At the Bedside: Infant born with arm malformation comes home after life-changing surgery

At just 2 weeks old, Isabella Halligan underwent surgery, with a tourniquet placed under her shoulder to lower risk of future arm amputation. (Photo courtesy of Claudia Salas Melchor)

Isabella's large AVM of the arm, pictured, caused her to enter heart failure and pulmonary hypertension several days after birth. (Photo courtesy of Claudia Salas Melchor)

Since her surgery in November 2023, the mass on Isabella's arm is significantly smaller, and her mother loves being home with her. (Photo courtesy of Claudia Salas Melchor)

When Isabella Halligan was born in late October 2023, the delivery nurse noticed a big red lump on the baby’s forearm. Doctors quickly diagnosed the lump as a large arteriovenous malformation (AVM), a tangle of blood vessels that irregularly connects arteries and veins, disrupting blood flow and oxygen circulation.

Before Isabella’s mother, Claudia Salas Melchor, had time to process the news, Isabella was sent via Life Flight to Children’s Memorial Hermann Hospital in Houston. At 4 days old, Isabella went into heart failure and pulmonary hypertension caused by the AVM.

Her care team with UTHealth Houston and the Pediatric Vascular Anomalies Program at Children’s Memorial Hermann Hospital sent images of the AVM to other doctors around the country; many recommended amputation, while others said nothing could be done.

However, Isabella’s care team developed a different plan. Wanting to save her arm, they decided to remove as much of the AVM as possible through surgery. To reduce Isabella’s chances of requiring amputation later on, they would also place a tourniquet underneath her shoulder, which would slow the blood flow entering and leaving her arm. The care team included UTHealth Houston faculty members Matthew Greives, MD, associate professor and the Dr. Thomas D. Cronin Chair in Plastic Surgery with McGovern Medical School; and Charles S. Cox Jr., MD, professor, the George and Cynthia Mitchell Distinguished Chair in Neurosciences, and the Glassell Family Distinguished Chair in the Department of Pediatric Surgery at the medical school.

On Nov. 10, Greives and Cox performed a six-hour surgery on the 2-week-old baby. A little over a week after the procedure, they gave Isabella a skin graft. Overall, she remained in the hospital for one month and 10 days, including Thanksgiving, before being discharged in December.

Claudia is grateful that she and Isabella were able to spend Christmas at home in Atascocita, Texas. Now, she’s getting to know her 3-month-old daughter, who has already shown grit and strength in her short life.

“If you saw her today, you wouldn’t know she was in the hospital for that long,” Claudia said. “The mass isn’t completely gone, so they’re still keeping an eye on it for the next six months. We learned how to be advocates, and we learned how much doctors are going to advocate for their patients.”

At the Bedside is a series of patient stories with UTHealth Houston physicians and staff.