19 June 2010
By Malathy Iyer
Mumbai, India
BABY BLUES: Aniruddha was born with his heart on the right and his great arteries transposed
Investigations revealed that his arteries were transposed–the aorta and the pulmonary artery were not arising from the usual chambers of the heart.
But doctors also found a rarer anomaly. Some of Aniruddha’s vital organs, including his heart, had switched positions and were located on the opposite of their normal side. The baby’s heart is on the right of his chest–a condition known as dextrocardia–as is his stomach, while his liver is on the left, says Dr Swati Gharekar, paediatric cardiologist at Kokilaben Ambani Hospital in Andheri (west), who visits the medical school at Somaiya Hospital, Sion, where Aniruddha was brought.
When Aniruddha was operated on less than two weeks after birth, surgeons at Kokilaben Ambani Hospital took an extra hour to rectify his problem. Doctors say the farm labourer’s son, now 20 days old, is taking feeds from his mother and is ready to leave the hospital in a couple of days.
Aniruddha’s surgery shows that even neonates (babies who are less than one month old) can be operated on and lead normal lives, say paediatric heart surgeons Dr Suresh Rao and Dr S Mohanty.
(Names of the family and child have been changed on request) ‘Babies heart care: Age no bar’
Mumbai: Just a few hours after birth, baby Aniruddha turned blue. His arteries were transposed, and some vital organs, including his heart, had switched positions and were located on the opposite of their normal side. In a rare condition, the baby’s heart and stomach are on the right, while his liver is on the left. The baby was operated upon less than two weeks after birth at the Kokilaben Ambani Hospital, Andheri (west).
Paediatric heart surgeon Dr Suresh Rao, who has done over 200 switch operations, says he only remembers one other child who had dextrocardia, plus a similar heart defect. "When we operate on a heart that has its apex on the right side, it is like operating on a mirror image and requires us to be extra mindful," he says.
Dr Anil Patwardhan, chief of the civic–run KEM Hospital’s cardiothoracic surgery department, says Aniruddha’s condition is a result of an unusual combination. Transposition of the great arteries is rare, and when combined with a heart that has its apex in the right, it is indeed unusual, says Dr Patwardhan, who says has he has never operated on such a combination. "At KEM hospital, we had a few cases of another defect along with right–apex heart."
Aniruddha’s father Ravindra Kadam, a farm labourer in Raigad, is still trying to absorb the import of his son’s condition. The cost of treatment was an issue too. "We had organised Rs 1 lakh by selling the family’s jewellery, but then the hospital waived off the entire cost of Rs 2.25 lakh that was initially cited," Kadam adds.
Dr Rao says, "Because of better detection and facilities, we operate on neonates and monthsold babies," he says, adding that it is the lesion in the heart and not the age or the weight of the baby that is the determining factor.
(Names of the family and the child have been changed on request) Transposition Of Great Vessels
WHAT: It is a congenital heart defect in which the two major vessels that carry blood away from the heart–the aorta and the pulmonary artery–are switched (transposed). As a result, there is decreased oxygen in the blood. Low blood oxygen leads to a bluish–purple color to the skin–blue baby syndrome–and shortness of breath. HOW: In hearts with transposition of the great vessels, the blood goes to the lungs, picks up oxygen and then goes right back to the lungs without ever going to the body. Blood from the body returns to the heart and goes back to the body without picking up oxygen in the lungs. TREATMENT: The baby will immediately receive a medicine called prostaglandin through an IV. This keeps the ductus arteriosus open, allowing some mixing of the two blood circulations. A surgery, Arterial Switch Procedure, is used; it switches the great arteries back to the normal position and keeps coronary arteries attached to the aorta. OUTLOOK: After an arterial switch, most infants do not have symptoms and lead normal lives.
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