Right to the Heart: Rare procedure minimizes cardiac surgery recovery time

Abigail Morgan's mama and daddy knew early on she'd need heart surgery to repair life-threatening defects.

But when the 2-year-old was wheeled into surgery Nov. 10 at Batson Children's Hospital, what would normally be a terrifying experience for Michelle and Seth Morgan was much less traumatic. That's because their only child's chest would not be cut open, standard procedure for closing a hole between the collecting chambers (atria) in a child's heart and repairing her mitral valve.  

Instead, Dr. Ali Dodge-Khatami with Children's Heart Center used an approach that has been performed in only a handful of centers internationally, gaining access to her heart by making an incision underneath her right arm to close the hole with a patch and repair her leaking mitral valve.

"What we do inside the heart is exactly the same thing as we do through the front, where 99 percent of surgeons do it," said Dodge-Khatami, professor of surgery in the division of pediatric and congenital heart surgery. 

The difference? 

Not only will Abigail avoid a long scar running down her chest, but her recovery time will be much quicker. "It's covered almost entirely by the right arm," Dodge-Khatami said of the surgical scar. "No one can tell the child has had open heart surgery."

As mom Michelle Morgan of Biloxi watches, 2-year-old Abigail Morgan gives her heart surgeon, Dr. Ali Dodge-Khatami, a high five just three days after he repaired a "hole" in her heart and her leaking mitral valve in an innovative procedure performed at only a few medical centers internationally.

After the surgery, Abigail's parents said, they were in awe when first allowed to see her - and more amazed as the day continued. 

"We expected her to have a breathing tube in. We expected lots of tubes," Michelle Morgan said. "But when she was wheeled into the ICU, there was no breathing tube. There was color in her face. We didn't expect her to be alert.

"In two hours, she was watching Frozen," her mom said, referring to the blockbuster Disney movie.

Credit that quick turnaround in part to the fact that "we didn't have to cut through her breast bone, but instead went between two ribs," Dodge-Khatami said. "The kids can be spontaneously breathing much more quickly. This child came off the ventilator in the operating room and was sitting up in bed the day of the surgery and sipping water."

"This beautiful little girl doesn't have to have a scar on her chest for life," said Dr. Jorge Salazar, professor of surgery and chief of cardiothoracic surgery, who co-directs the Children's Heart Center with Dr. Mary Taylor.

"Dr. Dodge-Khatami played a
major role in bringing this procedure to the attention of the international community," Salazar said. "It's very cutting-edge for pediatric heart surgery worldwide, and we don't compromise on the quality of the repair." 

A talkative and precocious little girl with blonde pigtails, Abigail had surgery Monday. She left the ICU for a regular room the next day and  immediately began letting her parents know that she'd rather be running around than stuck in a bed. She went home that Thursday morning.

"Never did I think we'd be having heart surgery on a Monday and be home before the weekend," Michelle Morgan said. "Part of the reason I haven't felt so nervous and anxious is because she's in such good health. She easily went into her nurse's arms to go back to surgery. I felt like she was in such good hands."

Nurse practitioner Keli Ballard listens to the heart of 2-year-old Abigail Morgan of Biloxi during a checkup exactly one week after the toddler underwent an innovative and rare surgery to repair a "hole" in her heart and a leaking mitral valve. The surgery by Dr. Ali Dodge-Khamati has been performed at only a handful of medical centers internationally.

Said Seth Morgan, an airman first class at Keesler Air Force Base in Biloxi until the family was transferred with the military to Virginia early this year: "It's good to have the extra two or three days of being able to recover more quickly."

Even though Dodge-Khatami approached Abigail's heart through an incision under her right arm, "the risks involved are absolutely the same, being very low," he said.

Michelle and Seth Morgan didn't hesitate.

If Abigail hadn't had the 2- to 3-hour surgery "before she was a teen, she would have gone into heart failure," Dodge-Khatami said. "Her heart would have dilated and failed, and she would have been a transplant candidate. So, we try to do this during infancy or definitely before the child is school-aged. Once we've done the surgery, they can go on to live a completely normal life."

Dodge-Khatami said he learned the rare procedure in Zurich in his native Switzerland, where he served as a staff pediatric cardiovascular surgeon at University Children's Hospital from 2003-08. He came to UMMC in 2013; before that, he was professor of cardiovascular surgery, chief of pediatric cardiac surgery and head of the congenital heart program at the University of Hamburg School of Medicine in Hamburg, Germany.

 "I'm not the first one to do the surgery, but probably no other center in the United States does these procedures from the side," Dodge-Khatami said. "My ex-chief in Zurich pioneered expanding the indications for performing more complex open heart repairs from the side, something I picked up in Switzerland 10 years ago.

"You can't do every single surgery from the side. You have to select which ones are possible from the side, and which are not," Dodge-Khatami said. But with the same type surgery, he said, "we can also do more complex repairs, such as working on valves and closing holes between two ventricles."

Although the surgery performed is innovative, Abigail's heart defects are very common, Dodge-Khatami and Salazar said. "We're pushing the envelope here in a very safe way to provide better care," Salazar said. "She had two problems, and we were able to fix both in the same operation, in a minimally invasive way that had the least impact on her, both physically and emotionally."

Expect more referrals leading to more procedures at the Children's Heart Center once word gets out to the national and international pediatric heart communities, the doctors say. Abigail's surgery was the second performed by Dodge-Khatami at Batson, with a third just days later.

Today, Abigail is doing wonderfully at her new home in Virginia, where she built her first snowman in mid-February.

"Since two to three weeks after the surgery, you would never have known she had it," Michelle Morgan said. "She has been steadily gaining weight, which she had not been doing the 10 months leading up to the surgery. I've noticed that her scar has faded a bit, and it doesn't stand out much at all."

Abigail is a happy little girl, her mom says. "Right now, one of her favorite things to do is run and run and run," Michelle Morgan said. "She will find a track around the house, or just a path she likes, and runs the same path over and over again. She loves to cook, both in the kitchen with me and in her play kitchen, and she has recently discovered and loves to play hide and seek."

As the family visited with relatives over Christmas, Michelle Morgan said, "it came up more than once just how well she did, and so much better than even the best-case scenario I had thought of going into this."

Abigail talks of the doctors and nurses at Batson, saying "they fix my heart," her mom said.

"We will always be amazed and thankful at how well this whole experience has gone, and for our healthy, beautiful little girl."