Delhi: Docs perform complex heart surgery on 1-yr-old Iraqi girl

Doctors from a city hospital successfully performed a complex corrective surgery on a one-year-old Iraqi national whose heart was growing in a pouch-like structure protruding from the body.

Doctors at Max Superspeciality hospital, Saket, who conducted the operation, said the toddler was born with a condition called Pentalogy of Cantrell, a syndrome that results in five birth defects: a missing sternum (the central bone of the rib cage); a diaphragm not in place; a defect within the heart that causes mixing of oxygenated and deoxygenated blood; a missing pericardium (a flexible covering outside the heart to keep it separate from other organs in the chest cavity); and an absent upper abdominal wall leading to the intestines also pushing into the pouch-like structure next to the heart.

“I have been a surgeon for 20 years and I have never seen anything like this. Dr Dagar saw one case while he was in London. We reached out to several surgeons, did 3D scans of her chest, planned everything meticulously,” said Dr Sunil Choudhary, chief of plastic surgery, Max Superspeciality hospital, Saket.

Doctors said such babies mostly do not survive more than a few days as the protruding heart can easily get damaged without bone protection.

“We met many doctors in Baghdad but they refused to do the surgery as they did not have such experience. We decided to come to India as many said that treatment here was good. We had to wait till she was nine months old because of Covid-19 restrictions,” said her mother Zainat Mohammed.

She said, “We had to watch her carefully so that she didn’t touch her heart while playing. Now she can play like other children. She can go to school.”

Doctors said the first challenge was to create enough space within the small chest cavity to fit the heart so that there wouldn’t too much pressure on it as it pumped. The doctors moved her left lung to create space between the lung and diaphragm.

The defect within her heart also wasn’t a simple one. While mixing of oxygenated and deoxygenated blood can be stopped by plugging the hole in the heart, in this case, both the vessels sending the de-oxygenated blood to the lungs for oxygenation and the one bringing the oxygenated blood back to the heart were on the right side of the heart, making it difficult for the doctors to divide the chambers.

“We had to short the circuitry of the heart. Now the vessel taking her blood to the lungs completely bypasses the heart and goes directly to the lungs. The blood is pumped with the help of gravity and the suction created by the lungs during breathing. Whereas, the pumping mechanism of the heart is preserved for sending the oxygenated blood throughout the body. This had to be done because we couldn’t simply separate the two parts of the heart,” said Dr Kulbhushan Singh Dagar, director, neonatal and congenital heart surgery.

After the repair, doctors used a synthetic membrane to cover the heart so that it didn’t stick to other organs or the rib cage. The doctors also split open a couple of ribs to reconstruct the missing rib bone.

“Usually, in such cases, the floating ribs are used to create the cage. But, that might have impacted the growth of her chest cavity and she is only one. So, we had to do something that would ensure that she can live a healthy life,” said Dr Chaudhary.

Next, the doctors pulled together two of the eight muscles of the abdomen slightly to the side to prevent the intestines from reaching the chest cavity. The doctors also split the outer layer of the abdominal wall to create space in the abdomen.

“We detached and moved the muscles while preserving blood supply. In children, even the important blood vessels look tiny like capillaries but we cannot afford to lose them,” said Dr Chaudhary.

The child, who underwent the surgery a week ago, was moved out of the ICU in two to three days. She was discharged on Thursday.