The doctors at the newly established Apollo Children’s Heart Hospital at Hyderabad have performed a rare and complex cardiac surgery on a ten-day-old child and a twenty-day-old child born with Transposition of Great Arteries (TGA).
One child was suffering from TGA alone and the second child had an additional abnormality (has single coronary artery instead of two) that usually places one in a high surgical risk. Such children are technically demanding and have high surgical mortality even in the best centres worldwide.
Dr KS Murthy, consultant paediatric cardiothoracic surgeon, Apollo and his team has successfully conducted the operations on these two children, both have been discharged and doing well. He performed these surgeries using an innovative technique that is described by him and is widely acclaimed as a novel technique that prevents acute complications in the immediate recovery period.
TGA is the congenital heart defect that occurs when the large vessels, which take blood away from the heart to the lungs, or to the body, are improperly connected. It is the second most common congenital heart defect that causes problems in early infancy. It occurs in five to seven per cent of all congenital heart defects.
“In India around 5,000 to 7,000 babies are born with TGA every year and the baby with this defect needs to undergo the corrective surgery within one month,” says Dr Murthy.
In a normal child one artery takes blood from the right side of the heart to the lungs for oxygen. A second artery takes oxygen-rich blood from the left side of the heart to the body. But in TGA, these two major arteries are reversed. The babies with TGA have two separate circuits- one that circulates oxygen-poor (blue) blood from the body back to the body, and another that re-circulates oxygen-rich (red) blood from the lungs back to the lungs.
According to Dr. Murthy, infants with TGA will have oxygen-poor (blue) blood circulating through the body -- a situation that is critical. Because of the low amount of oxygen provided to the body, TGA is a heart problem that is also labeled as ‘blue- baby syndrome’.
The obvious indication of TGA in a new- born is the baby becoming blue on the day of birth itself. This symptom can be noticed within 12 hours of a child’s birth. The other symptoms could include rapid and laboured breathing, rapid heart rate etc,.On notice of these symptoms, an eco- cardigram test can be conducted.
The surgical correction of TGA called ‘Arterial Switch Operation’ is carried out by splitting the breastbone and exposing the heart for surgery. A heart-lung machine is used to do the work of the heart while the heart is cooled, stopped, emptied and opened. Then the aorta and pulmonary arteries are disconnected and reconnected to their proper ventricles. After this the heart-lung machine is withdrawn and the heart is then restarted. The advantage of this technique is it avoids complications of handling coronary arteries.
Through this mode, post-operative course is minimized. This heart surgery costs around Rs. 1.1 lakh – Rs. 1.2 lakh in India. In US, it is found that for an open heart surgery one needs to spend at an average US $15,000- 25,000 and in cases with complications, the cost may go up to US $ 40,000.
Dr Murthy has worked in children heart institute in New Zealand, and is credited with performing more than 4000 cardiac surgeries including five surgeries relating to TGA (which he conducted earlier in Chennai) and has innovated several surgical techniques. His team at Apollo Children’s Heart Hospital consists of Dr Subhash C Reddy, a paediatric cardiologist who has been working for 12 years at Children’s Hospital of Pittsburg, USA, besides Dr Kinnari Bhatt (anaesthetist), Dr Anil Kumar (surgeon) and Dr Vishal Singh (intensivist).
Dr Murthy has created this technique two years ago. This kind of surgery is now performed in hospitals operating in cities like Delhi, Kochi, Bangalore, Chennai and recently Hyderabad.