Atrial Septal Defect surgery

4 year male child who came with complaints of poor weight gain. On evaluation, he was having a large Atrial Septal Defect (ASD) with very poor margins all around with dilated heart chambers. Family was counselled in detail regarding the requirement of surgery for ASD. ASD surgery was done through midline. Child was discharged on 4th post-operative day in stable state. On follow-up, child is doing well and now gaining weight.

Getting freedom from pain in lower limbs

Balloon Dilatation of Corctation of aorta with VSD device closure

  • 7 year child from Uzbekistan came with history of frequent leg pains specially on running and playing.
  • On examination, his vitals were stable with pansystolic murmur (abnormal heart sound heard on chest during examination). There were weak pulses in bilateral lower limbs.
  • On evaluation, child was having moderate sized “Ventricular Septal Defect” with severe “Coarctation of Aorta” (VSD with COA) on echocardiogram.
  • His chest X ray and ECG were normal for the age.
  • Family was counselled regarding the requirement of immediate ballooning of narrowed blood vessel (aorta, coarctation of aorta segment) along with VSD closure by angiographic technique (VSD device closure).
  • After taking written consent, child was taken to cardiac cath lab for Ballooning of coarctation of aorta followed by VSD device closure in the same sitting.
  • He underwent above mentioned procedure successfully with no complications.
  • Post procedure, child was kept on oral medicine (Aspirin) for 6 months.

Bringing back a hearty smile

PDA LIGATION

  • Preterm 1.2 kilogram baby referred from another hospital on non-invasive ventilatory (CPAP) support.
  • Child was tachypneic (breathing difficulty), having rapid heart rate.
  • Chest X ray showed increased lung vascularity (pulmonary plethora)
  • ECG was non-conclusive.
  • Echocardiogram done which showed Large Patent Ductus Arteriosus (PDA) of size 4.5 mm with enlargement of left atrium and left ventricle (dilated cardiac chambers).
  • After counselling the family regarding the necessity of PDA closure by surgical method (PDA ligation), baby was taken for the surgery.
  • Surgery was done and child remained stable in next 2 days and discharged in next few days.
  • On follow up, now the child is one year 5 months and is gaining weight.

Waiting for the right time

  • 6 months “African” child came for closure of PDA.
  • On evaluation, child was having features of Down Syndrome with laboured breathing and saturation of 75% in both upper and lower limbs with prominent heart sounds (loud S2).
  • On echocardiogram, child was having moderate sized PDA with severe increase in lung pressures (Pulmonary Arterial Hypertension, PAH).
  • Child was admitted in view of difficulty in breathing and kept under ICU care.
  • On further evaluation, child was having snoring and diagnosed as a case of sleep apnea with obstructed airways (OSA).
  • Child kept on CPAP support (non-invasive) ventilation for a long time and discharged on Bi-PAP support
  • PDA was not closed in view of high lung pressures.
  • Child is on regular follow-up for last two years and now off Bi-PAP support (child is on room air) and now his PDA is shunting mainly in favourable direction.
  • Further plan is to close the PDA in follow-up depending on his lung pressures.

Balloon Pulmonary Valvuloplasty (BPV)

  • 11 months “CONGO” child came with history of abnormal sound in chest with the diagnosis of narrowing in pulmonary artery (pulmonary stenosis).
  • His vitals were stable with normal saturation.
  • Echocardiogram done which showed severe narrowing in pulmonary valve (severe pulmonary stenosis) that required immediate balloon dilatation of pulmonary valve in cardiac cath lab (known as Balloon Pulmonary Valvuloplasty; BPV).
  • After taking informed written consent, child was taken to cath lab and by angiographic technique; his pulmonary valve was opened by using a balloon.
  • Post-procedure, child remained stable and is on regular follow-up.
  • Last follow-up showed well opened pulmonary valve.

ASD Device Closure

  • 10 years, 15 kilogram child from Jammu, India came with history of poor weight gain.
  • On evaluation, child was having an abnormal heart sound (wide and fixed spilt second heart sound).
  • Echocardiogram showed a large Atrial Septal Defect (OS-ASD) with dilated RA/RV (dilated cardiac chambers).
  • ASD was suitable for closure by angiographic technique (ASD device closure).
  • She underwent device closure and discharged on next day.
  • She was kept on oral aspirin tablet for six months.
  • Now, after more than twelve months, she is gaining weight and doing well on follow-up.

Pericardiocentesis

  • 4 year old girl child who was having history of fever with mild cough and cold.
  • Her vitals were stable.
  • Chest X ray showed large cardiac shadow.
  • ECG was suggestive of pulsus alternans.
  • Echocardiogram done which showed massive collection around the heart (pericardial temponade).
  • Family was counselled regarding the urgent removal of collection around the heart (Pericardiocentesis).
  • Child was taken to cath lab (without open heart surgery) for drainage of collection under fluoroscopic and echo guidance.
  • Approximately 250 ml straw coloured fluid was aspirated and that came out
  • Child was treated with steroids and anti-tubercular medicines (ATT) and now after 6 months, ATT stopped
  • Repeat echocardiogram did not show any signs of constriction around the heart.

Device Closure of PDA

  • 8 months male child came with history of poor weight gain since birth.
  • His vitals were normal
  • There was a continuous murmur in chest while examining the child.
  • ECG and chest X ray were suggestive of dilated left ventricle.
  • Echocardiogram was done which showed moderate sized “Patent Ductus Arteriosus (PDA)”.
  • Family was counselled regarding the requirement of PDA closure by device technique without open heart surgery.
  • He underwent PDA device closure and was discharged on next day.
  • He was not advised any medicines after the procedure.
  • Now, after more than eighteen months, he is gaining weight and doing well on follow-up.

Balloon Pulmonary Valvuloplasty (BPV)

  • 5 kilogram female child who was having moderate sized Atrial septal defect with small ventricular septal defect (ASD and VSD) along with severe narrowing in Pulmonary Valve (pulmonary stenosis),
  • Her vitals were stable with normal saturation.
  • Echocardiogram showed severely obstructed pulmonary valve (severe valvular pulmonary stenosis) that required immediate balloon dilatation of pulmonary valve in cardiac cath lab (known as Balloon Pulmonary Valvuloplasty; BPV).
  • Plan was made and discussed with family that we will do only BPV and will not touch ASD & VSD as these will not cause any harm as of now.
  • After taking informed written consent, child was taken to cath lab and by angiographic technique; her pulmonary valve was opened by using a balloon.
  • Post-procedure, child remained stable.
  • His ASD and VSD remained as such and now she is very well on follow-up.
  • Last follow-up showed well opened pulmonary valve with mild pulmonary regurgitation.

ASD Surgical Closure

  • 4 year female child who came with history of abnormal heart sound in chest
  • Echocardiogram showed a large Atrial Septal Defect (OS-ASD) with dilated RA/RV (dilated cardiac chambers).
  • Her ASD rims were deficient so plan was made to close ASD by surgical method.
  • Open heart surgery was deferred in view of girl child so MICS surgery was planned.
  • Minimal invasive cardiac surgery (MICS-ASD closure) was done
  • In MICS surgery, there will a very little scar on right side of the chest (not in midline)
  • She was discharged after 4 days of surgery.
  • She is gaining weight and doing well on follow-up.

VSD Surgical Closure

  • “African” female child (one year) who came with history of poor weight gain since birth.
  • Her weight was poor and not able to walk and stand as well.
  • Her ECG and chest x ray were normal.
  • Echocardiogram showed a large ventricular septal defect (VSD) with dilated left atrium and left ventricle.
  • As child was having low weight, there is high risk involved and after taking written informed consent, child was taken for open heart surgery.
  • She was discharged in 5-6 days
  • She is in constant touch with phone from her home country and now she is doing well and gaining weight.

VSD Surgical Closure

  • “Russian” child came with history of increasing breathing difficulty since birth.
  • On evaluation, child was having large VSD (Ventricular Septal Defect).
  • Child underwent surgical closure of hole.
  • Child is doing well on follow-up.

VSD Surgical Closure

  • “African” child, who came with history of very low weight and breathing difficulty since birth.
  • Echocardiogram showed large ventricular septal defect (VSD).
  • Underwent successful VSD surgical closure.
  • On follow-up, she is doing good with normal weight gain.

ASD Device Closure

  • 6 years girl child came with history of abnormal heart sound in chest.
  • On evaluation, child was having an abnormal heart sound (wide and fixed spilt second heart sound).
  • Echocardiogram showed a large Atrial Septal Defect (OS-ASD) with dilated RA/RV (dilated cardiac chambers).
  • ASD was suitable for closure by angiographic technique (ASD device closure).
  • She underwent device closure and discharged on next day.
  • She was kept on oral aspirin tablet for six months.
  • Now, after more than twelve months, she is gaining weight and doing well on follow-up.

VSD Device Closure

  • 4 years “Russian” girl child came with history of abnormal heart sound in chest (murmur).
  • On evaluation, child was having an abnormal heart sound (pansystolic murmur in left lower chest).
  • Echocardiogram showed a moderate sized “Ventricular Septal Defect (VSD)” with dilated LV (dilated cardiac chambers).
  • On evaluation, VSD was suitable for closure by angiographic technique (VSD device closure).
  • She underwent VSD device closure and discharged on next day with normal ECG.
  • She was kept on oral aspirin tablet for six months.
  • As per her translator, she is doing well in her home country.

Balloon Dilatation of Coarctation of Aorta

  • 10 year old male child from “CONGO” came with history of frequent leg pains while walking.
  • On examination, his lower limb pulses were absent along with systolic murmur all over the chest.
  • On evaluation, child was having “severe Coarctation of Aorta” (COA) with unicuspid aortic valve with “Severe Aortic Stenosis” (AS) on echocardiogram. Aortic valve was not in proper position, it was prolapsed.
  • Probably there was a Ventricular Septal Defect (VSD) that was closed by prolapse of aortic valve.
  • Family was counselled regarding the requirement of immediate ballooning of narrowed blood vessel (aorta, coarctation of aorta segment) leaving aortic valve for surgical palliation.
  • Aortic Valve Ballooning was deferred as it was prolapsed and while doing balloon dilatation, it may leak severely and lead to emergency like situation to the child.
  • After taking written consent, child was taken to cardiac cath lab for Ballooning of coarctation of aorta.
  • He underwent above mentioned procedure successfully with no complications.
  • Narrowed segment of Aorta opened well and there were good pulses in both limbs.

Tricuspid atresia heart disease

  • Tazakistan (Russian) patient underwent successful Fontan operation at BLK hospital for tricuspid atresia (Cyanotic congenital heart disease).
  • He came with history of increasing bluishness of lips and fingers (cyanosis).
  • He underwent Glenn operation few years back for single ventricle pathway.
  • After detailed evaluation, child underwent Pre-Fontan Cath study, and found suitable for Fontan operation.
  • Same was done and patient discharged on 5th day after operation and doing well on follow up.

Bringing back a hearty smile

Dilated Cardiomyopathy with Cardio-respiratory failure

  • 6 months old male child came in very sick condition with air hunger and difficulty in breathing.
  • He was diagnosed a case of severe left heart failure (Dilated Cardiomyopathy).
  • Immediately, child was admitted in PICU and intubated and ventilated.
  • Echocardiogram done which showed very poor heart pumping.
  • Child was treated with diuretics, inotropes etc.
  • His disease course was very fulminant and chances of recovery were very poor as child was not responding to medicines.
  • But fortunately, he recovered, and discharged in 2 weeks.
  • On follow-up, he gained weight with normal heart pumping (took almost 2 years for recover).

Saved a sick newborn from life threatening heart rhythm disorder

Supraventricular Tachycardia

  • 16 days old baby came on ventilator in sick state.
  • His heart rate was more than 300/min (normal is less than 160/min).
  • Echocardiogram showed very poor heart pumping.
  • ECG was done which showed signs of pre-excitation (WPW syndrome).
  • Baby was managed with IV medications (adenosine etc) but not responding.
  • DC cardioversion was done which was also not responsive.
  • Then multiple medicines were tried but all failed
  • IV Metoprolol was started for a long duration and now baby responded very well.
  • Patient discharged in 5-6 days and on follow-up, he is on medicines and is gaining weight with normal sinus rhythm in ECG.