Airway Reconstruction: Gabriel Herrera breathes easily following successful surgery
"He's a miracle from God"
Gabriel Herrera was referred to a US children’s hospital after doctors in his native Dominican Republic found that the respiratory problems he was having were the result of a narrowed airway. After several procedures failed to fix Gabriel’s problems, he was referred to Cincinnati Children’s. With the help of a multidisciplinary team, Michael Rutter, MD, performed life-saving surgery on Gabriel.
With limitless curiosity and energy to burn, Gabriel Herrera looked to be the picture of health during a recent follow-up visit to Cincinnati Children’s Hospital Medical Center. Nothing about the bubbly little 18-month-old boy with a mop of dark curly hair revealed the year-long ordeal he had been through that threatened to end his life.
Gabriel was born on August 1, 2007, in the Dominican Republic. According to his parents, Christian and Loren Herrera, everything was fine - just a little stridor - until Gabriel was about 2 months old and they noticed his lips were slightly blue. On their first trip to the hospital, doctors determined there were no serious issues and he was sent home. One month later, Gabriel returned to the hospital, this time with bronchiolitis. The doctor who examined Gabriel noted that he had a narrowed airway (or trachea), a condition known as stenosis. With this diagnosis, the doctor recommended that Gabriel be sent to a US hospital for treatment.
The Family Moves to the United States
On Nov. 17, 2007, Gabriel was admitted to a hospital in the United States. In addition to the tracheal stenosis, doctors diagnosed him with a pulmonary artery sling, a condition in which a person’s left pulmonary artery actually arises out of the right pulmonary artery. While the first surgery to correct the sling was successful, “patching” procedures performed to fix the tracheal stenosis were unsuccessful, forcing Gabriel to endure two more surgeries.
“After the first surgery, he was sedated and paralyzed for one and a half months,” says Loren. “And after his second surgery, he nearly died.” In fact, Gabriel’s trachea got a serious infection that attacked the patch and created a hole in his airway. The infection caused one of his lungs to collapse and his CO2 levels to rise higher than 100, a dangerously high and life-threatening level. “It was a miracle he didn’t die,” says Christian. “The doctors said it was a one in a million chance for him, but he got better anyway.”
Yet Another Surgery
The infection prompted a third emergency tracheal repair, during which a stent was inserted into Gabriel’s trachea. Unfortunately, tissue inside his trachea had built up due to all the damage it had sustained. Christian says this condition, known as granulation, “completely closed his airway. There was no space left for Gabriel to breathe. One time he woke up and stopped breathing and Loren had to give him CPR to revive him.” Doctors were forced to remove the stent. All three of these surgeries happened within two weeks.
After an examination in early summer 2008 showed that Gabriel was still suffering from severe airway stenosis and tracheal granulation, his otolaryngologist contacted the Division of Pediatric Otolaryngology / Head and Neck Surgery at Cincinnati Children’s. After a phone consultation with pediatric otolaryngologist Michael Rutter, MD, the cardiologists and otolaryngologist felt it best to transfer Gabriel to Cincinnati Children’s for treatment due to the otolaryngology division’s extensive experience in airway reconstruction.
At this time, Dr. Rutter also spoke with Loren and Christian. “We were skeptical of going to Cincinnati at first, we thought after all we had gone through that nobody could fix Gabriel’s condition,” says Christian. “But Dr. Rutter took the time to call us and spent an hour explaining everything to us. We were sure after we spoke with him that he understood Gabriel’s problem and knew how to fix it.”
Coming to Cincinnati Children’s
On July 3, 2008, Gabriel and his parents flew in an ambulance plane to Cincinnati. When he arrived at Cincinnati Children’s, Gabriel could not breathe on his own and required ventilation through a breathing tube. He was also weak and significantly underweight as a result of his many months spent in the intensive care unit.
Upon arrival, Gabriel underwent a bronchoscopy and, within a few days, his stent and breathing tube were removed. After a month, Gabriel’s tracheal stenosis was worsening, so his treatment team performed a balloon dilation to stabilize his airway. This procedure enabled Gabriel to stay out of the hospital and gain weight until his surgery.
A Very Happy Ending
On August 18, 2008, Gabriel finally underwent the surgery that would change his life. Dr. Rutter, along with Peter Manning, MD, a cardiothoracic surgeon at Cincinnati Children’s, performed a procedure called a slide tracheoplasty on cardiopulmonary bypass. The three previous operations had made mobilizing the trachea for this procedure much more complicated. Drs. Rutter and Manning have collaborated on more than 70 surgeries for severe tracheal stenosis, and this team approach has greatly benefited the outcomes for children with these complicated and challenging conditions.
Gabriel was breathing on his own the next day, and was able to be discharged a week later. Loren and Christian are happy to report that all is well with Gabriel. “He’s a miracle from God,” says Loren. “He spent over a month paralyzed and sedated, yet there are no delays. He’s active and he’s very smart.” His most recent examination showed that Gabriel is free of the tracheal stenosis, and he has virtually no problems whatsoever with his airway.
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