Open heart surgery without any blood transfusion on a 2-year-old with complex blue baby syndrome

Jan 19 2010

A team of cardiac experts led by Dr. N S Devananda, Consultant Cardiac Surgeon, Wockhardt Hospitals, Bangalore (Now a Network Hospital of Fortis) has performed a major open heart surgery on a 2-year-old baby from Nigeria. Baby Brendan was suffering from congenital heart defect called - Tetralogy of Fallot or complex blue baby syndrome.

"Baby Brendan was brought to us in a condition which was complicated and need surgical intervention to correct the anomaly. In this syndrome the pure and impure blood gets mixed in the heart and the amount of blood flow to the lungs is decreased. It is the most common complex heart defect, representing 55-70%, and the most common cause of blue baby syndrome. It can prove fatal if it is not treated in time," said Dr. N S Devananda, Consultant Cardiac Surgeon, Wockhardt Hospitals, Bangalore (Now a Network Hospital of Fortis).

The other bigger challenge which came before the surgery was the fact that the baby's parents belonged to the Jehovah Witness community and as per their religious belief they oppose to any form of transfusion of blood and any blood products however they could accept other from of treatment. This made the case all the more complicated.

"Babies with Tetrology of Fallout have two treatment options - the first is palliative where no open heart surgery is done and the defect is treated with shunt operation. The second is complete repair - which is definitive treatment where the patient undergoes an open heart surgery with a heart lung machine. In the case of Baby Brendan we obviously chose the second option due to its curative value. But the problem we faced was that the heart lung machine requires 500 ml of blood by itself to drive away the air and still haemoglobin at acceptable level. The challenge was with the baby weighed only 11 kgs and his blood volume was 800 - 900 ml and to conduct an open heart proved difficult without additional usage of blood" said Dr. Devananda.

The team devised many things technically to make operative time shorter and do the best possible ways so that re-operation or re-exploration can be avoided and the ICU stay is reduced. The heart lung machine circuit was modified in such a way that total priming volume was reduced to the least possible; the haemo-filteration technique was used in such a way that excess water from the body is removed and it gives back the RBC's to the body. We also had to reduce the sampling to the least possible for various tests.

"We did everything technically possible to reduce the requirement of blood. With all these modifications the baby underwent the open heart surgery and was out of ICU within 24 hours and is flying back to his native on the 7th post operative day. In an era where a lot of talking is happening around blood transfusion and adults have been undergoing surgery without blood transfusion, the same thing on a child is quite complicated. However with technical modification and surgical skills it is definitely possible and should be encouraged so that no child from the community remains untreated" said Dr. Devananda.

Brendan can live an active life like any other child of his age as this is a one time complete correction and his post op ECHO is satisfactory.

Brendan's mother Ettieh's faith in Jehovah has strengthened after this incident. She says, "Everybody should give proper attention to their child and keep monitoring the health of the baby time and again. Till one year when Brendan was not keeping too well and was not gaining weight we got very concerned and kept taking to the local physicians in Nigeria. However nobody could give us a proper answer to his continuous ill health until last year August, 09 Brendan complained of breathlessness and pain on his left chest. A thorough examination indicated that my baby has some heart complication which needed to be treated immediately. Being a member of the Jehovah Witness community our challenge was to take Brendan to the right hands where surgery was possible without using blood transfusion. That's when one of our friends at Nigeria who knew about Wockhardt Hospitals, Bangalore (Now a Network Hospital of Fortis) and their expertise in performing surgery without blood transfusion suggested us and we finally decided to fly Brendan down here for treatment. Initially when we decided to come to India for treatment I was engulfed with mixed feelings, but with the kind of care and response we received here I was quite confident that I have brought my baby to the right place."

SOURCE Wockhardt Hospitals Bangalore (Now a Network Hospital of Fortis)