| Papworth on the BBC! |
 Clare Braybrook with daughter Emily and Consultant Cardiac Surgeon
Mr Samer Nashef Just before celebrating her first Mother's Day, 32 year old Clare Braybrook from Longstanton in Cambridgeshire returned to Papworth Hospital, with her husband and eight-week-old baby daughter Emily, to say 'thank you for saving my life.' On 13 January this year when Clare was 31 weeks through her pregnancy and looking forward to the birth of her first baby she suddenly experienced agonising chest pain. Her husband Patrick rushed her to the emergency department at Addenbrooke's Hospital where it was discovered that Clare needed immediate emergency heart surgery to save her life and she was 'bluelighted' to Papworth Hospital. Papworth Hospital's reputation as a heart and lung hospital is well known but to have a baby delivered at Papworth is a very rare occurrence. Only 3 other babies have been delivered at Papworth in the past 20 years. Mr Samer Nashef, Consultant Surgeon at Papworth Hospital, who performed Clare’s surgery said "Clare had an aortic dissection, which is a tear in the wall of the aorta, the body's main artery. This is a dangerous condition and usually fatal if not treated quickly. An emergency team was assembled at Papworth and included specialists from anaesthesia and heart surgery from Papworth Hospital and obstetrics and neonatal paediatrics from Addenbrooke's Hospital. First of all baby Emily was safely delivered by Caesarean section and just twenty minutes later Clare was undergoing major heart surgery. We changed Clare's aortic valve and her aorta and joined her own coronary arteries to the new aorta. She made a quick recovery and went home just four days later. I am delighted to see both Clare and baby Emily doing so well."  Consultant Cardiothoracic Anaesthetist Dr Nicola Jones interviewed for the BBC Look East news and current affiars programme.
Dr Nicola Jones, Consultant Cardiothoracic Anaesthetist at Papworth Hospital, who anaesthetised Clare for her surgery said that the most important thing she had to avoid was fluctuations in Clare's blood pressure. "Had this happened it would have proven fatal for both Clare and her baby". Clare said "I just wanted to bring Emily back to Papworth Hospital to say an enormous thank you to Mr Nashef and the team for saving my life. Without their skill I would not have survived. It was an enormously frightening time for my husband Patrick and my family. I was out of it but they had to face the reality of possibly losing both of us. But we have a happy ending. Emily is now home with us and is thriving and I am here to celebrate my first Mother's Day as a mum. She was due to be born this week and now weighs 7lbs 2oz, which would have been a healthy birth weight. She was actually born on my dad’s birthday, 13 January." A little bit of history repeating itself? Almost three years ago to the day, in January 2009, Mr Nashef performed the same life-saving procedure on Nina Whear, a 38 year old woman from Norfolk. In the later stages of a twin pregnancy, Nina sustained an acute type A aortic dissection. The twins - Alfie and Evie - were delivered by Caesarian section before Nina's damaged aorta was replaced. To our knowledge, Nina was the first mother of twins in the UK, and one of only a handful worldwide, to survive surgery for aortic dissection during pregnancy without foetal loss.
 Because of her pulmonary hypertension, 29 year old mother Susan Buckle required home oxygen 24 hours a day.
In 2011, soon after delivering her daughter, 29 year old Susan Buckle noticed that she was becoming more and more breathless on exertion. Her doctors diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) - a build up of blood clots in the arteries supplying her lungs had caused a life-threatening increase in pressure. Left untreated, Susan's life expectancy might have been limited to just a few years. Susan was referred to Consultant Cardiothoracic Surgeon Mr David Jenkins at Papworth Hospital for pulmonary endarterectomy (PEA) - a highly complex and potentially life saving surgical operation. Susan's extraordinary journey was documented by presenter and general practitioner Dr Sarah Jarvis for BBC One's The One Show. Papworth Hospital is the only UK centre to undertake this type of surgery and one of only a handful worldwide. In 2011-12, Mr Jenkins and his colleagues perfromed over 130 PEA procedures, making Papworth Hospital the largest centre for PEA surgery in the world. 
Consultant Cardiothoracic Surgeon Mr David Jenkins shows Susan's pulmonary angiogram to One Showpresenter Dr Sarah Jarvis. Without surgery Susan's life expectancy might have been limited to just a few years.
Susan was admitted to Papworth Hospital in January 2012. The operation, which typically takes over seven hours, was performed under general anaesthesia with extensive haemodynamic monitoring and selective cooling and monitoring of the brain. After placing Susan on cardiopulmonary bypass (CPB) using a 'heart-lung machine', she was gradually cooled from her normal body temperature (37°C) to just under 20°C. In order to get a clear view inside the pulmonary arteries, Mr Jenkins explained that Susan's body had to be completely drained of blood and all circulation stopped for periods lasting up to 20 minutes. Mr Jenkins described these periods of so-called 'deep hypothermic' circulatory arrest as 'suspended animation ... as close to being dead and still being able to be revived.' During deep hypothermic circulatory arrest (DHCA) patients are cold, have no heart-beat or pulse and are completely unresponsive. 
Consultant Cardiothoracic Anaesthetist Dr Joe Arrowsmith explains to One Show presenter Dr Sarah Jarvis how reducing Susan's body temperature to 20°C and cooling her head with an ice-water jacket protects her brain during periods of circulatory arrest lasting 20-30 minutes.
Consultant Cardiothoracic Anaesthetist Dr Joe Arrowsmith explained that most of the precautions taken during the operation were designed to protect the brain. Complete circulatory arrest at normal body temperature, he said, would start to produce irreversible brain damage after only 3-4 minutes. Following removal of the organised, fibrotic clots from her pulmonary arteries, Mr Jenkins put Susan back on cardiopulmonary bypass and over the next two hours she was gradually warmed back to 37°C. As she was warmed, Susan's heart began to beat again. After more than five hours on the heart-lung machine, Susan was weaned from cardiopulmonary bypass and her heart took over the job of pumping blood around her body. Blood pressure monitoring and transoesophageal echocardiographic imaging at the end of the operation revealed that the procedure to clear clots from Susan's pulmonary arteries had been successful. 
Since her successful pulmonary endarterectomy (PEA) surgery, Susan has been able to care for her daughter Emily without becoming breathless.
Following surgery, Susan was transferred to the Intensive Care Unit. She was kept sedated and her lungs mechanically ventilated until the following morning. Susan made an excellent recovery and went home less than two weeks after surgery. Susan's life expectancy should now be normal, although she will need to take anticoagulants (drugs that 'thin' the blood) for the rest of her life. Since Susan's life-saving surgery as many as five patients a week have undergone pulmonary endarterectomy at Papworth Hospital. |
