Catching a heart defect in utero: Marco’s story

Meagan and Dante Cipulli quickly settled on a name when they discovered their third baby would be a boy: Marco, which meant God of War.

And that name would become especially apt a few weeks later. When Meagan was about six months pregnant, the couple learned their baby had a congenital heart defect called tetralogy of Fallot and would need open-heart surgery soon after birth.

“Knowing my unborn baby would need open-heart surgery after birth was the scariest experience of my life,” Meagan says. “After receiving his diagnosis, we realized we couldn’t have picked a better name for our little heart warrior.”

Finding heart defects before birth

When a second ultrasound by a perinatologist confirmed that baby Marco’s aorta was enlarged, Meagan was referred to CHOC pediatric cardiologist Dr. Nita Doshi.

Dr. Doshi performed a fetal echocardiogram, which uses sound waves to create a picture of an unborn baby’s heart.

The evaluation confirmed that Marco had tetralogy of Fallot, a heart condition comprised of four related defects that cause inadequate amounts of blood to reach the lungs for oxygen, thus sending oxygen-deficient blood throughout the body.

“I was in complete shock,” Meagan says. “As a nurse, I knew exactly what tetralogy of Fallot was and that he would need open-heart surgery.”

Planning began immediately. With the help of Dr. Doshi, the Cipullis began researching hospitals, cardiologists and surgeons who could care for Marco when the time came.

CHOC emerged as the clear choice, and the Cipullis opted for Dr. Doshi to continue as Marco’s cardiologist and Dr. Richard Gates to perform the corrective surgery.

Organizing pre- post-birth care

Meagan moved her obstetric care to a physician aligned with St. Joseph Hospital so Marco could be transferred next door to CHOC’s neonatal intensive care unit (NICU) immediately upon birth.

During a perinatal conference, the Cipullis met with the obstetrical team at St. Joseph and CHOC’s neonatal team to discuss the baby’s birth and care.

“That allowed me to have all my questions answered and gave me peace of mind that all those related to our care were on the same page,” Meagan said. “I knew that I had made the right choice after meeting with the care team.”

The remaining weeks of Meagan’s pregnancy were an emotional roller coaster. They couple prepared their older sons as best they could for what was to come with their younger brother.

And while the family was scared to not understand the full extent of their baby’s medical needs, they felt assured knowing a plan was in place.

“Each day of my pregnancy after diagnosis was filled with worry and fear, but also gratitude and hope knowing we were fortunate enough to have Marco’s diagnosis in utero and we were able to plan for his care after birth,” Meagan says.

The Cipullis didn’t have to wait long for Marco. On May 16, 2017, Marco was born five weeks ahead of schedule. After a brief rest on his mother’s chest, Marco was moved to CHOC’s NICU, where he stayed for five days.

Surgery day

Marco was back at CHOC about three months later for surgery with Dr. Gates to repair his heart defects.


“At first it all seemed so surreal and somehow I was able to keep it all together until the moment they wheeled Marco into the operating room,” Meagan says. “While he was lying in the crib, he looked over his shoulder and gave me and his dad this smile and look like, ‘I got this, guys, don’t worry.’ I don’t think I have ever cried harder in my life.”

The surgery went well, and Marco spent five days recovering in CHOC’s cardiovascular intensive care unit.

Today, Marco is happy and healthy 9-month-old who loves to smile and laugh. He sees Dr. Doshi every four months for follow-up appointments, but otherwise requires no additional medication or therapy.

Many babies with tetralogy of Fallot will require additional surgeries as they age, but the Cipullis are hopeful that Marco’s early interventional measures will last for many years.

Feeling positive

Meantime, the Cipullis are enjoying every minute with their three boys, and are grateful for the care they received at CHOC after catching Marco’s condition early.

Meagan recommends that other families who find themselves in similar situations be vocal about their fears, but also stay positive about their baby’s future.

“My husband and I each night would talk about what we were feeling that day,” she recalls. “At first, it was more about our fears and worries, but eventually each day we would talk more about our excitement and joy to meet our little warrior.”

Learn more about CHOC’s fetal cardiology services.

CHOC’s VP of Human Resources Joins Cast of Footloose Follies

One of Orange County’s most popular fundraisers , CHOC Follies, is back March 29-31 with their newest musical production, “Footloose Follies,” benefitting CHOC Children’s. Set against an 80s backdrop, the humorous toe-tapping show, featuring a cast of local social and business leaders, is sure to be fun for the whole family.

We talked to Tom Capizzi, CHOC’s vice president of human resources, about his role in the upcoming show.

Tom Capizzi, CHOC Children’s vice president, human resources

Q: How long have you been at CHOC?

A: I have been with CHOC two and a half fantastic years.

Q: How did you get involved with the show? Why is this important to you?

A: I have been a fan of the Follies for many years. I always felt it would be great to be a part of the production and give back as a senior leader at CHOC. In my role, I am always in front of many associates and love the opportunity to speak to as many people as I can. This year I decided, “Why not; let’s do it!”

Q: Did you have any experience with theater prior to the CHOC Follies?

A: I did some theater while in college, and later when my daughter was in a children’s regional theater group I was asked to participate in several adult parts.

Q: What is your favorite part of the show?

A: The cast brings such energy and passion to the show, which in my opinion is very infectious and speaks to our mission and why we all are aligned – associates, physicians, donors and volunteers – with our mission to nurture, advance and protect the health and well being of children.

Q: Why should the community support the show?

A: Join us, it’s a wonderful time, very entertaining. And the dedication, passion and time commitment that the cast makes every year, which is all voluntary, speaks volumes to how important CHOC is to them and how critical philanthropy is to the success of our mission to care for our community’s children and their families.

“Footloose Follies” will be held March 29-30, 8 p.m.; March 31,  2 p.m. and 8 p.m., at the Robert B. Moore Theatre at Orange Coast College, in Costa Mesa. Visit for tickets.

Acute and Chronic Headache Management in Children and Teens

When child and adolescent patients complain to their parents about a headache, it can be anything from a plea to stay home from school in hopes of avoiding a test, to a sign of something more serious. Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice to the referring community on acute and chronic headache management in children and teens, including headache hygiene, non-medical intervention options, and referral guidelines.

Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s

Types of headaches often seen in children and adolescents

Migraine symptoms in kids

  • At least 5 attacks that meet the following criteria:
  • Headache lasting 1 – 72 hours
  • Headache has at least two of the following features:
    • Pain on both side or one side of the head
    • Pain is pulsating
    • Moderate to severe intensity
    • Aggravated by routine physical activities
  • At least one of the following:
    • Nausea and/or vomiting
    • Sensitivity to light or noise
  • Chronic migraines are indicated by 15 headache days per month over a three-month period, and at least half of those are migraines.
  • About 1 out of every 20 kids, or about 8 million children in the United States, gets migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

Tension headache symptoms in kids

  • Headache lasting from 30 minutes to seven days
  • Headache has at least two of the following characteristics:
    • Pain in two locations
    • Pressing or tightening feeling (not a pulsing pain)
    • Mild to moderate intensity
    • Not aggravated by routine physical activity such as walking or climbing stairs
  • No nausea or vomiting – many children experience a loss of appetite
  • Either sensitivity to light or sensitivity to sound
  • Tension headaches occur most often in children ages 9-12

Cluster headache symptoms in kids

  • At least five headaches that meet the following criteria:
    • Severe pain in one location: within the eye, above the eyebrow, or on the forehead, that lasts from 15 minutes to three hours when left untreated
  • Headache is accompanied by at least one of the following symptoms on the same side of the body as their headache:
    • Conjunctival injection and/or lacrimation
    • Nasal congestion and/or excess mucus in the nose
    • Eyelid swelling
    • Forehead and facial swelling
    • Droopy eyelid and/or small pupil
    • A restlessness or agitation
    • Cluster headaches usually start in children at around 10 years old

Post traumatic headache symptoms in kids

  • Acute post traumatic headache: lasts less than three months and caused by a traumatic injury to the head
  • Persistent post traumatic headache: lasts more than three months and caused by a traumatic injury to the head
  • Both acute and persistent headaches develop within one week of: the injury to the head, regaining of consciousness following injury to the head, or discontinuing medicine that impairs the ability to sense a headache following a head injury
  • Extended recovery risk factors:
    • Prolonged loss of consciousness or amnesia
    • Females
    • Initial symptom severity
    • Premorbid history of ADHD, mood disorders, and migraines

Sleep apnea headache symptoms in kids

  • Typically a morning headache
  • Pain is present on both sides of the head
  • Lasts more than four hours
  • Not accompanied by nausea, nor sensitivity to light or sound

Medication overuse headache symptoms in kids

  • Headaches on 15 or more days per month
  • Takes over-the-counter medication for headaches more than three times per week over a three-month period
  • Headache has developed or gotten worse during medication overuse
  • Pattern of headaches resolves or improves within two months after discontinuing the overused medication.

Remind parents of headache hygiene tips

There are a number of things parents can do to prevent headaches, says Dr. Taraman. Remind parents to practice headache hygiene:

Non-medical interventions

A variety of non-medical interventions can be helpful for children who are suffering from headaches, including ice packs; warm baths; taking a nap in a cool, dark room; neck and back massage; and taking a walk.

Medication as treatment for headaches in children

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, should be limited to no more than three days per week, with no more than two doses per day, in order to avoid medication overuse headaches.

Triptans are often used to treat moderate to severe migraines or cluster headaches, but should not be prescribed to patients with cardiovascular disease, uncontrolled hypertension, basilar migraine or hemiplegic migraine.

Encourage patients to keep a headache diary

Encourage your patients to keep a journal of their headaches so you can identify a pattern. Patients should keep track of:

  • Headache start date and time
  • What happened just before the headache?
  • How much did your head hurt, on a 0-10 pain scale?
  • Where did your head hurt?
  • What did you feel just before and during the headache?
  • What did you do to make yourself feel better?
  • Did you feel better, on a 0-10 pain scale?
  • Headache end date and time

When to refer cases of headaches to pediatric neurologists

Dr. Taraman offers the following guidelines on when to refer headaches to a pediatric neurologist for imaging:

  • Diagnosis of neurofibromatosis of tuberous sclerosis
  • Immunosuppressed child
  • If the child is awoken on a regular basis by headache pain or vomiting
  • Headaches beginning shortly after arising from bed in the morning (i.e., positional headache)
  • Syncope
  • Chronic progressive headaches
  • Persistently posterior headaches
  • Chronic headaches in patients less than 3-5 years old

When patients have a history of the following symptoms during headaches, Dr. Taraman offers the following guidelines on when to refer headaches for imaging and possible neurology consultation:

  • Double vision
  • Abnormal eye movements and/or nystagmus
  • Unilateral ptosis or complete 3rd nerve palsy
  • Motor or gait dysfunction or hemiplegia
  • Hemisensory disturbance
  • Confusion
  • Vertigo

CHOC is the only specialized imaging facility in Orange County just for children, and we only use board-certified pediatric radiologists and specially trained pediatric radiology technologists, nurses and child life specialists.

Parents should immediately be sent to the emergency room for headaches when:

There are some clear instances of severe headaches that warrant an immediate trip to the emergency room, says Dr. Taraman. These include:

  • Thunderclap headache: severe, sudden onset of pain that occurs anywhere in the head, and grabs your attention like a clap of thunder. Pain usually peaks within 60 seconds to a few minutes.
  • Any headache that comes with acute focal neurologic deficit.
  • Changes in vision due to papilledema, which can include blurred or double vision, flickering, or complete loss of vision.
  • If the child had a shunt placed for a condition such as hydrocephalus, and it becomes obstructed or infected, they can show symptoms of untreated hydrocephalus.

Learn more about the Neuroscience Institute at CHOC Children’s.


Longtime CHOC Pediatrician Retires

Dr. Michael Shannon can’t walk through the lobby of Sea View Pediatrics without at least one parent coming in for a hug.

After nearly 45 years in pediatric health care in Orange County, he’s earned more than a few fans – and the respect is mutual.

“Much of what a pediatrician learns is after training,” Dr. Shannon says.

Bring on the hugs though: At the end of this month, the 73-year-old will retire, completing a career that has spanned more than four decades and thousands of patients.

Born in Kansas, Dr. Shannon crisscrossed the country as a youth and young adult before ultimately attending medical school at Northwestern University in Illinois.

Dr. Shannon pursued a career in medicine following a childhood with frequent visits to doctor’s offices.

“I had bad allergies as a kid, an early tonsillectomy, a hernia at 7, appendicitis and asthma,” he says. “I was in the doctor’s office quite a bit. My parents seemed to like him, so I thought that would be a good thing to do.”

When it came to choosing his specialty, Dr. Shannon settled on pediatrics because he enjoyed children’s innocent natures.

“I always liked kids. Children don’t judge you, and their charts were really thin,” he says with a laugh.

When it came time to a residency and internship, Dr. Shannon and his wife, who’d long grown tired of cold Midwestern winters, headed west to California.

Ultimately, the pair settled in Orange County, where Dr. Shannon began a private pediatrics practice in July 1973. He practiced near Mission Hospital until 1995, when he joined Sea View Pediatrics, now a part of the CHOC Children’s Network.

Over more than four decades of practice, Dr. Shannon has treated thousands of Orange County children.

Steve Concialdi and Dr. Shannon

“I remember him being a cool doctor,” says Steve Concialdi, a patient of Dr. Shannon’s as a child and who is now a captain with the Orange County Fire Authority. “He was hip and he was fun.”

The doctor reached an icon status for a young Steve when he was about 10. He’d been battling a cold and his mother thought he should skip a school whale watching trip. After hearing Dr. Shannon’s opinion, mom Bonnie was swayed and Steve went on the trip.

“I went and I had a blast,” he says. “I ended up throwing up, but that’s because I got sea sick. But I just remember as little boy, what a cool doctor he was. We saw Dr. Shannon for years.”

And so, when Steve and his sister, Carrie, started their own families, Dr. Shannon was a clear choice for their children’s pediatrician – and Bonnie agreed.

“I told them, you’ve got to go to Dr. Shannon,” she said. “I wouldn’t stand for anyone else. I went to their first appointments too. I wanted to see Dr. Shannon because I missed him.”

The Concialdis are just one of many families in Orange County that have had generations of children see Dr. Shannon. The phenomenon is a testimony to Dr. Shannon’s long career and strong relationships with his patients and families.

Dr. Shannon with Gracie Concialdi at her first appointment; her father, Steve Concialdi; grandmother, Bonnie; and her brother, Andy Concialdi.

And that bond was never more evident than in March 2011, when he was seriously injured in a car accident. His patients and families – past and present – showed an outpouring of concern for him during a long recovery period.

The swell of support clarified for Dr. Shannon the impact his career had made on patients and families.

“The accident made me feel even more than ever before that I didn’t want anything happening to my babies,” he says of his patients.

And now, nearly seven years later, Dr. Shannon says he’s ready to hang up his stethoscope and entrust the care of his babies to the other Seaview physicians.

Dr. Shannon plans to spend his retirement traveling and focusing on his grandchildren. His future trips include travel to Louisville, Ky., to visit his daughter, Vanessa, and Ireland and Spain in 2018.


Dr. Heidi Stephany Joins CHOC Children’s Urology Team

CHOC Children’s urology program, ranked one of the nation’s best by U.S. News & World Report, has grown with the addition of Dr. Heidi Stephany.   A fellowship- trained pediatric specialist Dr. Stephany most recently served as assistant clinical director for the division of pediatric urology at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), where she was also an assistant professor.

Dr. Heidi Stephany, pediatric urologist
Dr. Heidi Stephany

“The pediatric program at CHOC is a distinguished specialty with a solid reputation. I was drawn to work alongside such remarkable physicians, including Dr. Antoine Khoury, who is world-renowned in the field of pediatric urology,” says Dr. Stephany. “I was also attracted to the opportunity to help educate and train residents and fellows, in addition to working on challenging patient cases.”

Dr. Stephany’s clinical interests include complex reconstructive surgery, specifically hypospadias and disorders of sexual differentiation. Her clinical outcomes research is focused on voiding dysfunction.  She hopes to develop a combined urology/gastroenterology clinic for patients suffering from the condition.

A desire to solve problems and help others sparked, during her high school years, Dr. Stephany’s interest in surgery. After shadowing a urologist at the start of medical school, she knew urology—offering the perfect mix of medicine and surgery— was the specialty for her. She was intrigued by the wide array of complex issues and procedures within the specialty.

Working with children is particularly fulfilling for Dr. Stephany.

“In pediatrics, we have the opportunity to identify, address and achieve positive outcomes that will have a lasting impact on our patients’ lives,” she explains.

Since joining CHOC, Dr. Stephany has enjoyed immediate camaraderie with her colleagues and the team approach to care, which she says extends beyond her specialty and benefits patients. “It makes working here a truly fulfilling experience,” she adds.

Dr. Stephany is dedicated to treating patients like her own family members, and communicating complex issues in a compassionate way that is easily understood. She looks forward to becoming an integral part of the medical community in Southern California.

“I am excited to be here and want to be a resource for serving children in the area who need our care. I pride myself on being approachable and am eager to work collaboratively with local pediatricians,” says Dr. Stephany.

For physician referrals to Dr. Stephany, call 888-770-2462.