This Case Couldn't Wait Six Months

"I was exhausted and getting maybe two hours of sleep at a time," she recalled, saying that she "lost it" when the office balked at telephoning Children's for an appointment. "I called Jason and said, 'I don't know what to do and I need help.' "

Initially, the visit to the Fairfax outpatient center seemed routine. The family saw a nurse practitioner, then a pulmonologist, both of whom agreed that the nebulizer treatment wasn't helping. After listening to the description of Matthew's illness and scrutinizing the X-ray that had ruled out pneumonia, the pulmonologist said she wanted Martin to take a look at the baby.

Anna Nelson remembers that the cardiologist chatted briefly with them, then "just stared at the baby for two minutes. I thought, well, that's weird." Jason Nelson remembers that Martin asked three questions: Did Matthew scream a lot when he came home? Did the screaming stop after a while? Is he getting better or worse?

Martin then scooped up the baby, saying he'd be back shortly. Martin recalls he was all but certain he knew what the problem was, but when he confided his suspicion to his colleagues before tests confirmed it, "Everyone looked at me like I was a little bit insane."

Less than 10 minutes later he reappeared, looking somber but calm.

"I'm going to be blunt," he told the Nelsons, according to Jason's recollection. "Your son does not have asthma. He's had a heart attack and is in heart failure, and he's going to have surgery within 24 hours." Matthew had "cardiac asthma," wheezing associated with heart failure. The seizure he'd had during circumcision was actually a heart attack, Nelson said. Martin explained that a team was en route to whisk the baby to Children's Hospital, where Richard Jonas, the cardiothoracic pediatric surgeon who had operated on Martin's nephew for the same problem, would try to save the baby's life.

"It was just unbelievable," Jason Nelson recalled. Accompanied by a physician, Anna Nelson climbed into the ambulance next to her baby, who was strapped to a gurney. Sirens shrieking, the ambulance hurtled down Route 50 bound for the hospital. Jason Nelson numbly followed in the car.

Matthew's problem, diagnosed by echocardiogram and apparent on a second X-ray, was precisely what Martin had suspected: an anomalous left coronary artery from the pulmonary artery, or ALCAPA. The extremely rare condition occurs early in fetal development when the left coronary artery is connected to the pulmonary artery, which carries oxygen-poor blood, instead of to the aorta. Deprived of sufficient oxygen, the heart starts to die, leading to a heart attack, according to the federal government's Medline information service.

Left untreated, about 90 percent of babies born with the condition do not survive their first year. Of the 500 pediatric heart patients seen annually at Children's Hospital, only two or three have ALCAPA, according to Martin. "With prompt treatment, these kids can have excellent outcomes," he said.

Common symptoms include uncontrolled crying, often mistaken for colic, which occurs about the same age. The reflux the baby was experiencing was actually angina, chest pain that occurs when the heart isn't getting enough blood, Martin said. And that slightly enlarged heart? That, Martin said, was the tip-off, along with the persistent wheezing. Both should have triggered a prompt referral to a cardiologist, he said.

"Babies may wheeze with a respiratory infection, but they should get better within a few days," Martin said. The second X-ray showed that Matthew's heart was 30 percent bigger than it should have been.

While he was being readied for surgery, Matthew had another heart attack, Jason Nelson said. The couple was told their son had an 80 percent chance of surviving the 6 1/2 -hour operation, in which the artery was removed from its incorrect location and connected to the aorta.

The baby pulled through, but there were other worries: about postoperative infection, which Matthew escaped, and the inevitable long wait to see whether he would develop normally.

Those concerns have been laid to rest, too. "He's a loud, typically obnoxious 4-year-old who plays football," his father said. Matthew now sees Martin once a year; he has no restrictions and seems unscathed by his ordeal.

"There is no doubt in my mind that Dr. Martin saved his life," Jason Nelson said. "We were one of the lucky ones."

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