A boy belonging to a farmer’s family in Aurangabad was referred to Sir H N Reliance Foundation Hospital and Research Centre by a noted Paediatric Cardiologist from Pune, Dr Pankaj Sugaonkar. The boy was having a complicated heart defect in which all the heart chambers and arteries were interchanged.
The heart had a large hole and the artery connected to the lung was narrow resulting in very poor supply of impure blood to the heart for purification. Matters were worsened because the heart was located at the right side of the chest instead of the left and the coronary arterial courses were too crowded for an area to be selected for connecting the heart and lungs with the interposition conduits.
There was an initial clinical evaluation after which the child underwent a detailed echocardiography to observe the findings and to chart out the surgical process for correction of the defects. The attending doctors were faced with 3 choices:
1. A simple surgery in which the entire oxygen poor blood would be diverted into the lung arteries that would at best give a limited life to the boy with an inferior quality.
2. Plugging the hole in the heart and installing an artificial tube from the left chamber to the artery carrying the blood to the lungs. A sub -optimal pump would have to be assigned to pump blood in this option.
3. An extremely complex repair to make the natural pumping chamber the main pump of the heart so that a near normal life and longevity of life was ensured.
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Additionally, there were high chances that a pace maker to correct the heart rate and repair heart block would be required to be installed owing to the inherent nature of the problem. In the case of Sanket, the surgeon would have to be extremely careful while trying to plug the hole in the heart so that a heart block is not triggered.
After a lot of discussions and thinking, the option of complex repair was chosen by a team of doctors comprising a cardiac surgeon, an intensivist and an anaesthetist. Plan B was also in place should Plan A fail for which the patient was worked up. The pressures in the lung arteries were checked with the help of a cardiac catherization test so as to be prepared for the second surgery if the need arose. All the steps of the surgery were discussed and planned meticulously right from the opening of the chest to closing it.
The operation went smoothly and like clockwork, because of which the operating time was reduced as well as the time required to use the bypass machine while the heart was being operated upon. The lesser amount of time required ensured minimum injury to the lungs and heart. This meticulous planning and execution bore fruit and resulted in the child being taken off the ventilator the very next day after the surgery. The blood pressure medication too had only to be given for a small period. The boy is now taking food orally and is in the ICU.
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Dr Shreepal Jain, Senior Paediatric Cardiologist of the hospital, said, “This case highlights the importance of team work, meticulous planning and perfect execution in the entire peri-operative period. Very few hospitals in the country have the kind of surgical expertise and infrastructure required to carry out such a complex surgery on a kid. By undertaking this route, we have provided Sanket with.”
The successful execution of this complicated surgery, shows Sir H N Reliance Foundation Hospitals’ enthusiasm to succeed and stretch the frontiers of science to help humanity. The team of doctors too were inspired to continue breaking the status quo.
The children coming for treatment at Sir H N Reliance Foundation Hospital are ensured that “quality will never be compromised.” They will always get the best medical option and not just keeping the ease of the operation or immediate safety of the procedure in mind.