Bangalore's Manipal Heart Foundation (MHF) has performed a 'double switch procedure' to rectify the functioning of the heart valves. The procedure was performed for the second time in India, the first being done at All India Institute of Medical Sciences (AIIMS).

In India, the AIIMS, New Delhi, was the only centre, which has published data on this procedure. The 8-hour surgery was performed by Dr R C Srivyas, cardio thoracic surgeon, MHF and his team on a teenage patient who was suffering from congenitally corrected transposition of great arteries [ccTGA]. The valve, which was used for rectifying the defect, was of cadaver organ donation. MHF performed the surgery at a much-reduced cost.

The patient was born with a condition in which the lower chambers [ventricles] are interchanged [right to left and vice versa]. The defect resulted in an abnormal communication between the two ventricles allowing the mixing of pure and impure blood. "If the condition is neglected, then the right ventricle fails as it is not designed to support the high pressure systemic circulation," explained Dr. Srivyas.

The double switch procedure involves establishing the normal physiology. Dr. Srivyas did a Sennings operation, where the blood from the atrium was directed to enter into the respective ventricles by creating an intra-atria redirection of blood flow. The blood was directed to the aorta and pulmonary artery by creating an intra ventricular tunnel and a homograft conduit or a cadaver artery with valve. The procedure is referred to as Rastelli operation. "Even though it is technically complex, it promises a normal life to the patient," he added.

The cost of surgery was subsidised to Rs. 94, 000. However the actual cost would have been Rs. 1.29 lakh. Midtown Rotary Club, Bangalore provided the financial aid for the patient. The homograft [cadaver artery with valve] used for the surgery was donated by the 'Brain Bank' set up by Dr. Sankar at NIMHANS who collects the organs at medical autopsy after consent from the families of the deceased. Dr. Srivyas, who has performed 75 heart transplants and 25 lung transplants said that awareness of cadaver was very low in India, although doctors in New Delhi are encouraging the same to save lives.

There are only few centres in the world that perform this procedure. The usual treatment followed in most centres in the world is a palliative procedure like VSD closure, relieving obstruction to the pulmonary blood flow or a shunt operation. But as there is no change in the function of the congeniality switched ventricles, the right ventricle fails.