Gurugram: Owing to the unprecedented circumstances due to COVID 19 pandemic optimal treatment of complex congenital heart diseases sometimes becomes a test of patience for a suffering child and the parents. 16 years old girl Monika faced much more than that as she was born with a complex heart disease known as Tetrology of Fallot with very small pulmonary arteries, in which there is a hole in heart with marked narrowing of the passage for blood flow from right side of the heart to the lungs. This leads to major limitation in the blood supply to the lungs and as a consequence the oxygen levels in the blood remain very low. She grew up with major restrictions in her physical activity as her parents found it financially difficult to get her corrective surgery done. Besides, Monika had an extremely rare blood group called Bombay Blood group, which is present only in 1 out of around 10,000 individuals, and amid COVID 19 pandemic with the unprecedented restrictions the arrangement of suitable blood group became far difficult. When there was no hope in sight, doctors started blood donation from the patient herself at an interval of 8 to 1o days and stored those units of blood for her surgery. Over it the ideal age of surgical correction required in this disease is 5 years of age which she had already crossed. Hence the whole process involved great risks and complications which required experienced supervision and great amount of patience. The surgery was performed by experienced Dr. Rachit Saxena, Senior Consultant, CTVS, Narayana Hospital, Gurugram. Now Monika has completely recovered and is back to her normal routine life.
Dr. Rachit Saxena, Senior Consultant, CTVS, Narayana Hospital, Gurugram said that, “Since the patient’s clinical condition was deteriorating, it not wise to wait further for COVID restrictions to be eased. She was even finding difficult to do her normal daily tasks like going to the wash room and at times she couldn’t even have a proper sleep due to breathing difficulty. We had waited for almost 4 months in an attempt to be able to find suitable donors but most of them refused to travel to Delhi for blood donation due to the pandemic. Hence, we came up with a bail out option of having the patient donate blood herself under strict medical supervision which would then be stored in our blood bank for her surgery. The basis of this approach was that in this kind of congenital heart diseases the haemoglobin of the patient remains around 20 gm which normally is around 12 to 14 gm in female children, although it is an abnormality but it was a blessing in disguise for us as we didn’t have to be worried about her haemoglobin count during the process. However, despite this it was definitely risky to remove blood from her circulation because her blood oxygen levels are very low due to her cardiac defects and therefore we had to ensure that blood donation should not cause any further fall in her blood oxygen concentration. We needed at least 4 units of blood for such a major cardiac surgery, and she being a cardiac patient weighing less than 50 kg could have had adverse effects due to blood donation. Secondly the maximum duration of storing blood safely is 35 days which meant we have to collect all the units of blood and also operate within one month of initiating the process of blood donation. We had discussed all the associated risks with her parents and with their consent we started this process. Doctors started giving her iron and folic acid supplements 2 weeks before the blood donation. All blood donations were done under cardiac monitoring”.
He further added, “Once this major issue of saving blood units was resolved we planned her for surgical correction. Here the first concern was occlusion of the abnormal vessels supplying the lungs which was done by our intervention pediatric cardiologist. The next day she was taken up for the surgical correction wherein we closed the hole in the heart, removed the obstructive muscle bands from the right side of the heart to the lungs. The entire passage for blood flow to the lungs was reconstructed along with reconstruction of the pulmonary valve. She recovered completely and was fit for discharge from the hospital in just five days. Monika is now back to her normal life playing and enjoying life with her siblings with no restriction to her physical activity. I convey my sincere regards to my entire team of doctors and medical staff for cooperation and hard work for this successful surgery.”
With the advancements in treatments the process has been eased but still early diagnosis and immediate treatment is the key for any type of congenital heart diseases. It should not be delayed at any cost. As the child grows the complications rise and condition worsens as the time passes by. Narayana Hospital, Gurugram is always ready to provide best advanced healthcare services and treatment to its patients with its team of experienced doctors and staff.
