A Philadelphia Surgical Team Saves a Newborn Baby's Misplaced Heart

Even though Chris Wall was out of work, he and his wife, Teresa, looked forward happily to the birth of their first child. On August 10 a five-pound boy was born in Marlton, N.J.—and within an hour tiny Christopher Wall Jr. was in an ambulance racing toward nearby Philadelphia Children’s Hospital, siren at full shriek. The baby had been born with its heart growing outside its body.

At Children’s Hospital a team headed by Dr. Naresh Saxena, an Indian-born surgeon, and anesthesiologist Dr. Robert Kettrick immediately took the baby into an operating room. “I felt that we should try whatever we could,” Saxena says. “We had nothing to lose. If we did not act the baby would die.”

Christopher Jr. had no sternum (or “breastbone”), the cartilage that joins the ribs and normally holds the heart in place. Without it, pressure from the other organs simply squeezed the baby’s heart out of its chest. In five attempts the surgeons were unable to push it back into place. Similarly, an attempt to cover the heart with a plastic shield failed.

Saxena finally made an incision from throat to navel, stretched the skin over the heart and sewed it back together. “It turned out that the simplest thing we could do was the best thing for the baby,” Saxena says.

The medical name for Christopher’s condition is ectopia cordis, and only about 100 cases have been reported in medical history. None is known to have survived longer than 19 days. Yet Chris, now more than a month old, has “a real potential for a normal life,” according to Dr. Kettrick, whose contribution as anesthesiologist was no less crucial than that of the surgeon.

Kettrick, 33, is a graduate in medicine from Temple—like his surgeon father—and is married to a surgical nurse. At the start of the four-hour operation he totally immobilized the infant’s muscle activity by drugs “so that we could breathe for him.” That was done by a hand-operated oxygen pump.

Saxena, 34, came to the U.S. in 1966 and trained in Washington, Chicago and Philadelphia, including a year in pediatric-cardiac surgery at the celebrated Children’s Hospital. Yet he and his team of six had no time to consult the medical texts; they had to improvise throughout.

Acting on a hunch, Saxena’s team examined the baby’s heart during surgery and found dangerous structural defects. Both the pulmonary artery and aorta leave the heart’s right ventricle. In a normal heart the aorta should leave the left ventricle. There is also an opening between the normally separate ventricles. The doctors say that in three to five years, when Chris’s heart is large enough to perform the delicate surgery, they will correct these defects. And at that time they may cover the heart with an internal protective cage or an artificial sternum. Until then a foam rubber-covered metal plate will be attached to the baby’s chest to protect the heart. While the plate is being made, an ordinary Ace elastic bandage holds the heart in place.

Meanwhile, Christopher’s parents wait. Camden, N.J. natives, they were married in 1973 and were living in Fort Lauderdale, Fla. when Wall’s employer, a cleaning service, went out of business. In June the couple moved back to New Jersey to be near their families as they awaited their first child.

As his son’s chances seemed to improve dramatically, Chris Wall Sr. got more happy news. He landed a new job as an investigator for the Camden County prosecutor’s office. The Walls are cautiously optimistic.

“Christopher may never be an all-American linebacker,” says his father, “but he will be able to play the piano.” Adds his mother, “I’m grateful to be able to pick the baby up and hold him. I just live day to day.”

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