Cardiac wonder saves lives

Amazing Arterial Switch operations now in Sri Lanka:

by Indeewara Thilakarathne

It would have been a crucial moment for the team of cardiac surgeons as they were about to perform a critical Arterial Switch operation on a seven-week old baby girl.

The baby girl was diagnosed suffering from a complex heart condition known as Transposition of the Great Arteries (TGA) and the condition without any clinical intervention, at this stage, would have been fatal with 90 per cent babies dying within the first month from birth.

In the same ward , a seventy seven-year-old man occupied the next bed, who was also to undergo critical heart surgery on the same day as the baby was being dressed up for the operation.

The successful surgeries were performed by a team of cardiac surgeons at Apollo hospital in the first week of January 2007. The team was led by the eminent cardiac surgeon Dr. Prasad Krishnan.

"The baby was just under two months and was suffering from a complex heart condition known as Transposition of Great Arteries (TGA). This condition without any medical intervention would have been fatal, with 90% of babies dying within the first months.

The challenge was performing an Arterial Switch Operation on a tiny baby with a heart the size of a strawberry with a less than 0.1 mm accuracy. Apollo hospital Colombo claims that it is the only hospital which is equipped to do such operations in Sri Lanka "said jubilant Dr.Krishnan after successfully performing the life saving operation.

"The satisfaction after saving the lives is indescribable "acknowledged Dr. Krishnan attributing the amazing feat to technological advancement in the field of medicine and the dedication of the highly qualified team of surgeons at the Apollo hospital.

Dr.Krishnan, a resident surgeon at Apollo hospital, is the recipient of the Gold medal for original work by the Sri Lanka Heart Association in 2004. Dr.Prasad has over 20 years clinical practice in adult and paediatric cardiac surgery with training at the renowned Mayo and Cleveland Clinics in the USA.

Another surgery was performed, at the same time, in the same ward, on a septuagenarian who required Coronary Artery Bypass Grafting (CABG) for severe coronary artery disease with angina and a previous severe heart attack, causing considerable damage to the heart muscle.

CABG restores blood flow to the heart muscle providing alternative routes for blood, bypassing the blocks caused by cholesterol deposition and blood clots, virtually starving the heart of oxygen killing the heart muscle.

According to Dr.Krishnan, the CABG operation is much simpler surgery compared to switching operation performed on a seven week old baby as the surgeons have to maintain a high degree of accuracy with a heart the size of a strawberry.

However, in this particular case, it became complex due to the person's age and damaged heart.

"Coronary Artery Bypass is the commonest type of heart surgery performed the world over on adults and constitutes around 50% of our workload.

However, this case is more complex due to the gentleman's age and damaged heart, from the attack, which rendered his heart surgery in the 8th decade of life more complex and riskier compared to surgeries in the 5th or 6th decades of life.

Despite this, CABG is a much simpler operation to do as compared to an arterial switch as the structures are much larger in an adult "said Dr. Krishnan.

"Under this particular condition, nature developed a heart disease. Connections got the wrong way. So when blue blood comes and goes back into the heart, these children could not absorb oxygen into the blood circulation.

This leads to almost certain death soon after the birth. "said Dr.Krishnan describing the delicate nature of the surgery.

The condition known as Transposition of Great Arteries (TGA) is a hereditary ailment often determined by the genes at birth with 90% of babies dying within one month from birth.

Oxygen to the heart muscle is blocked and the baby is like a proverbial fish out of water, unless clinical intervention is made immediately, the child will die due to lack of oxygen.

Most of the children die due to shortage of medical facilities. However, after performing the successful Arterial Switch Operation, a child can lead a normal life as any other children.

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