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ALCAPA-anomalous left coronary artery from the pulmonary artery
Michael Moretti

Today, Children’s of Alabama cardiac intensivist Santiago Borasino, M.D., M.P.H., jokingly calls 3-year-old Michael Moretti “his little Alpaca.”

But in early December of 2012, the mood of Michael’s doctors at Children’s was anything but jovial. The tests had come back, and pediatric cardiologist Edward Calvin, M.D., had just told Becky and Joe Moretti of Huntsville that their 5-month-old son had an extremely rare (1 in 300,000 children) congenital heart defect called an anomalous left coronary artery from the pulmonary artery—ALCAPA for short. Surgery would be necessary to move the coronary artery to its proper position, and that surgery was not without risks.

It was something Becky and Joe never could have imagined for their baby, whose first few months had progressed normally. “But then, he began screaming and crying whenever he was fed,” Joe said. “He quickly started to lose weight and he fell off the normal growth curve.”

The Morettis took Michael to his pediatrician and to a pediatric gastroenterologist, but nothing seemed to help—and he was eventually admitted to a local hospital with a diagnosis of “failure to thrive.” After about a week, a chest x-ray revealed that Michael had an extremely enlarged heart and was actually in severe congestive heart failure. He was transported to the Pediatric Intensive Care Unit and, from there, the decision was made to fly him via Children’s Critical Care Transport helicopter to the Pediatric & Congenital Heart Center of Alabama in Birmingham.

“ALCAPA caused the left side of Michael’s heart to receive poorly oxygenated blood, and that lack of oxygenated blood caused his heart tissue to die,” Joe said. “His heart grew weaker and weaker, and by the time he was admitted to Children’s, his heart was pumping roughly 10 percent of blood volume with each beat. (This is called the ejection fraction, or EF. An EF of around 60 percent is normal, with anything less than 30 percent considered heart failure.)

Cardiac intensivist Kimberly Jackson, M.D., explained to the Morettis that eating requires a significant amount of blood flow to the gut—and that Michael was experiencing pain equivalent to a heart attack every time his parents attempted to feed him. That is why he stopped eating.

On December 6, 2012, Robert Dabal, M.D., performed open-heart surgery on Michael, who crashed several times in surgery and once again after surgery. “Unfortunately, his heart did not recover like doctors were hoping it would, and after a few weeks they sent us home with Michael still in heart failure,” Joe said.

Follow-up visits showed little improvement. Then, just as Becky and Joe were coming to terms with the likelihood of their son being placed on the heart transplant list, his EF increased and his heart started “remodeling.”

“At Michael’s latest cardiology checkup in December of 2015, his EF was back up in the high 60s and his heart was looking great,” Joe said. “When we talk to any of Michael’s doctors, they all consider his recovery to be nothing short of a miracle. That is so humbling.”

The Moretti’s three-year journey with Children’s has left them with fond memories and huge respect and admiration for Michael’s caregivers. “Besides world class professional care, what we received at Children’s of Alabama was love and compassion from the doctors, surgeons, nurses, techs, staff and the transport team,” Joe said. “We feel safe when we are at Children’s—and when we see the staff and physicians we have come to know, it feels like we are visiting with our family.”

The Morettis believe Children’s has left its mark on Michael in ways that go beyond his heart care. “As he was recovering at the hospital, you could see his inquisitive personality come through as he would try to understand what was going on around him,” he said.

Michael’s mom agrees. “If you ask him today what he wants to be when he grows up, he will almost certainly tell you a cardiologist, although sometimes he will also tell you Spiderman,” Becky said. “We think he believes both have superpowers!”
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