Defying all odds: The story of a seven hour surgery
August 28, 2020
Seven-month-old Musmiri Riyanshi is the only child of Bathini Mamatha and Musmiri Balakrishna from Medak in Telangana. Born in a government hospital, within a month Musmiri began to show a bluish discoloration of the lips along with difficulty in breathing. She also faced a lot of problems in taking feed. This worried the parents, so they took her to a government hospital. While examining, the doctor detected a murmur and suspected aCongenital Heart Defect. They were referred to a private diagnostic centre in Medak for further evaluation.
An Echo was conducted and the diagnosis revealed that Riyanshi was suffering from a complex heart defect called theTransposition of Great Arteries (TGA) with multiple VSD’s (holes in between the lower chambers of the heart). Moreover, there was a major obstruction in the Descending Aorta (Coarctation of Aorta). Parents were advised to consult a pediatric cardiologist in Hyderabad for the future course of the treatment.
Bathini and Balakrishna were extremely worried that their only child had a major heart defect and they did not know what to do. As time passed, Riyanshi’s problems also increased. A pediatrician in Medak referred them to Krishna Institute of Medical Sciences. Due to the Covid-19 lockdown, no transport was available. The treating doctor helped them in arranging an ambulance from the government.
On arrival at the hospital, an Echo was done and the diagnosis was confirmed. Parents were counselled regarding the risks involved in the surgery.
Since Balakrishna is a chemist earning Rs 7166 per month, he was unable to arrange the required money for Riyanshi’s treatment. The hospital reached out to us for further support and with help from WPP CSR India Foundation and State Government Insurance Scheme, Riyanshi was operated upon.
The child underwent a complex cardiac surgery that included an Arterial Switch Operation with closure of multiple VSDs and simultaneous repair of Coarctation of Aorta through midline sternotomy on cardiopulmonary bypass (CPB). It was also noted that the child had only one coronary. In a normal heart there are two coronaries. The single coronary was translocated with anterior pericardial hood. The repair of coarctation of aorta was done along with augmentation of the hypoplastic aortic arch without using circulatory arrest by adopting a technique called selective cerebral perfusion. For augmenting the arch and for the anterior pericardial hood of the single coronary artery, bovine acellular pericardial patch was used.This patch would not calcify in future and would promote normal growth of the surrounding tissues. The surgery lasted for 7 hours.
The difficult combination of arterial switch operation with association of single coronary artery, multiple VSDs and coarctation of aorta is a very high-risk surgical challenge.
Luckily, the post-operative period was uneventful. Riyanshi recovered and was discharged in a stable condition.
