BEST CARDIAC SURGERY

BIRTH DEFECTS OF THE HEART

PRESENTATION

Birth defects of the heart may present immediately after birth with breathlessness and failure to take feeds. The pediatrician will have to detect these defects. Usually these defects are in the form of holes in the heart leading to abnormal flow of blood between the chambers. If not corrected, these defects may limit the life span. These are acyanotic heart diseases which do not usually have bluish discoloration of the lips and the fingertips

There are other defects with gross abnormality of the chambers of the heart and there may be mixing of pure and impure blood leading to blue color of the lips and fingernails. There may be swelling of the ends of fingers and toes (clubbing) or there may be a tendency to fall down and become breathless suddenly. These blue babies can be treated by corrective surgery. These are cyanotic heart diseases and they have bluish discoloration of the lips and tongue and the fingertips. The ends of the fingers may have clubbing and appear like drumsticks.

PREVENTION

As these are birth defects, we cannot do much to prevent them from appearing. However, we can be forewarned by doing fetal scans(ultrasound scans of the baby before birth). Fetal medicine is a growing field and we do not find many who are experts at the prenatal diagnosis. One such centre in Hydrabad is the Amruta Scan Centre Ameerpet, Hyderabad (phone +91 9391005502)

TREATMENT

Treatment of these lesions is by corrective surgery called intracardiac repair. Surgery in the early childhood is more risky than surgery in adults and there is need of extreme care especially in the postoperative period. In case of non-correctable lesions, one may have to think of heart transplant

Above a few of the conditions are described so as to enable the reader to get illuminated about preventive care.

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RARE CASE: FONTAN SURGERY PATIENT HAS LIVE PREGNANCY

Six years ago, a 16 year old girl with univentricular heart (single ventricle) underwent Fontan surgery (total cavopulmonary connection). Being an adult case at the time of surgery, she did go through a stormy postoperative period. She faced severe problems at that time with her hemodynamics.

Over the years, she has gradually improved and was carrying on her life. She eventually got married last year and then had a pregnancy. We wondered as to whether to allow her to undergo the stress of going through pregnancy. We finally allowed her to undergo the pregnancy as her condition was good.

She reached full term and underwent a caeserian section done by Obstetrician Dr Prameela Shekhar and the anaesthesia was managed by Dr U Srinivas. In the world, there are very few reports of Fontan surgery patients undergoing live childbirth. This makes the case a rare one and shows that the team effort between us and the Obstetric team along with anaesthesia is one of the best and also a standard one of international calibre.





SURGERY FOR CONGENITAL HEART DISEASE

Certain children are born with the congenital defects or birth defects, which are because of improper formation of the heart. The children are usually very sick although some of them do not have any symptoms till they grow up. In patients in whom the oxygen does not reach the blood, there is a blue color to the whole body and these patients have breathlessness or have to squat while playing and sometimes go into a state described as “spell”. If the patients present at younger age, they usually are sicker and need earlier surgery and of course the results may not be that good.

Operations usually need good anaesthesia support as these children are very sick and the margin of safety is very less. One needs more life-support modalities and hardware and experienced nursing care for children because children are not just “small adults”.

We have performed about 582 pediatric cardiac surgeries in these last 3 years and are happy to see the children growing well.



BILATERAL NEONATAL PNEUMOTHORAX

went home successfully. As no IPPV was administered to the baby, I wonder as to how it actually occurred