Mellorrie Gander, 2, holds her teddy bear while hugged by her mom, waiting for the pre-op meeting.
Mellorrie Gander, 2, holds her teddy bear while hugged by her mom, waiting for the pre-op meeting.
Doctors Alan Britten, John Lamberti and Carlos Moreno-Cabral perform an open-heart procedure on Mellorrie.
FOR TWO YEARS, the Kaneohe couple watched their daughter turn purple trying to keep up with her older brother and kids at day care.
When her breathing is difficult, the frightened parents must carry her and blow in her face to increase her oxygen.
Rudy and May Gander had waited anxiously for open-heart surgery on Mellorrie, born Feb. 9, 1994, with a heart defect. They thought an operation scheduled last week would end their fears.
Then, after two agonizing days at Kapiolani Medical Center for Women and Children, they got heartwrenching news. "It's going to drag on another year," Rudy Gander said.
The winsome child, called "pooh" or "pookins" by her parents, left the hospital Tuesday clutching a teddy bear to her still-defective heart.
The Ganders knew Mellorrie's case was complex. But even the surgeons didn't know how complicated it was until they examined the toddler's heart.
The cardiac team included Drs. Carlos Moreno-Cabral, head of Kapiolani's Pediatric Cardiac Surgery Program; John Lamberti, pediatric cardiac surgeon from San Diego Children's Hospital, and Alan Britten, pediatric anesthesiologist.
They discovered a coronary artery where the incision would go. Pre-operative tests at Straub Clinic & Hospital - even extra angiograms - failed to detect the rare anomaly, they said.
"There is a certain amount of her anatomy where God holds the cards," said Donna Granda, director of preoperative services.
The surgeons called Dr. Edgar Ho, the family's heart specialist at Straub. He rushed to Kapiolani to explain the situation to the child's distraught parents and aunt, Liberata Orallo.
Ho told them to prepare for another operation - Mellorrie's third - in about a year, probably in San Diego.
"She's still fine, that's the main thing," May Gander said, in tears. "What hurts is the pain she has to go through again."
"We're excited but nervous and stressed," said May Gander as her unconscious child was carried into the operating room.
She manages the Kaneohe Liberty House; her husband is starting a satellite TV business on Oahu with the firm AlphaStar. They tried to prepare for their daughter's surgery - but there was no way to prepare for the emotion.
Tears flowed from mother and daughter, aunt, nurse and even onlookers as Britten discussed risks of bleeding and putting Mellorrie on a bypass machine to take over for her heart temporarily.
"I will treat her like my own," he promised.
Moreno-Cabral noted that he last saw Mellorrie when he created a shunt to improve the blood flow from her heart to her lungs. She was two months old.
He told the family Mellorrie has a condition called tetralogy of fallot - a hole in the wall separating the two sides of her heart, combined with narrowing of the path from the heart's right side to the lungs.
Blood goes through the hole instead of to her lungs. So when Mellorrie tires, she has trouble breathing and turns purple. "Her grandmother called her 'the purple girl,'" May Gander said.
"The previous operation, that alone tells you a number of things about the complexity of the case," Moreno-Cabral said. "It's about as complex as we're doing."
Nine tubes and two wires were attached to Mellorrie to monitor her heart and blood pressure, administer medications, prevent clotting and perform other tasks, including pain control.
There were no tubes to prevent the parents' pain. But Merla Takenaka, Kapiolani nurse and pre-admission coordinator, gave them reports on what was happening in the operating room.
The tense hours stirred memories: How Mellorrie (named after both grandmothers) was born in an emergency Caesarian operation. How, when she started to talk, she'd touch her chest and say "owie." How family members here and across the mainland were waiting to hear she was OK.
After she was taken to the intensive care unit for recovery, Moreno-Cabral and Lamberti told the family why they felt it was unsafe to go ahead with the surgery.
Lamberti diagrammed where they found the stray coronary artery which, if injured, would cause a heart attack.
"This kind of anatomy that she has I've only seen about two times before," Lamberti said. It occurs in only one of 200 to 300 children with Mellorrie's type of heart defect, he said.
Click on the picture to see a full-size graphic explaining the operation.
He said a tube will have to be installed that jumps over the abnormal artery. Mellorrie will need a series of operations after her heart is repaired until she's big enough for an adult valve, he said.
Moreno-Cabral said it's best to let her grow for a year. Meanwhile, he said, they created a new shunt on the other side of the child's heart to improve the blood flow to the lungs.
The family's spirits lifted when Lamberti told them Mellorrie "should be able to do anything she wants" after her heart is repaired.
"She's not going to be a competitive athlete in major sports that require a lot of cardiac reserve," he said.
"But she should certainly be able to run a mile, or play tennis. She certainly could be president of the United States."
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Kapiolani Team
Heart Graphic