Baby of Shaheen (name changed for privacy) had a very abnormal right side heart valve (Tricuspid valve) called Ebstein’s Anomaly, where the valve is abnormal and leaks profusely. He also had atresia of pulmonary valve, which meant that no blood flow was going to his lung from the heart for oxygenation. This life threatening abnormality was detected by the doctors at Apollo Hospitals Hyderabad when the baby was still in the womb through a fetal echocardiography.
A medical team at Apollo Hospital, Jubilee Hills Hyderabad, comprising of Paediatric Cardiologist, Obstetrician, Neonatologist and Paediatric Cardiac Surgeon took utmost care to meet any contingency during the birth of the baby considering his precarious medical condition. The baby being born prematurely at 34 weeks of gestation coupled with growth retardation presented a challenge to the team. Initially the team put him on ventilator support soon after birth and hoped to manage him medically for a few months before surgery could be planned.
However, a natural connection between his aorta and the artery to the lungs called ductus arteriosus was closing. Hence this connection had to be kept open using a special medicine for taking blood to the lungs for oxygenation. The closure of the artery would have snuffed life out of the baby and therefore it was imperative that Cardiac surgery to restore blood flow to lungs was performed on a war footing. The surgery was especially challenging because of his deteriorating condition, tiny size, small size of the heart (no bigger than an adult thumb) and organs. The task was daunting and the team had to perform the surgery with great dexterity, says Dr Girish Warrier, Senior Paediatric Cardiac Surgeon, who led the team in performing the surgery.
After a detailed consultation with the family, the team decided to go ahead with surgery on September 14th, albeit at a high risk, since without surgery, the child would not have survived tiny size. The child had to be placed on Cardiopulmonary bypass as preparatory to working inside the heart. Being only 1.2 Kg at birth and 11 days at the time of surgery, specially designed circuitry had to be used to place the child on bypass. He required an urgent tube graft that would send blood from his aorta to lungs. However, leaving his tricuspid valve leaking so badly would have jeopardized the function of his heart and ultimately the recovery. The leaking tricuspid valve was closed using a patch. Thereafter a shunt was created to provide reliable source of blood supply to the lungs for purification. The child tolerated the procedure well and was taken off the bypass machine and then shifted to the intensive care unit. He gradually recovered from the surgery and was shifted to the ward on the 14th post-operative day.
The infant needed a multidisciplinary team approach right from being inside the womb to his recovery that involved Paediatric Cardiologist Dr Kavitha Chintala, Obstetrician Dr. Prameela Sekhar, Cardiac Anaesthetist and Critical Care Specialist Dr Meena Trehan, Paediatrician Dr Sharmila Kaza, residents, fellows, nurses and ancillary staff.
Dr Girish Warrier commented," Cardiac surgery in such tiny children requires an advanced infrastructure and a highly trained staff who form the backbone of any successful team. Additional challenges to his surgery were nutrition and infection control, but he is now recovering well and is planned for discharge in a couple of days from the hospital. This type of surgery is a high-risk surgery which has not been performed till date in India and Apollo Hospitals Hyderabad is proud to be a pioneer in this field".
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