Fortis Escorts Heart Institute (FEHI) conducted an emergency open heart surgery on an 18 hour new born baby, the youngest reported case in the country till date. The surgical team of doctors was headed by Dr. K S Iyer, Executive Director- Paediatric & Congenital Heart Diseases at FEHI.
The baby, Mayank Agarwal, was born with a heart defect called the Obstructed Critical Total Anomalous Pulmonary Venous Connection (TAPVC). TAPVC is a medical condition in which the blood does not take the normal route from the lungs to the heart and out to the body. Instead, the veins from the lungs are attached to the heart in abnormal positions. The abnormal vein is also narrow and blood tends to dam up. The oxygenated blood enters or leaks into the wrong chamber and blood gets dammed in the lungs. The blood passing through the aorta to the body does not have normal amount of oxygen, which causes the child to become breathless and look blue. The only option is an emergency surgery to avert fatal consequences.
The baby was born in the city of Mathura and within minutes of his birth was declared to have severe breathing difficulty. After being in two local hospitals in Mathura, the local doctors were still unable to treat the baby and asked the family to rush the child to a multi-super specialty hospital in Delhi. Upon the refusal of the hospital in Delhi, the child was subsequently referred to Dr. Iyer at FEHI. A decision to perform an Open Heart Surgery was taken which involved cutting the chest open and performing the surgery on the muscles, valves, or arteries of the heart.
Dr. K S Iyer, Executive Director, Paediatric & Congenital Heart Diseases, FEHI said, “Rapid advances have taken place in the diagnosis and treatment of paediatric congenital heart defects over the last few decades. There are diagnostic tools available today by which a more accurate diagnosis can be made even before birth. With currently available treatment modalities, over 75% of infants born with critical heart diseases can survive beyond the first year of life and many can lead near normal lives thereafter. However, the key is early diagnosis and timely intervention.” Added Dr Iyer, “This child was born with an additional defect of abnormal and narrow veins that posed a bigger challenge as the veins had to be treated immediately.”
Dr. S. Radhakrishnan, Director & HOD Paediatric & Congenital Heart Disease, FEHI said, “Treating a patient as young as this is a huge challenge, starting with anaesthetic challenge on the onset of the procedures itself. Even when the surgery is successful, the challenges are not over as post-surgery the chest had to be kept open for three days to keep the new born under dedicated observation for any emergencies. Currently, the baby is showing normal growth as any three month old would and we expect that it would continue with timely check- ups and regular follow-ups. ”
At the time of this surgery for TAPVC, the pulmonary veins are reconnected to the left atrium and the atrial septal defect is closed. The child will need regular follow-up with a paediatric cardiologist and, once the child reaches adulthood, lifelong regular follow-up with a cardiologist with special training in congenital heart defects. Follow-up is needed to make certain that any remaining problems, such as an obstruction in the pulmonary veins or irregularities in heart rhythm, are treated.
Dr. Somesh Mittal, Zonal Director, FEHI said, “Fortis Escorts Heart Institute is the first hospital with a specialised multi-disciplinary team of Paediatric Cardiologists and Paediatric Surgeons. Our trained team brings a vast experience; pioneered several cardiac techniques for children and has produced results that are comparable to the best in the world. The Paediatric & Congenital Heart Diseases team at FEHI has performed a record of over 13,000 heart surgeries on infants and children over the last two decades. This challenging open heart surgery performed on the new born further highlights the expertise and skills of our doctors.”
Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. The total live births in India are estimated at nearly 28 million per year. The reported incidence of congenital heart disease is 8-10 per 1000 live births in the world and in India 6-8 per 1000 live births. Nearly 33% to 50% of these defects are critical with nearly 180,000 children are born with heart defects each year in India requiring intervention in the first year of life itself. Of these, nearly 60,000 to 90,000 suffer from critical cardiac lesions requiring early intervention.
Gopal Agarwal, a resident of Mathura and father of the infant, expressed his gratitude, “I have no words of gratitude for Dr. Iyer and his team. After 28 years, we experienced the joy of the birth of a baby in my family and it was a happiness that we almost lost. Despite the time that we lost in reaching Dr. Iyer, he immediately started the corrective procedures on my baby. I am so grateful to have come to Dr. Iyer who restored the joy and happiness in my family.”