Doctors at Mumbai’s Wockhardt Hospital have successfully treated 9-year-old Tejas Ahire who suffered from a complex congenital heart disease. The child was treated through a novel surgical and transcatheter technique. After the procedure, the child exhibited improvement.
The doctors performed the procedure, (which generally requires two surgeries months apart) by modifying the surgical technique at first stage so that the second stage could be done in the cath lab without surgery.
After examining Ahire’s reports, the doctors found that the child had transposition of the great arteries, which happens during fetal growth when the baby's heart is developing.
Transposition of arteries is a rare heart defect present during birth (congenital). In this condition, two main arteries leaving the heart are reversed (transposed). This heart defect requires surgery.
The doctors pointed out that transposition of the great arteries changes the way blood circulates through one’s body, leaving a shortage of oxygen in blood flowing from the heart to the rest of the body.
Without sufficient supply of oxygen-rich blood, the body can't function properly and the child was likely to have serious complications. Furthermore, he also had Ventricular Septal Defect (VSD) which is a hole in the wall separating the two lower chambers. It was also noted that the blood flow to his lungs had decreased.
The doctors said that such a complex defect usually requires surgery in two stages - (the first stage is called as a Glenn shunt and the second one is Fontan completion). An intracardiac repair could not be done because of the complex internal composition of the child’s body.
Hence, the only option left was Glenn shunt (second of three congenital heart surgeries performed to correct hypoplastic left heart syndrome (HLHS) and other single ventricle heart defects), followed by a Fontan surgery (third stage of the repair).
A heart catheterization is conducted before the Fontan or Uni-ventricular pathway which is needed in any congenital heart disease. Here, the two vessels carrying impure/deoxygenated blood from the body are surgically attached to arteries going directly to the lung in a staged manner.
In the first stage, a vessel carrying impure/deoxygenated blood is attached to the lung artery and in the second stage, the vessel (IVC) carrying impure/deoxygenated blood from the lower half of body is attached surgically via a tube to the artery to the lung which leads to draining of whole of the impure blood to lungs for purification/oxygenation and the oxygenated blood is pumped by the heart to the body.
Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Wockhardt Hospital said that in case of Tejas, in the 1st stage itself, the tube carrying blood from the lower body to the pulmonary artery was added, but the communication was closed using a membrane.
Dr Joshi added that the connection is made into the tube so that the deoxygenated blood gets directed to heart only, thereby avoiding sudden flooding of lungs and providing a platform to finish the 2nd stage in cath lab without the need for surgery.”
Six months later (February 2019), the completion of the Fontan was carried out in a cath lab by Dr. Manish Chokhandre, interventional pediatric cardiologist.
Dr Chokhandre perforated the membrane between the tube and pulmonary artery, and balloon dilated the communication and closed the other holes (which was directing blood to the heart) with a device so that the deoxygenated blood from the lower half of the body easily gets directed to the lungs.