruction just below the aortic valve. This intricate surgical procedure aims to improve blood flow from the left ventricle to the aorta.
A Happy Homecoming
Christina and Terrance were able to bring Kellan home from Rady Children’s eight weeks after his aortic arch surgery—on Mother’s Day. It was the perfect gift. “We were so happy,” says Christina.
For the next year, Christina stayed home from work to care for her son, who needed a feeding tube for several months and had slightly delayed motor skills due to his surgeries. But by the time Kellan reached age 1, he was developmentally on track.
Today, Kellan is an active 4-year-old who enjoys swimming, hiking and building elaborate models of car washes with his Legos. He and his parents will participate in the Shamu & You Family Walk on Oct. 26 at SeaWorld, where his dad works as a penguin keeper. The Walk is an annual fundraiser for Rady Children’s.
“Our team is called Kellan’s Krusaders and includes my mom, sister and friends,” says Christina. “We want to help Rady’s continue to have the best technology, not just for Kellan, but for all kids.”
Dr. Davis, whom Christina and Terrance describe as “a kind, gentle person with a very calming manner,” will continue to see Kellan and closely monitor his heart. In his teens, Kellan will likely need yet another surgery, as he could outgrow the aortic valve repair.
“Kellan is doing well and for the most part can lead a full and healthy life,” Dr. Davis says. “He’s very active and is on no medication. He behaves and looks like a perfectly healthy boy. If you couldn’t see the scar on his chest, you’d never know what he has been through. That is our goal for Kellan and for every patient like him.”
Advanced technology, cardiac experts save lives in newborn heart surgeries
For complex newborn heart operations, like Kellan’s, Rady Children’s Hospital-San Diego has among the best outcomes in the nation. This is largely due to advancements in technology, as well as the surgical expertise of the cardiac team.
“We have achieved better than average outcomes on the most complex newborn and infant heart procedures performed today,” says Daniel J. DiBardino, M.D., pediatric heart surgeon and surgical director of cardiac critical care at Rady Children’s. One such outcome is for a particularly difficult procedure called the Norwood operation. National statistics show an 81 percent survival rate for newborns undergoing this surgery. At Rady Children’s, the survival rate is more than 90 percent, and nearly 100 percent of newborns survive similar types of repairs.
Heart-lung bypass machines are an important part of the technology that enables these lifesaving operations to proceed, says Dr. DiBardino. The machines take over the functions of the heart and lungs during cardiac surgery, enabling doctors to work on the heart while it is stopped. First introduced in the 1950s, the machines—which pump, oxygenate and circulate blood throughout the body—have undergone numerous improvements over the years and serve as a critical component of complex heart surgery.
“Modern technology allows us to replace the function of the heart while we repair the heart,” says cardiac surgeon John Lamberti, M.D., director of Rady Children’s Heart Institute. “It is now possible to perform intricate repairs with great precision, while the heart is completely at rest.”
The machines are used not only in the operating room, but a special bypass machine called ECMO (extracorporeal membrane oxygenation) can be used after surgery to help babies recover. “They can stay on the machine for a few days,” Dr. DiBardino says. “It sometimes helps the sickest babies to bridge the gap to recovery, so their vital organs can rest and recover.
Originally published in U-T San Diego, October 2014