Complex cardiac surgery performed on a two-day-old neonatal at Apollo, Indore

During the surgery, the pacemaker was fitted in the abdominal cavity with its leads attached to the surface of heart

Complex cardiac surgery, Apollo, Indore, Congenital Heart Block, Paediatric Cardiac Surgeon

A 2-day-old female child (baby of Ms. Nishad), who was born at another hospital and was referred to Apollo Hospitals, Indore with heart failure and severe respiratory distress.

On examining the baby at Apollo Hospitals, Indore, she was diagnosed with Congenital Heart Block and her heart rate was less than 50 beats per min. An adult heart normally beats from 65-80 times every minute. In children, this is much faster and depending on their age it may vary from 120-160 per minute. The 50 beat per min heart rate of the baby was less than normal which was further causing cardiac failure. This condition was diagnosed in a timely manner by Pediatric Cardiologist, Dr Sanjukta Bhargava. The baby was further seen by Paediatric Cardiac Surgeon, Dr. Nishith Bhargava and surgery was planned.

“The team faced major problems regarding the unavailability of pacemaker leads for the child in the city as well as in the state. “But, fortunately we got it from Nagpur and within 36 hours it reached us,” said Dr Nishith Bhargava.

During the surgery, the pacemaker was fitted in the abdominal cavity with its leads attached to the surface of heart. The doctors have followed similar procedure followed during surgery to reach her heart, said Dr. Bhargava. “Normally, the pacemaker is put in the chest cavity but as the child had no space for an adult sized pacemaker, we used a specially designed pacemaker compatible with child’s size,” said Dr. Bhargava.

Dr. Sanjukta Bhargava also mentioned that the biggest challenge during surgery was to convince the parents for surgical repair in a child who was just 2kg in weight. We are very happy the team was able to overcome the challenges and the child is safe and healthy now’

CHB (Congenital Heart Block) is a rare disorder with incidence of 1 in 22,000 and with a very high morbidity and mortality. It mostly occurs because of maternal antibodies crossing the placenta and reaching the foetal circulation. These antibodies attach to the heart’s muscle cells (Cardiomyocytes) of the foetus and damage the conduction tissue. Additional structural defects of heart may also be present. In its most severe forms, the foetus dies within the womb and is aborted.

Only 2-3% of offspring’s of mothers with these antibodies develop CHB but rate of recurrence in subsequent pregnancies is 17-20%. If left untreated leads to 100% mortality of the child.

The timely diagnosis by Paediatric Cardiologist, Dr. Sanjukta Bhargava and prompt intervention by Paediatric Cardiac Surgeon, Dr. Nishith Bhargava prevented an otherwise certain mortality. Pacemaker implantation was the only treatment option for the child. Special epicardial leads were arranged and pacemaker was implanted to restore the heart rate compatible with life. The parents were counselled and they had full faith in the team of Apollo Hospitals. They readily agreed and gave consent for the procedure. Dr Bipin Arya, Cardiac Anaesthesiologist, took care of the baby during anaesthesia. The team consisting Dr. Nishit Bhargava, Dr. Sanjukta Bhargava, Dr. Zafar Khan, Dr. Bipin Arya at Apollo Hospitals, Indore successfully performed the surgery and implanted the permanent pacemaker.