“We Missed It”

“The valve is really hard to see, and we missed it,” he says. “I think we were too far in.” He deflates the balloon and tries again. This time, Thompson checks and double-checks the markers on the catheter until he’s satisfied it’s positioned where he wants it.

Thompson inflates the balloon again. On the monitor, the expanded balloon at first appears dark, like two links of sausage amid the gray-and-white opacity of the heart. The narrowing I see between the “links” is where the valve is.

“Watch this,” Thompson says as he pumps more fluid into the balloon. Suddenly, the balloon expands and the narrowing disappears as the balloon rips open the leaflets of the once-shuttered valve. Thompson deflates the balloon quickly.

He stands back and claps his hands. “Yeah, success!” he says, pointing to the blood streaming for the first time through the pulmonary valve on its way to the lungs. I see a dying heart suddenly come alive.

“Balloon coming out,” Thompson says. “How’s the right ventricle doing? I want to see the outflow pressure.”

He watches the pressure drop from 90 to 70, the result he hoped for. The ideal pressure is around 25, and Thompson knows that as Ryder’s right ventricle relaxes in the coming weeks, the pressure across the pulmonary valve will drop into the normal range.

Thompson strides down the hospital’s corridors to the maternity section to talk with Rebecca and Ryan. The couple had Ryder baptized before the catheterization and have spent the morning praying.

“Everything went very well,” Thompson tells them. “As you know, I was pretty worried about what we could do, but I think he’s going to be fine, and I don’t think he’ll need any more procedures, but we’ll have to wait and see on that.”

The couple thanks him profusely. Rebecca, still weak from her C-section two days earlier, calls home to tell her family the results and learns that her Aunt Jane has been saying rosaries and telling God to “keep this baby safe.”

“It must have worked,” Rebecca says.

Ryder remains in intensive care and on prostaglandin for several days while his right ventricle recovers and relaxes after the months of punishment it endured. When he’s eventually weaned off prostaglandin, his right ventricle has to work hard to make up for the closing of the ductus arteriosis. It’s soon up to the task.

After 17 days, Ryder is well enough to be released from the hospital. When I meet with Rebecca and Ryan at their Frederick home a couple of weeks after that, they tell me they didn’t truly feel like parents until Ryder came home. They’ve had a steady stream of family visitors, and people at Rebecca’s school got together to deliver home-cooked dinners every night.

As we talk in their living room, Ryder cries in another room. Ryan goes and picks him up, carries him to the living-room sofa, and offers his young son a bottle. Ryder looks healthy as he takes the bottle and nestles on his father’s chest. He’s slowly being weaned off the beta blockers he’s being given to maintain a steady heart rate.

Thompson has told the couple that another procedure is unlikely to be needed because of the heart’s ability to mend itself. He has told them that Ryder will lead a normal, healthy life.

Like other families I’ve spoken to, they ask about my life after my heart repair, and I assure them I’ve led a normal life in the 50 years since. I married the woman who waited for me during my operation and have had a long and happy marriage, three healthy children, and four healthy grandchildren—the same things they want for their child.

“The Worst Feeling in the World”

Lucas Collazo rises early in his Great Falls home, before his wife, Karen, and their two young children. As he showers, his mind locks in on the surgery he’ll perform that day on a septal defect. He tries to anticipate any surprises.

Collazo is motivated by his perfectionism and his fear of what he calls “the long walk” from the OR to the waiting room to inform a family that a child has died.

“It’s the worst feeling in the world, and it never goes away,” he says. “I can tell you the names and dates of every child under my care that has died. I can’t remember the successes.”

Photographs of little children he’s treated, along with thank-you notes and a Valentine’s card he receives every year from the same little girl, hang on a wall in his office to remind him of his successes. But it’s the losses that drive him.

“I never want to take that long walk again,” he says. “Every time I operate, I know there is a possibility that something unexpected could happen and the patient might die. That thought never leaves my mind.”

After graduating from Columbia University, Collazo, the son of Puerto Rican immigrants, attended SUNY medical school in Buffalo. There, during his first rotation, he watched cardiac surgery and knew he had found what he wanted to do with his life.

The broad-shouldered and barrel-chested Collazo’s hands are so large that, when he graduated from his surgical residency program, his classmates presented him with a bucket of ladyfinger cookies as a joke.

Unlike Shen, who operates exclusively on congenital defects, Collazo also performs adult cardiac surgery for valve replacement, coronary bypass, and other acquired problems. The two men frequently operate together, a practice that’s unusual.

Several independent cardiologists I spoke with over the summer and fall believe Inova has forged one of the strongest pediatric heart programs, if not the strongest, in the Washington area.

Kari Dyer follows her three-month-old son, Griffin, as he’s wheeled into the operating room while her husband, Cary, remains in the hall outside. A nurse lifts Griffin onto the operating table. Tearful behind her surgical mask, Kari leans down and whispers, “I love you.”

Griffin has Down syndrome, and children with this chromosomal abnormality often have congenital heart defects. Griffin’s hadn’t been detected at the time of his birth on June 7, but his mother became concerned a few weeks later when his appetite waned and his breathing became labored. She took him to pediatric cardiologist Patrick Callahan; an echocardiogram revealed an atrial-septal defect.

Jim Thompson later catheterized Griffin to see if there were any other cardiac abnormalities the scans might have missed. He found none but confirmed that Griffin also had an unusually small mitral valve that would require medical attention. Because of the severity of Griffin’s atrial-septal defect—the infant essentially had no wall separating his left and right atria—Thompson couldn’t repair it in the cath lab.

Because it’s Collazo’s case, Shen stands on Griffin’s left and Collazo on the right. They need to devise a new atrial septum for Griffin. Watching the procedure, I marvel at the speed and ease with which the two talented surgeons operate.

Collazo saws the sternum, cartilage still not yet hardened into bone, down the middle. It makes me uncomfortable: The same thing was done to my sternum 50 years ago, and the painful effects lingered for weeks. I remain grateful for the morphine given me in the days following my surgery.

The surgeons expose Griffin’s pulsing heart. To see a human heart beating in a chest always seems to convey something sacred. They put Griffin on bypass, cool his blood and body to the low 90s, and stop his heart. Every time I observe this, I think back 50 years to when my heart was stopped while I slept and for a few brief moments I was clinically dead.

Collazo makes an incision in the pericardium, snips out a rectangular patch, and turns it over to physician assistant Thomas Lauer, who dips it into a solution of glueraldehyde. The pericardial tissue is normally floppy, but a few minutes in this solution toughens it the way tanning toughens leather, making it strong enough to patch the hole in Griffin’s septum.

Cutting into the heart muscle, Collazo and Shen expose the area between the atria. Collazo secures the patch cut from the pericardium and attaches it with sutures to what there is of Griffin’s atrial septum. Their fingers move and mesh amid a cat’s cradle of suture threads in the tiny confines of Griffin’s chest.

This surgery is considered “routine” compared with many open-heart procedures, and there are moments of light banter. When the conversation turns to actress Lindsay Lohan, Shen confesses that he has no idea who she is.

“Irving probably has a big poster of her inside his office door,” someone says.

Everyone chuckles, including Shen.

The repair complete, Shen and Collazo watch the pulsing heart in Griffin’s chest as they remove the cannulas and take him off the heart-lung bypass machine. Griffin’s heart starts to beat on its own.

“Sixty-nine minutes on bypass,” the perfusionist notes.

“No surprises on this one, thank God,” Collazo says.

They go through a checklist to account for every instrument, needle, and sponge involved in the operation.

Still asleep from anesthesia, Griffin is wheeled to the pediatric ICU. Collazo meets his parents in a small room. It’s a warm September day, and the couple has walked anxiously around the hospital grounds for more than two hours. Collazo assures them the repair is complete, that Griffin has come through fine, and answers their questions. Cary asks if Griffin will need another septal repair as he grows. Collazo says he won’t, that the tissue surrounding the patch will grow with Griffin.

On an October afternoon three weeks after Griffin’s surgery, I visit the Dyers’ home in Alexandria. Kari speaks softly to Griffin as he nestles in her arms. He’s eating better, she says. Their three-year-old daughter, Lilly, plays with toys on the living-room floor.

Kari says she suffered several miscarriages before Griffin was conceived, so she hadn’t wanted to risk amniocentesis. Everything had appeared normal during the pregnancy, so the Down syndrome came as a shock.

She puts Griffin on the living-room rug. He’s a beautiful baby, round and pink. He takes medication to control pulmonary hypertension. As is often the case in children with multiple heart defects, Griffin’s story is incomplete—he may require additional cardiac intervention someday to repair his mitral valve.