* Swimming lessons? Check. Banging on the piano? Check. Playing in
the snow? Check. Toddler Alex Bracebridge is now living a normal life –
the life his parents dreamed for him.
STANFORD, Calif.–(BUSINESS WIRE)–To the casual observer, Alexander Bracebridge is just another curious,
fun-loving 20-month-old. He enjoys running, throwing balls, taking
swimming lessons, and playing with TV remotes. When he wants to go
outside, he lets his parents know by bringing his shoes to them.
First-time parents Russ and Robyn don’t take these seemingly ordinary
moments for granted. That’s because their son — and his medical history
— are extraordinary. Alex was born with a rare heart condition called
tetralogy of Fallot, which consists of several related defects present
This past fall, the Bracebridges traveled nearly 3,000 miles from their
home in northern Virginia to Lucile
Packard Children’s Hospital Stanford so that Frank
Hanley, MD, could perform a complex, 12-hour surgery on Alex.
Hanley, chief of pediatric cardiac surgery at the hospital’s Children’s
Heart Center, has helped Alex and thousands of other children with
serious heart conditions lead normal lives.
Hanley invented and perfected an innovative surgical technique called unifocalization
to treat ToF. His remarkable 98 percent success rate with the procedure, which
allows him to do in one marathon surgery what other surgeons would stage
over months or years, has helped him build the largest program
anywhere for this complex surgery. It’s a program noted
by the Children’s Hospital Association for having exceptional
outcomes — even while tackling the most complex cases in the country.
“We are grateful that the surgeon who pioneered unifocalization was
willing to do the surgery for Alex, and we’re even more grateful that
the outcome was so good,” Russ said.
The Bracebridges are just one of countless families that have traveled
from around the corner and around the world so that Hanley could perform
their child’s surgery. From Germany to South Africa to the Bay Area,
Hanley has built a “destination program,” with the most challenging
types of pediatric heart surgeries performed routinely — even those that
many other centers can’t or won’t attempt.
An extreme form of ToF
ToF occurs in about 1 of every 1,000 babies because of abnormal
development of the fetal heart during the first eight weeks of
pregnancy. In infants like Alex with the most complex form of this
condition, the blood vessels that should connect the heart to the lungs
instead connect the lungs to the aorta (the body’s main artery), and the
heart has a hole in the wall separating its lower chambers (ventricles).
“This extreme form of ToF occurs in about one-fifth of cases,” explained
Hanley, who is also a professor of cardiothoracic surgery at the Stanford
University School of Medicine.
Complex ToF also includes pulmonary atresia (a missing heart valve
between the pumping chamber of the heart and the lungs) and major
aortopulmonary collateral arteries (small arteries that develop to
supply blood to the lungs to compensate when pulmonary circulation is
This abnormal anatomy increases lung blood pressure, which can damage
the lungs and prevent the body from receiving fully oxygenated blood.
Hanley’s one-stage unifocalization for complex ToF corrects this problem
by combining the collateral arteries into one unified,
functioning pulmonary (lung) artery.
A reoperative case like Alex’s takes even more experience, skill
Alex had his first major ToF surgery at an East Coast center in late
2014 when he was 5 months old. While the procedure initially addressed
some issues, follow-up tests during the next 10 months showed that
Alex’s right pulmonary branch remained small, and he faced other serious
The Bracebridges, who learned of Hanley and his pioneering surgical
techniques from Alex’s cardiologist, thought he might be able to help.
They were right.
Last October, shortly before Alex turned 16 months, Hanley performed a
unifocalization to address the lingering pulmonary artery problem. He
likens a pulmonary artery to an oak tree with a trunk, branches and then
more branches — with the potential for blockages anywhere along the way.
“Alex had blockages way out on the secondary and tertiary areas
affecting both of his lungs, which we were able to correct,” he said.
Alex also had a dangerous bulge on his pulmonary artery called a
“pseudo-aneurysm,” caused by high lung blood pressure, which Hanley
successfully removed. “They can get larger and larger and cause fatal
complications,” he explained. He also replaced the first donor heart
valve that Alex received and closed a small hole in his heart.
The surgery was 12 grueling hours, with no breaks for Hanley and team.
But the results were well worth it: Alex showed dramatic improvements in
his pulmonary blood pressure and blood flow almost immediately. It was,
Robyn said, “the best news we could have hoped for.”
While unifocalization is ideally performed by Hanley during the first
few months of an infant’s life, about 30 percent of his ToF cases are
reoperations like Alex’s, in which an initial surgery was performed
elsewhere but serious problems remain.
“Unifocalization is more complex when these children have already had
surgery, so it’s best if we have the first shot for the best outcomes —
however, Alex’s result with the reoperation was very, very good,” Hanley
So good, in fact, that he has already successfully met several
post-surgical milestones. If everything is progressing as hoped at
Alex’s one-year cardiology visit, he will only need routine checkups
once or twice a year.
Alex will periodically outgrow his heart valves “just like kids outgrow
shoes,” Hanley explained — but the operations to replace them are simple
compared with the unifocalization. And once Alex is fully grown, a
replacement valve will be needed every decade or two.
Hanley’s pioneering approach is another chapter in the story of Stanford
Medicine’s ongoing innovation in cardiac care. In 1968, Stanford’s
Norman Shumway, MD, pioneered America’s first successful human heart
transplant. It’s where the first
pediatric heart-lung transplant in the country was performed. And
today, Stanford is home to 20 clinical trials in pediatric
cardiovascular medicine, while scientists at the Stanford
Cardiovascular Institute are researching the origins of congenital
heart disease and pediatric heart failure.
Spreading the word
Throughout their journey, the Bracebridges have received encouragement
from other parents through online and in-person congenital heart defect
support groups. When Alex’s cardiologist recommended Hanley, they were
able to quickly connect with parents whose children had successfully
undergone surgery with him — in some cases, even after others had said
nothing more could be done.
“Dr. Hanley’s name should be on the tip of everyone’s tongue when a baby
is diagnosed with a complex heart problem,” Robyn said.
Now, the Bracebridges pay it forward every chance they get: Robyn even
serves as a co-leader of the Washington, DC, chapter of Mended
Little Hearts, a nonprofit that supports children with congenital
heart defects and their families.
A bright future
Looking ahead, the Bracebridges’ experience has given them some added
perspective when it comes to the hopes and dreams that all parents have
for their children.
“I want him to do whatever he wants, to do sports if he wants, or be a
‘nerd’ — whatever he wants to be, as long as he’s happy,” Russ said.
Russ and Robyn’s greatest hope is for Alex to live a long, healthy,
high-quality life, which they now believe is possible.
“Because of Dr. Hanley,” Robyn said, “Alex’s future is so much brighter.”
* Discover more about the pediatric heart surgery program at
Lucile Packard Children’s Hospital Stanford here.
About Stanford Children’s Health and Lucile
Packard Children’s Hospital Stanford
Stanford Children’s Health, with Lucile Packard Children’s Hospital
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