Apollo Children's Hospital successfully performed a complicated Surgery on a Five Month Old Baby

Chennai: Apollo Children’s Hospital doctors successfully saved a new born baby by performing a high-risk procedure recently. The new born baby was presented to the hospital with a very rare condition called Left Atrial Appendage Aneurysm. Left atrial appendage aneurysm (LAAA) is a rare cardiac malformation that is reported very rarely.

When the five month old baby suddenly developed breathlessness her panicked parents brought her to Apollo Children’s Hospital on time. Dr CS Muthukumaran and Dr Anuradha Sridhar, Senior Interventional Paediatric Cardiologists, confirmed that the baby was suffering from this rare condition. The left atrium (the upper chamber of the heart) had developed an aneurysm, which had become so huge that it had already compressed the heart and lungs, distorting these vital organs.

The baby was struggling for breath both due to heart failure and lung collapse. She was admitted pre-operatively to the cardiac ICU to stabilize the heart. Within matter of hours the surgical team consisting of Dr Neville Solomon, Dr Musthafa Janeel Moosa and Dr V Swaminathan took the baby up for an open heart surgery. The surgery went uneventfully, and the aneurysm was closed off and excised.

Speaking further about this procedure, Dr. Neville Solomon, Paediatric Cardiac Surgeon, Apollo Children’s Hospital pointed out that, “The baby did not tolerate the procedure as the blood that was being accommodated in the aneurysm pre-operatively was being suddenly diverted entirely into the left ventricle, which is the main pumping chamber of the heart. The left ventricle failed and the mitral valve started leaking acutely. The condition was looking bleak and we decided to place the baby on ECMO (Extracorporeal Membrane Oxygenation). The heart was hardly contracting the first night. We added some critical life-saving medications to stablise.”

He also added, “However, over a period of 48-72 hours, the heart started to recover and we were able to get the patient off ECMO. With a few further days on ventilator and several days of intense care given by our doctors, nurse and technicians in the ICU, the baby progressed steadily and has been successfully discharged from the ICU.”

As we are comfortable operating on babies less than 2.5 kgs and in the new-born period, we offered surgery as we felt we should operate before the baby developed heart failure or stroke from this condition.

This condition is very rare with less than 5 cases among children below One year of age being reported and less than 10 children  cases among two years or younger. This condition possibly goes undetected or misdiagnosed. These high-risk surgeries should be taken up in tertiary centers such as ours with ECMO back up available and our ability to use this skilfully was a game-changer. The support from dedicated paediatric cardiac anaesthetists (Drs Rajagopal and Hema), intensivists (Drs Suchitra, Rajeswari, Priyavardhini, Vasanthkumar) and perfusionists (Mr Sundara Rajan, Sriram, Aneesh) and nursing team is vital for a successful ECMO program. Another important take-home message is that cardiac surgery in new-born babies is being done commonly and with excellent results provided they are done in high-volume centres. We feel baby would have sailed through more smoothly if done within the first month of life. About 10% of our work is on neonates (<1 month of age) and 40% of our surgeries are on babies less than 5 kgs in weight.

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