Cardiac surgeon brings hope, health to children

COLUMBIA, Mo. -- Martha Johnson, a managed-care specialist at Boone Hospital Center, knows better than most parents how frightening a hospital operating room can seem to a child.

Her son Ben had open-heart surgery when he was 3 at a hospital in St. Louis.

Afterward, his fear of doctors was so intense that the sight of his father in scrubs -- his father is a surgical technologist -- caused little Ben to cling to his mother and bury his face in her neck.

So when doctors told her that Ben needed a second operation because the first one failed to fix the birth defect, her own heart nearly failed.

"It was like being kicked in the gut," Johnson said. "The first thing I thought of was, 'What if it brings up bad memories of the first operation and it affects him psychologically for the rest of his life?'"

The second time around, however, the Johnsons learned that University Hospital had a comprehensive pediatric cardiac surgery unit and a gifted surgeon named Pierantonio Russo. Russo had just arrived from Philadelphia in October of that year, completing the PCS unit, which had been missing a surgeon for two years.

Sense of continuity

One surprise soon followed another. In addition to being spared the two-hour drive to an unfamiliar city far from the support of family and friends, there were many differences between the local program and the big-city program the Johnsons first experienced.

First, the doctors at University Hospital took care to provide Ben with a sense of continuity. Most of his stay occurred in one room of the intensive care unit. The same nurses visited him every morning, afternoon and evening, which made it easy to remember their names. And the team of doctors who performed the operation and regular examinations looked in on Ben throughout the process.

The atmosphere contrasted dramatically with the multiple examination rooms, doctors and unfamiliar nurses Ben experienced in the large ward of the St. Louis hospital. Back then, Ben had stretched out his arms and cried as he was rolled away from his parents to surgery. At University Hospital, doctors anesthetized Ben, allowing him to sleep before taking him away.

The attention to detail precluded the greatest surprise: Ben's previous surgery had been an all-day ordeal requiring him to remain medicated for nearly 36 hours during recovery, Martha Johnson recalled. The sternal wire stitches in his chest felt hard under his skin, and her son appeared tired and groggy upon waking up, she said.

At University Hospital, doctors operated on Ben in the morning. By midday, he was sitting up in bed watching television and drinking fluids. During the surgery, doctors removed an aneurysm, closed a ventricular septum hole and fixed a valve.

They also removed the metal stitches and replaced them with a softer ethibond stitch that would blend in with tissue and not show up on X-rays.

The doctors said, "in 10 years, no one will even know he had open heart surgery," Ben's mother recalled.

Came because of need

Mid-Missouri might seem like the last place in America that a prestigious pediatric heart surgeon like Russo might end up. Among his achievements, Russo has performed a heart transplant on one of the nation's youngest recipients, just 4 days old.

He has performed numerous successful heart transplants in adults and 52 transplants in children. In addition, he volunteers and consults to set up pediatric cardiac programs in underdeveloped nations as a member of the Philadelphia-based Gift of Life International, a not-for-profit charity.

Indeed, with his experience, it is unlikely that any hospital in America would have turned him down after he left his position as head of pediatric cardiac surgery at St. Christopher's Hospital for Children in Philadelphia due to financial difficulties at that hospital.

Several reasons led the doctor to choose mid-Missouri as his new home, he said. One was that the new dean of the University of Missouri Medical School had been the chairman of pediatrics at the Mayo Clinic, where Russo trained. Another was need.

Zhudi Lababidi, the chief cardiologist at University Hospital, estimated that 150 babies a year are born with heart defects in mid-Missouri, yet the hospital's pediatric heart surgery program has remained sporadic as surgeons have come and gone over the years. Russo said he came to Columbia to help fill this need and to take the opportunity to team up with such well-known cardiologists as Lababidi.

Lababidi, as well as cardiologist Guy Carter and anesthesiologist Joseph Tobias, provided a perfect team to develop a multidisciplinary child heart surgery program, Russo said.

Carter, for example, provides in-utero diagnoses of patients, allowing doctors to operate on babies with heart defects as soon as they are born. Lababidi, meanwhile, is renowned for his pioneering work in noninvasive heart treatment.

The perfect team

Along with Tobias and Russo's wife, Joanne Russo, who headed the perioperative nursing program at Russo's former hospital, Russo said he has the perfect team to implement a pioneering surgery system known as the ultrafast-track system.

"Now we could start talking about a program," he said.

Ultrafast-track surgery has been practiced in Loma Linda, Calif., for about five years. It ensures that heart surgery is "expeditious, well-organized and cost-efficient" by increasing the efficiency of operations, Russo said.

Patients are subjected to shorter durations on bypass machines, thereby reducing stress on their kidneys, lungs and other organs. Doctors also use special anesthesia protocols, allowing patients to wake up from surgery quicker and leave the hospital faster, which reduces costs.

"The children recover much faster, leave the hospital sooner, the parents are reunited with their child soon after surgery and cost of the operations is substantially less," Russo said.

The lynchpin of the process depends on a skilled surgeon. Colleagues who have worked with Russo say he is one of the best they have worked with.

Tobias said that Russo possesses an acute sense of spatial proportion, which enables him to visualize an infant's heart without actually seeing all of it during surgery.

"Some people are gifted with God-given talents," Tobias said, referring to Russo. "He's just one of those people meant to be a cardiac thoracic surgeon."