A hidden scar, a healthier heart: One of Florida's first pediatric underarm heart surgeries

Emma’s journey began on the day she was born, when her pediatrician detected a heart murmur. In the years that followed, her family hoped the hole in her heart would close on its own.

Emma had an atrial septal defect (ASD), a common congenital heart defect that affects more than 5,000 babies born in the United States each year. The condition creates a hole in the wall separating the heart's two upper chambers, allowing oxygen-rich blood to flow from the left side of the heart to the right side rather than directly to the body. Although she experienced few symptoms, the extra blood flow could enlarge and strain the heart over time if left untreated. By age 8, doctors determined she needed surgery.

"In that exact moment, my life froze," said Betina, Emma's mother. It was a nerve-wracking time for the entire family, but they felt reassured by the care team at Nicklaus Children's Heart Institute, where Dr. David Kalfa led Emma's surgery. Kalfa is chief of cardiovascular surgery and co-director of the Institute, and a professor and researcher at FIU Herbert Wertheim College of Medicine (FIU Medicine).

The surgical team accessed Emma's heart through a small incision on the side of her chest rather than through a traditional incision down the center of the chest-- one of the first right vertical mini-axillary open-heart surgeries performed in Florida.

"By placing the incision beneath the arm rather than across the chest, the procedure leaves a less noticeable scar — an important physical and emotional benefit for young patients like Emma, who can avoid a more visible reminder of their surgery as they grow," said Kalfa.

Emma and her twin brother; the discreet underarm incision used to repair her atrial septal defect

Following a remarkably swift recovery, Emma is back to doing what she loves: Taekwondo and spending time with her twin brother and family, who have been with her every step of the way.

Her story reflects the impact of combining surgical innovation with patient-centered care, a hallmark of Kalfa's work and the academic medical partnership between FIU Medicine and Nicklaus Children's.