An unconventional approach beats coronary ostial stenosis

(SACRAMENTO) - Woodland resident Greyson Anable was a healthy, energetic 6-year-old, until he collapsed from cardiac arrest last month.

Greyson Anable

Greyson Anable

“His face was contorted and he just stopped breathing. 911 was called and my wife performed CPR until the paramedics came,” said Mike Rector, Greyson’s dad.

When paramedics arrived, they used an automatic external defibrillator (AED) to shock Greyson’s heart twice and were able to get his heart to start beating again. Then they transported him to UC Davis Children’s Hospital for diagnosis and treatment.

Greyson was placed on extracorporeal life support (ECLS), also known as extracorporeal membrane oxygenation (ECMO), which is one of the most advanced forms of life support available to patients experiencing acute failure of the cardiac and/or respiratory systems. The ECLS machine does the work of the heart and lungs, artificially oxygenating the blood and returning it to the body, allowing the patient's heart and lungs to rest and heal.

During this time, the UC Davis Pediatric Heart Center team performed tests to find the cause. When he wasn’t improving, a cardiac catheterization was performed and the team discovered that Greyson had coronary ostial stenosis, obstructing blood flow into the coronary arteries. This is a very rare diagnosis in children, and comes with a high fatality rate. He was quickly taken into the operating room for exploratory heart surgery. It was a risk, but proved to be one that was worth taking.

Once in the operating room, they found that the obstruction was caused by a hood of tissue that covered the opening of his left main coronary artery. Pediatric cardiothoracic surgeon Gary Raff was able to resect the hood of tissue and repair the coronary artery to normal function. 

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“It’s a very rare heart condition and even rarer to diagnose this prior to autopsy,” Raff said. “We were able to provide excellent care for him because we function very well as a team and everyone had the opportunity to review and discuss the data and agree on a prudent, albeit unconventional, approach. In this day and age, surgeons rarely go to the operating room without a firm diagnosis. This is an example of teamwork at its best.”

UC Davis chief of pediatric cardiology Frank Ing said that Raff’s decision to operate urgently made all the difference.

“Most kids just die without having this diagnosis,” Ing said. “I’m proud that we were able to find the cause of his cardiac arrest and save this child’s life.”

Greyson is back home now and has returned to his usual energetic self. He recently celebrated his 7th birthday — a birthday he may not have seen without the help of the team at UC Davis Pediatric Heart Center.     

“I would say his experience at UC Davis was a good one. The doctors and nurses were very attentive and caring. As of now, Greyson is doing great,” Rector said.