Keeping pace
The arrival of a new baby can bring both joy and concern to parents. Just ask Anna Castaneda and Luis Morales, whose two sons were born with heart conditions that required pacemakers be placed in their tiny bodies when they were just days old.
Anna, 28, suffers from lupus, a disease in which the body's immune system attacks its tissues and organs. Unfortunately, it also attacked both of her unborn babies, first Alex, then Angel, causing a condition known as "heart block."
According to Children's Hospital Boston cardiologist Mark Alexander, MD, "Heart block occurs when the top of the heart is not talking to the bottom of the heart. The missed signal causes a very slow heart rate." The average heart rate for a newborn is 120 to125 beats per minute; Angel's was only 40 beats per minute. His older brother Alex, now 1 and a half, had a heart rate of 50 beats per minute at birth.
"It was very stressful for the both of us," says Luis. "There was a different story every day."
Anna and Luis's first son, Alex, received a pacemaker to correct the problem at Children's when he weighed just 4 pounds. So when Angel was born with the same problem, Anna knew there was nowhere else she would go. "I wanted to have Dr. Alexander work with Angel because I felt so comfortable with the work he had done for Alex," says Anna.
She was monitored extensively prior to delivering Angel at Brigham and Women's Hospital on June 11, two weeks prematurely. Weighing only 2.2 pounds, Angel became a world first just four hours after birth when Children's cardiac surgeon Emile Bacha, MD, implanted a quarter-sized pacemaker, making him the smallest baby ever to undergo such an operation. Routinely, pacemakers—battery-operated devices that regulate the heart's rhythm’Äîare placed directly on the abdominal wall. However, Angel's was too small to hold the pacemaker, so Bacha resorted to an old-fashioned procedure.
"The only option was to implant the device on Angel's diaphragm, where it would fit properly and offer enough support," says Bacha. But this wasn't an easy task given that Angel weighed a mere 2 pounds, and the pacemaker's wires needed to be sewn into the heart muscle. "This is an everyday procedure," says Bacha, "but with Angel, his heart muscle was really soft, so we had to be extra careful."
The procedure was a success, and Angel has since done well, putting on nearly 3 pounds and being transferred to a hospital closer to his home in Providence, R.I. His Children's doctors expect the tiny pacemaker they implanted will last two-to-three years and will need to be replaced regularly. But right now, Angel's parents are focusing on the fact that both of their sons are doing so well.
Alex offers hope that Angel will thrive. He is a typical toddler who loves to play outside, climb on boxes and splash around in the bathtub. "Alex is the best thing going for me right now," says Luis. "He makes me laugh."
And when the family visits Angel, Luis enjoys holding his two little boys and studying their faces. "Angel is a little Alex," says Luis. "I look at him and can tell that he is mapping and planning in his head how much running he and his brother will be doing and how much chasing I will be doing; I have a lot of work ahead of me!"
