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Paediatric Cardiology
Case Studies |
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Kerala's
Tiniest Open-heart Surgery Patient to Date
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| September 2001 - A
23-day-old male baby, diagnosed with Transposition
of Great Arteries, Large VSD
and Aortic Coarctation was
admitted to AIMS in a marasmic
condition with a respiratory tract infection. His weight
at admission was around 2 kg, which reduced to 1.8 kg
due to a combination of poor feeding, the underlying heart
condition and the respiratory infection. In the ward the
child was given high calorie tube feeds and antibiotics,
which arrested the weight loss. When the baby reached
a weight of 1.9 to 2 kg, he underwent complex open-heart
surgery involving arterial switch operation, VSD closure
and repair of the aortic coarctation - all in one stage.
The baby had to be ventilated for a week as he underwent
elective delayed closure of the sternum. For the first
five days after the operation, he needed sequential atrioventricular
pacing after which he spontaneously reverted to
normal sinus rhythm, resulting in a rapid recovery. At
discharge on the 14th postoperative day the child weighed
2.3 kg, was pink and convalescing well.
Congratulations to the CVTS (CardioVascular and Thoracic
Surgery) Paediatric Cardiology Surgeons and for successful
completion of this complex surgery on such a small infant,
to the Dept. of Anesthesia for managing the lines and
ventilation, and the division of CV perfusion for achieving
excellence in perfusion in this tiny baby undergoing
a very prolonged and complex repair. Excellent Nursing
by the CVTS/OR and ICU nurses and the physiotherapists
helped in the rapid recovery of this baby.
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AIMS
Makes Headway in Treating Heart Defects
Without Surgery
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| September 2001
- Between 130,000 to 270,000 children are born with birth
defects of the heart each year in India. Holes in the
heart are among the most common of these birth defects.
Newer developments in technology now allow closure of
selected heart defects without an operation. The closure
is performed using devices and coils that are delivered
by a catheter. This avoids the pain and trauma of surgery
and allows discharge from the hospital on the same day
or the next day after the procedure. The procedures are
performed in the cardiac catheterization laboratory and
require no more than a needle prick in the groin for inserting
the catheter.
Atrial septal defect (ASD),
patent ductus arteriosus (PDA),
and selected ventricular septal defects (VSD)
are examples of heart defects that can be closed without
surgery. In the past 3 years, the doctors of the Paediatric
Cardiology Division have closed 100 atrial septal defects.
According to Dr. Krishna Kumar, Chief
Paediatric Cardiologist, the 100 atrial septal defect
closure surgeries performed at AIMS is the largest number
performed in a single center in South India. Nearly
400 PDAs have been closed at the hospital making AIMS
the largest center in the world for catheter closure
of PDA. The smallest child who underwent this procedure
at AIMS was 25 days old and weighed 2.5 kg. In the near
future the Paediatric Cardiology Division at AIMS plans
to develop and test newer and improved devices. |
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EXPLANATION
ON DIFFERENT HEART DEFECTS
Transposition of Great Arteries results
in the condition described in "blue baby".
This is a congenital cardiac irregularity in which the
pulmonary artery arises from the left ventricle and
the aorta from the right ventricle so that there is
no communication between the circulation between the
blood and breathing systems.
VSD - Ventricular Septal Defect, an
abnormal opening in the septum separating the ventricles,
permitting blood to flow from the left ventricle to
the right ventricle and to re-circulate through the
pulmonary artery and lungs.
Aortic coarctation is congenital cardiac
abnormality consisting of a narrowing of the aorta.
Marasmic condition - a malnutrition
disease resulting from the deficiency of both calories
and protein and characterized by severe tissue wasting,
dehydration, loss of subcutaneous fat, lethargy and
growth retardation.
Atrioventricular pacing - one type
of artificial electrical stimulation of a heart rhythm.
ASD - Atrial Septal Defect is a congenital
cardiac irregularity characterized by an abnormal opening
between the atria.
PDA - Patent Ductus Arteriosus is an
abnormal opening between the pulmonary artery and the
aorta caused by failure of the channel to close after
birth.
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| Abdominal Solid
Organ Transplant Programme |
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AIMS has been recognized
by the Kerala Government, Human Organ Transplant Act 1995,
for performing both live donor and cadaveric renal transplantations.
The programme assimilates the most modern technology for
the benefit of its patients. Dr. V.N. Unni, Consultant,
HOD, AIMS Nephrology Dept., has long been looking forward
to a kidney transplant programme at AIMS : "The only
real cure for end stage renal failure is transplant surgery.
Given any number of dialysis machines, there will always
be a maximum capacity for numbers of patients that can
be treated by dialysis by any institution. When a dialysis
patient receives a transplant, the dialysis machines are
available to another patient in need."
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Dr. VN Unni |
| Accomplishments - The first kidney
transplant at AIMS was performed by on 4th September,
2001. The patient's mother had donated one of her kidneys.
He and his mother were discharged after only ten days
with excellent prognosis. In the four months after inauguration,
five transplants were performed and all been completely
successful. Many more patients are awaiting compatibility
results with their potential donors before being accepted
for surgery. By March 2004, the department completed 50
live related transplants. We do not perform living transplants
from donors unrelated to the recipient due to the disreputable
and immoral nature of this form of transplants in our
country. Currently, the kidney is removed from the donor
by the key hole or laproscopic approach so that the cut
in the body, as well the recovery period, is considerably
shorter than the traditional open approach. |
| Staffing - The programme features
a dedicated team of medical professionals involved to
provide comprehensive package of care for the individual
renal transplant recipient and donor. The team includes
personnel from the departments of Nephrology, Vascular
Surgery , Urology , Anaesthetisia and Radiology together
with the nurses and anciliary staff in theatre and the
ICU. |
| Support Services - Our in-house,
state-of-the-art Molecular Biology Lab performs HLA Typing,
Lymphocytotoxic Crossmatches on all renal transplant patients.
We also carry out selective angiographies and MR scanning
from the Radiology Department for our live donors. We
have a team of renal transplant pathologists, microbiologists
and infectious disease experts to deal with the complex
issues involved in renal transplantation, plus transplant
surgeons, urologists, anaesthetists and selected dedicated
renal transplant nurses. The live related donors and recipients
are identified by the Nephrology Department, which offers
the full range of state-of-the-art dialysis facilities.
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Liver Transplantation
Liver transplantation is surgery to remove a diseased
liver and replace it with a healthy liver. It is the only
treatment modality for patients suffering from end stage
liver disease, unlike in kidney failure, where there is
the alternate option of dialysis. A liver transplant is
not a simple step to take, but it can save a patient's
life. Survival rates after transplant operations have
improved remarkably over the past several years. Currently
outside of India, over 80 to 90% of people survive liver
transplantation and enjoy a good quality life subsequently.
For a variety of reasons, despite the large number of
patients who die of liver failure, liver transplantation
has not had the same advancement as a kidney transplant
in India. AIMS has all the facilities for a liver transplant.
Our team involves multiple departments including GI surgery,
Hepatology, Anaesthesiology, Radiology, Transfusion Services,
Infectious Diseases, Microbiology, Histopathology, Nephrology
and dedicated ICU staff. |
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