Evelyn Brummel crawled past the colorful stack of toys on her living room floor—a baby on a mission.
With a determined look on her face, she scooted to the coffee table, pulled herself up and reached for the prize—the TV remote.
“You’d never know she just had heart surgery a week ago,” her mom said as she set the remote aside.
She shook a rattle, capturing the attention of her busy 10-month-old daughter.
For Audra and Mitch Brummel, there is no greater satisfaction than watching their sweet, spirited little girl at play.
Just nine days earlier, Evelyn underwent coronary artery bypass surgery at Spectrum Health Helen DeVos Children’s Hospital.
The procedure typically is associated with adults. But Evelyn underwent the operation at 10 months old to correct an extremely rare heart defect.
“It’s amazing how fast she has bounced back,” Mitch said.
Answer to a prayer
Mitch and Audra, sweethearts since their days at Unity Christian High School in Hudsonville, have been married for 10 years.
When their baby girl was born a year ago, they chose the name Evelyn for her.
“We really loved that name, specifically the meaning of it,” Audra says. “It means a ‘wished for’ or ‘prayed for’ child. And Evelyn definitely was prayed for.”
Evelyn arrived in April 2020, a pink-cheeked baby girl with a touch of fuzzy reddish hair. She showed no signs of a heart defect.
No issue showed up on the prenatal ultrasound. And in her first months of life, Evelyn thrived. She ate well, grew steadily and became more alert and active every day.
But unknown to her parents, Evelyn had a condition called complete left coronary artery atresia.
Her left coronary artery—the one that delivers blood to the left side of the heart—was not connected with the aorta. The aorta carries oxygenated blood to the body, so that connection was vital.
In Evelyn’s case, however, the left coronary artery did receive blood from an alternate source—the side vessels of the right coronary artery. Although that allowed her heart to function in infancy, problems could arise as she grew.
“There might be enough blood supply as an infant, just to take her bottle,” said Yasser Al-Khatib, MD, an interventional pediatric cardiologist with the Congenital Heart Center at Helen DeVos Children’s Hospital. “The problem is going forward, as she starts walking, that will place a different demand on her heart.”
The condition is rare—only 92 cases have been reported in medical literature, said Marcus Haw, MD, a congenital heart surgeon and co-director of the Congenital Heart Center.
Doctors are still learning how it will affect an individual child long-term if left untreated. However, they know that, in some cases, it can lead to death from sudden cardiac arrest.
In search of the artery
Audra and Mitch consider it a miracle they found out about Evelyn’s heart defect before any problems surfaced.
When Evelyn saw her pediatrician at a well-child visit, her doctor heard a faint heart murmur. She referred her to the Congenital Heart Center at Helen DeVos Children’s Hospital.
That’s how Evelyn met Dr. Al-Khatib.
Because of the referral to the specialists, Evelyn underwent a screening electrocardiogram at 5 months of age. It showed a healthy, functioning heart.
Dr. Al-Khatib determined the heart murmur was not a sign of a serious problem.
“Children commonly have an ‘innocent’ heart murmur—a small vibrating noise we hear as the blood moves through the heart chambers and blood vessels,” Dr. Al-Khatib said.
That was the case with Evelyn.
However, the sonographers reported they could not get a good view of the left coronary artery in the echocardiogram. This is not unusual, Dr. Al-Khatib said.
“The left coronary artery has a course hidden inside the heart structure. It is a very tiny vessel in little babies,” he said. “But part of my practice is not to leave any area of doubt or any stone unturned.
“I asked the family to bring her back again when Evelyn was 8 months old.”
Again, the echocardiogram showed the chambers, vessels and valves of Evelyn’s heart were healthy and functioning. But again, the sonographers could not get a good view of the left coronary artery.
Dr. Al-Khatib followed up with a CT scan, which provides a three-dimensional view of the heart. And in the scan, he could not see a connection between the left coronary artery and the aorta.
When Dr. Al-Khatib performed a cardiac catheterization, he confirmed Evelyn’s diagnosis of complete left coronary artery atresia.
At first, Audra and Mitch couldn’t comprehend the surprising diagnosis. Sweet little Evelyn was so full of charm, sass and willpower.
“If something’s across the room and she wants it, she is going to find a way to get it,” Mitch said.
“Everyone who has seen her smiling face says, ‘You would never know this sweet, healthy little girl has a heart defect,” Audra said. “That is what made the decision to have surgery so hard.”
They debated whether to wait until Evelyn was a little bigger before her surgery, asking friends and family and members of their church for support.
“We had to trust that God would help us make the right decision for the best long-term outcome for her,” Mitch said.
Ultimately, they decided to go ahead with surgery, worried that problems could develop as Evelyn grew.
In addition to the risk of sudden cardiac arrest, the condition can eventually cause leaking in the mitral valve, which controls the flow of blood between the left chambers of the heart, Dr. Haw said.
A new blood supply
On Feb. 15, 2021, Evelyn underwent open heart surgery.
She weighed about 16 pounds. Her heart was the size of a small plum. And her coronary artery measured 1 millimeter wide—about half the width of a spaghetti noodle.
As the Brummels waited during the surgery, they felt reassured to know that Dr. Haw has performed a similar bypass on infants several times. In three of the cases, the children had the same heart defect—complete left coronary artery atresia.
“Obviously, Dr. Haw has a ton of experience working with small arteries and vessels,” Audra said. “We felt really confident in his abilities from all his experience.”
In the surgery, Dr. Haw used a mammary artery from Evelyn’s chest for the bypass. He connected it to the left anterior descending artery, joining the two blood vessels with very fine sutures.
A CT scan taken after the surgery showed healthy blood flow into Evelyn’s left coronary artery.
“It looks beautiful,” Dr. Haw said.
Evelyn’s medical team believes the mammary artery will grow in length and width, along with Evelyn and her heart. In fact, that has proven to be the case with another child, who underwent bypass surgery a year ago, Dr. Haw said.
For Evelyn’s medical team, watching her bounce back after her surgery is gratifying.
“Everyone says she is remarkable,” Dr. Haw said. “And she’s a very cute baby.”
Dr. Al-Khatib credits the expertise of the cardiac sonographers, who performed Evelyn’s echocardiograms, in helping the medical team detect her heart defect.
“I’ve worked at top centers in this country, and this group of people are among the finest I have ever worked with,” he said. “I give them the credit to perform such a diligent and careful examination.”
The congenital heart team will continue to follow Evelyn and monitor her progress. But for now, her doctors do not recommend any restrictions on her diet or activities.
Evelyn came home from the hospital three days after surgery. A week later, except for occasional fussiness and a scar on her chest, she showed little sign of her medical journey.
“She is getting her appetite back. She is starting to giggle and babble,” Audra said. “It is nice to see our happy, determined, bubbly little girl come back after surgery.”