While 17-year-old Anwar from a small village in Saunsar tehsil in Chhindwara district was being operated for a rare cardiac defect at a city hospital his relatives and grandparents prayed from him at Mecca-Madina.
The family was aware that the chances of his survival were extremely remote as both the disorder and the surgery were equally rare. But, call it faith or wonder of science, the boy survived the surgery and is now hail and hearty. Dr Avinash Sharma, cardiac surgeon at the Sri Krishna Hrudalaya performed the open heart surgery successfully giving new lease of life to Anwar.
Anwar's father Abdul Qureshi, who despite being a poor farmer understood the complexities and risk involved in the operation, is all praise for the doctor's team who detected the problem and treated it correctly. The team led by Dr Mahesh Fulwani, cardiologist who diagnosed the congenital (birth) defect which in most cases would have killed the person before the age of one, passes on the credit to anaesthetist Dr Vinay Kulkarni who actually drew Dr Fulwani's attention to a minute and important parameter monitored pre-surgery.
"The patient had come to us with history of a common defect called ASD (atrial septal defect). He had undergone regular check-ups from doctors at Chhindwara and at Nagpur since six years old for ASD and was on regular medicines. So we were to operate him for it when he came to us. But the night before the surgery Dr Kulkarni noticed that oxygen level in blood was very low. This called for further investigations which helped me get to the route cause which was much more than ASD," said Dr Fulwani.
Dr Fulwani did not hesitate in admitting that had they opened up the patient for ASD without picking up the rare disorder medically called as 'total anomalous pulmonary venous connection (or TAPVC) to coronary sinus with ASD and pulmonary stenosis', the patient would have died on the operation table.
But the Echo test conducted after realizing the low oxygen level led Dr Dulwani to conduct an angiography. The actual defect was picked up then. "I wonder how the boy survived with the defect for 17 years. But closer observation showed that the entry into the lungs of main blood vessel was too narrow which prevented lungs from overflowing with blood," he said.
Dr Sharma tells that the defect is known to occur in just 1-3% of all the heart birth defects. And of these coronary sinus is occurs in 10% cases. In Anwar's case the purified or oxygenated blood from lungs by all the four veins from veins from the lungs was getting shunted to the right side of the heart into the coronary sinus instead of draining into left atrium (upper left half portion of heart). The huge amount of blood from the four veins in turn was again flowing to left atrium from the hole between the two chambers (ASD). The flow of mixed blood into the lungs caused the entire problem of breathlessness. This makes the body appear bluish.
"I could reroute the pure blood from veins coming from lungs via the sinus into the left atrium. The ASD hole was also closed. The narrowed opening into lung was also opened up. All this was done by taking the entire flap with four veins to together to take blood to the heart. Patient was discharged on seventh day and will require no further surgery in life again," said Dr Fulwani.
Dr P K Deshpande, the senior-most cardiac surgeon in the city, admits that both the surgical procedure as well as the disorder is not common. But he himself has done two such cases in the past 20 years on two patients aged 23 and 16. "Recognizing the defect in fact to me is more important than the surgery," he remarked.
SURVIVAL INSTINCTS
The problem
A rare birth defect in heart which instead of taking purified blood from veins coming from lungs takes it to the right part of heart instead of left
Pure and impure blood was getting mixed and flowing back into lungs
There was a hole between the two upper chambers of heart which carry purified blood
The opening into the lungs carrying blood was very narrow
The mixed blood was flowing back into lungs
Solution or surgery
Blood flow was rerouted by taking all four veins from with the flap to left atrium.
ASD was closed.
The pulmonary stenosis (narrowed blood vessel to lung) was opened up
No comments:
Post a Comment