Bella, 6 months old
Bella Haines was only a few days old when physicians at Children’s Hospital of Richmond discovered that she had a ventricular septal defect (VSD)—a hole in her heart allowing blood to mix between the left and right ventricles.
Bella was born on December 27, 2010 to parents Nikki and Eddie, and it wasn’t until the next day that they suspected anything might be wrong. “At birth, it seemed like Bella was just like any other healthy baby,” Nikki remembers, “but the second day we were in the hospital, Bella’s doctor heard a heart murmur.”
The family’s pediatrician contacted Scott Gullquist, MD, Associate Professor, Division of Pediatric Cardiology at Children’s Hospital of Richmond, who visited the family and performed an echocardiogram (an ultrasound examination of the heart) that identified Bella’s VSD.
“At birth, it is hard to tell what kind of impact moderately large VSD’s will have,” says Dr. Gullquist. “We went through the process together of understanding what our potential next steps would be. I told them, ‘Bella will show us what we need to do.’”
As time went on, it slowly became clear that the hole was not going to close spontaneously, and Bella began to show signs of congestive heart failure. Without surgical intervention, it was likely that Bella would not be able to have a normal quality of life, or life expectancy.
In order to minimize the overall risk during surgery, Dr. Gullquist wanted to wait until Bella was at least two months old, and Nikki and Eddie were told that she needed to gain weight and increase her strength. “Bella gained steady weight for about two or three weeks after she was born,” Nikki says. “Then she gained only one ounce in the next thirty days. She was failing to thrive.”
The family was referred to the hospital’s Division of Pediatric Gastroenterology and Nutrition to address Bella’s nutritional needs. When Bella was eight weeks old, Nikki and Eddie made the decision to put their daughter on a feeding tube.
Nikki remembers how difficult the decision was, but it was quickly apparent that they had done the right thing. “Bella did really wonderfully on the feeding tube,” she says. “We did tube feedings for about three weeks to beef her up, as the doctors described it.”
On March 14, weighing 11 pounds and 3 ounces—nearly twice her birth weight—Bella went into the five hour cardiac surgery to repair her VSD.
From her mother’s arms in the pre-surgery area, Bella was taken by an anesthesiologist to the operating room. Preparation before the surgery takes more than an hour, and it included inserting a central venous catheter and breathing tube. During the surgery, Bella’s heart was put on a cardio-pulmonary bypass machine, which allowed the surgical team to stop her heart and open it up so that the surgeon could apply a patch to repair the VSD.
The success of the operation was determined immediately, while Bella’s chest was still open, via an echocardiogram that showed that the hole was closed and the pressures and flow inside the heart had returned to normal. Bella came out of surgery that morning and was admitted to CHoR’s Pediatric Intensive Care Unit (PICU) where she spent the next four days healing, under sedation and on a breathing tube.
“With patients as young as Bella, it’s less likely that they will come off the breathing tube immediately,” says Dr. Gullquist. “You have to slowly coax them into breathing on their own again.”
“Bella got off the breathing tube on the fifth day we were in the PICU. It was such a relief,” Nikki says. “That was on a Friday, and we were able to take her home again just a few days later. We were glad to get home, but everyone at the PICU was amazing.”
Nikki remembers seeing a completely different side of her daughter soon after they brought her home. “I heard her be really loud for the first time, screaming like other kids,” she says fondly. “Bella was too weak to do that before the surgery. She has so much more energy these days.”
Bella still returns to see Dr. Gullquist for routine follow-up, but her prognosis is excellent with no lasting effects of the VSD expected. The patch over the hole will grow together with her heart as time goes on, and today Bella is a happy and healthy baby.
“It’s amazing to look at her now,” Nikki says. “She is as happy as can be.”