Medical technology is the greatest!

Little Zachary Davis was born October 20 with an abnormal heart. It was a marvel in its own right. Besides having many features of known congenital defects, it also had something not previously recorded in the history of medicine. His coronary arteries, which normally deliver oxygen and nutrients directly to the heart muscle, were instead supplied by a bizarre circuit routed through his brain.

Richard A. Jonas, a heart surgeon at Children’s National Medical Center, said “It usually takes a lot for us to say ‘That’s amazing.’ We see a lot of unusual things, but this was way out there.”

This exotic misassembly was good enough to get the baby through gestation, but he would not have been able to make it through life. A week after Zachary was born, Jonas took his heart apart, added missing pieces and reconstructed it to something close to its original specifications. It took about four hours and included a 25-minute period when the infant was packed in ice, with no blood circulating.

This is simply amazing to me. This little child would not have survived if it had not been for this doctor who specializes in “early primary repair”.

"There are only a handful of people in the world who can take a problem like this, think it through, do a complete repair, and have the child turn out so well," Mary T. Donofrio, Children's director of fetal cardiology, said of Jonas. "He actually did three operations, and [Zachary] had no leftover heart defects."

A newborn's heart is about the size of a large walnut. The operation is done with the surgeon wearing jeweler's magnifiers attached to glasses. How long a baby can be kept safely in "circulatory arrest" varies, but it is generally not more than 45 minutes. With each minute beyond a time limit that the surgeon cannot pinpoint exactly lies brain damage, a lifetime of lost potential, unhappiness and death.

Jonas sketched out the repair, determined the order of his work and kept a running total of how long it would take. (He prefers to do this the night before, explaining that "you do literally sleep on it; you run through the steps in your sleep.") There were 10 steps, the first seven requiring circulatory arrest. "What is difficult about an operation like this is coordinating all those modules," Jonas said. "You do not have an unlimited amount of time." The right order of work is not always obvious. In this operation, for example, he sewed one end of a donated vessel as Step 6, and the other end as Step 10. The price of doing things in the wrong or inefficient order can be very high. "You can paint yourself into a corner. You can literally get in a position where you can't get there anymore because you did things in the wrong sequence."

Zachary ended up with a normal appearing four-chambered heart in which the blood flows in the right direction.
Talk about stressful jobs!