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Kristy Mackey began singing again recently.

Her audience of one and biggest fan is her talkative, blue-eyed baby girl, Madelyn, now almost 11 months old and walking about her parents' southwest Santa Rosa home with steadier steps every day.

Stuffed animals cover the furniture and brightly colored musical toys are strewn on the floor around every corner. One plays a looped tune about Old MacDonald and his farm.

The snapshot of early parenthood is very normal.

But the path to this point for mother, daughter and all who have rallied around them has been extraordinary.

It started 33 years ago with a heart defect discovered in the moments after Kristy's own birth. An open-heart operation followed when she was 3 months old and a cardiac arrest almost killed her in her early 20s. Ten surgeries would follow.

But some of the most complicated challenges came a decade later, in near life-or-death decisions about what should have been a happy development in her young marriage — the news, unexpected and unplanned, that she was pregnant.

Since her heart failure, she had long been told by physicians that carrying and delivering a child would put too much strain on her heart. She and her husband, Lauren Mackey, had tried surrogacy instead and when that failed they considered adoption.

Yet once she was pregnant, doctors in San Francisco saw new vitality in Kristy's once-fragile heart. Motherhood was making it stronger.

Buoyed by their medical and family support, the couple decided to go forward, prepared all the while for a struggle that could include months of bed rest or worse — the possibility of Kristy's heart failing again and having to end the risky pregnancy.

Eight months of weekly or daily trips to the doctor's office followed, and when Madelyn arrived on that dark January morning in a large 15th floor hospital room overlooking San Francisco Bay, it wasn't the family's first wonder.

"When she cried when they were holding her, I thought 'She's alive, she made it,'" said Kristy Mackey, who graduated from Santa Rosa's Montgomery High School in 1998.

Then it dawned on her: "And I'm alive. It's over. We did it," she said.

A family accustomed to grave worries over matters of the heart was able to celebrate, just as they will Thursday in Santa Rosa, marking Madelyn's first Thanksgiving in the local clan.

"It's something to be thankful for, for sure," said Lauren Mackey. "We're looking at the second generation of miracles."

Kristy Mackey's heart was the size of a golf ball in 1980 when a team headed up by Denton Cooley, arguably the most acclaimed U.S. cardiac surgeon, opened up her tiny chest.

The goal was to fix what was essentially a plumbing problem caused by transposed arteries that left her body starved for oxygen-rich blood within hours of her birth.

She was a "blue baby," and was whisked away from her mother's hospital bedside in Decatur, Ill., and rushed by ambulance to an operating room in St. Louis for an emergency procedure.

"I put my hand in this little incubator thing and I patted you and then they took you away," Sher Miersemann, Kristy's mother, recounted to her daughter this week. "It was awful."

Three months later, Cooley, who performed the first successful human heart transplant in the United States in 1968, used a piece of the membrane surrounding her heart, called the pericardium, to create a shunt or tunnel that tied the two closed loops of her artery network together and allowed oxygenated blood to flow throughout her body.

The operation left a thin scar running from her breastbone to her belly button. It was far from her last major procedure.

Two decades later she would turn to another batch of cardiac specialists, stretching from Cleveland to San Francisco, to save her life. She would rely on her parents, sisters and other loved ones for help — physical, emotional and financial.

The treatment took a toll on the middle-class family.

But in the intervening years she had a normal childhood. She was surrounded by three sisters — two older and one younger — in an active home. The family moved from Illinois to Rohnert Park when she was 9 months old.

She skied in the snowy mountains and on water behind boats. She swam and took horseback lessons. She played in one memorable game for her middle school basketball team.

She recalls a single setback from those years: not being allowed to go out for the school's cheerleading squad. The doctor wouldn't sign the note.

"The whole cardio thing — I couldn't really do long distance stuff," she said. "But I felt pretty normal."

Her heart condition was not something the family made widely known. Her older sisters found out only when she was in kindergarten and they saw a clipped newspaper article about her open-heart operation.

As she grew older, she told friends. Eventually, that scar on her chest became something of a badge of courage.

"I was proud of it," she said "I thought it was cool."

She first talked to doctors about motherhood around that time.

"I remember asking them: 'Am I going to be able to have children? Am I going to be able to have children?'<TH>" she said. "They would always tell me, 'We don't know yet. We'll see how you are when your child-bearing years come, when you get older.'"

After high school, she studied at Santa Rosa Junior College and Sonoma State University.

In the fall of 2002, she took off on a two-month tour of Europe with her three sisters. They'd planned the trip for a long time, quitting jobs and closing up apartments.

But in the second half of the tour, she fell ill. Her ankles were swollen. Her breathing became shallow. She had trouble sleeping and ascending stairs.

Unbeknownst to her, her heart had gone into overdrive, fluttering at nearly six beats per second and failing to properly push blood through her body. Fluids started to well up in her torso so that she couldn't fasten her bra. She felt like she was drowning from within.

Her heart hadn't been a problem for years, so her family thought it was pneumonia. She cut short her trip and flew home.

A day later, she was in the intensive care unit at UCSF Medical Center, the home base for doctors and nurses who had cared for her for years.

They scheduled a surgery to install a watch-sized device that would serve as both pacemaker and internal defibrillator to detect and correct the erratic beats of her heart.

But days before her scheduled operation, her heart gave out. She sat up in bed that morning and then leaned over, feeling light-headed.

Her mother watched next as she passed out, her arms shooting behind her and her upper body pitching over, her face and head hitting the floor.

"I screamed," Sher Miersemann said. "The nurses rushed in and they started shocking her with paddles right on the floor."

Mackey was 22. She recalls the brush with death in a calm, matter-of-fact way, letting other family members play up the drama.

"I don't think I ever felt like that was it," she said. "I always feel now that I'm in really good hands and I'm going to make it through everything."

She would go on to spend more than two weeks in the hospital, beginning a series of surgeries to install, calibrate and repair implanted devices to aid her heart. Most of those surgeries spanned the next decade; the latest one happened just five weeks ago.

Her convalescence was long and difficult. But her friends introduced her to a new face in their group. Lauren Mackey had moved down from Oregon, where he grew up. The pair hit it off and they were soon dating.

The condition of her heart was no secret between them, nor were her physicians' concerns about what it meant for motherhood.

"I know we discussed it," said Lauren Mackey, 35, and an electrician. "I think we figured we'd cross that bridge when we came to it. And I was adopted, so that was always an option."

They were married in 2005. They lived for two and a half years in San Diego, where Kristy earned her real estate license. She now works for her mother's Santa Rosa brokerage.

In 2008, wishing to start a family, the couple began a costly two-year attempt at surrogacy that ultimately proved unsuccessful.

It involved hormone shots and required a change in blood thinner medication for Kristy's heart that had to be injected.

"And I hate needles, so that was the worst," Lauren Mackey said.

"It was mentally, physically and emotionally exhausting," he said of that period.

The couple decided to take a break on the family thing.

"We just needed to put it on the back burner and not even think about kids," Kristy Mackey said.

The unexpected and unplanned happened about two years later, during a break in Kristy's use of an implanted IUD birth control device.

The couple laughs about it now.

"We were using other methods," she said.

"And then we weren't using other methods," he said.

"And that's when we got pregnant," she said.

But the news prompted an immediate wave of trepidation in the family.

"I thought my cardiologists were going to say, 'You cannot do this. You're going to die.' That's what I expected," Kristy Mackey said. "I didn't want to terminate (the pregnancy) but I felt like I knew I had to. And I thought, 'Isn't this the icing on the cake. Now I'm forced to do something where I totally want the opposite.'"

Opinion among relatives was mixed. Her mother and eldest sister were the most skeptical about the pregnancy and voiced their concerns.

"There were a lot of things to consider and it was a big risk," said Heidi Fabish, her oldest sister. "We were all just on pins and needles and it was super stressful for the entire family, even though we tried to hide that from her."

Valerie Bosco, Mackey's cardiac nurse at UCSF, got one of the first calls.

"I said 'OK, here's what you need to do. We'll support you. We'll work with you,'" said Bosco, a senior clinician in UCSF's adult congenital heart disease program. (She is not related to Doug Bosco, the Santa Rosa attorney and former congressman.)

That first conversation and many afterward set in motion a decision based on the couple's wishes and advancements in medicine for expectant mothers with congenital heart troubles. The outlook for those hopeful women has improved considerably in the past decade.

"At one point in time these patients were told they couldn't have babies," Bosco said. "But we've learned a lot from our experience."

Nevertheless, Mackey was told that she would be a pioneer among the group — the only one who had her type of congenital heart defect and had suffered congestive heart failure.

"They said, 'We think you can do it,'" she recalled. "The doctors really made me feel comfortable and confident. They said that my heart had healed a lot in the last 10 years."

The number of assembled family members in the delivery room at UCSF in early January made even veteran physicians do a double take. Aside from her husband, her mother and sisters, they included her father, Karl Miersemann, plus Ray Shipway, her mother's second husband, and many others who were on hand at times.

"It was a family affair," Bosco said. "Everyone came with her."

She was hooked up to a raft of monitoring equipment and surrounded by a fleet of nurses. Mackey was prohibited from pushing. A cesarean section, because of its related trauma, was only a fallback option.

But after 12 hours in what amounted to an untroubled labor, the birth happened in rhythm with her contractions and some pulling assistance from physicians.

Madelyn Mackey was born at 3:06 a.m. Jan. 8. She weighed 5 pounds, 7 ounces and was just a week early. She announced herself with a good, strong cry and was later given a clean bill of health by nurses.

Relief, her father suggested, was an understatement for the emotion unleashed. "It wasn't a purely happy day until she was born," he said.

She joined her mother as one of the family's "miracle girls."

"For us, it's a miracle Kristy is alive, several times over, and now there's also this miracle of her having and raising a child, which is what she always wanted to do," said Fabish, her sister.

She said Kristy used to sing to herself years ago. Doctors have recently given her a good prognosis, and she has resumed singing, serenading her daughter around the house.

"It's her dream come true," Fabish said.

The new parents are set to host Thanksgiving dinner this year in their home south of Hearn Avenue. Family will top the list of those they want to thank. Kristy's medical team will also be in their thoughts.

"It's who we have around us that matters," Lauren Mackey said, sitting at their dinner table one evening this week.

Madelyn was bouncing on her mother's knee, drawing gazes.

"I'm thankful for her," Kristy Mackey said. "That we're here and made it through and that she's here and healthy. That we made the decision to keep her."

"I'm thankful for that, too," Lauren Mackey said, looking at his wife, both of them tearing up.

"For many years, we've been thankful for all the things we've had to go through and that it's been successful," he said. "This one in particular is really sweet."

(You can reach Staff Writer Brett Wilkison at 521-5295 or brett.wilkison@pressdemocrat.com.)