Jan 19 2010
- Faith by Their Side, This Case Challenged Medical Excellence
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)