A Warrior Who Won the Battle Against CHD
Doctors at NHMMI successfully close large PDA with IVC and severe Kyphoscoliosis.
On this Congenital Heart Defect Awareness Day, NHMMI Narayana Superspeciality hospital has taken an initiative of inviting this 13-year-old girl “A Girl Who Had Congenital Heart Disease Now A Warrior Who Won the Battle.”
This young girl had complaints of breathing difficulty on doing routine work and running, cycling or walking fast since last few years as far as she could remember. Upon evaluating she was found to have a large PDA along with severe deformity of the spine that was curved excessively to the right and backwards. In medical terminology this curve in spine is called kyphoscoliosis. The whole chest is deformed because of this spinal deformity.
Upon further evaluation by Dr Kinjal Bakshi, consultant – pediatric cardiology, NHMMI Narayana Superspeciality Hospital, Raipur a large PDA was confirmed and echocardiogram detected another anomaly of a major vein that drains blood from lower part of body into the right side of heart i.e. IVC (Inferior Vena Cava) was found. Dr Kinjal Bakshi (Consultant Pediatric Cardiology) explained “Instead of a normal sized vein opening into the right heart, only a doubtful small channel was seen and it was expected that the vein is not draining directly to the right heart but taking a different course and opening into the vein that carries blood from the upper part of body to the heart. This vein is very important for closing the PDA by device therapy because it is the standard approach and the only major route to reach inside the heart for taking the device.”
The angiogram done before device closure had confirmed the rare anomaly of this vein where, it was duplicated and at the same time had several bends that were obstructed partly. Also, it was not opening directly to the right heart. There was no way that the device used for closing PDA could travel through such a path. This was the first challenge. We had now to approach the heart through another vein from the neck (called right internal jugular vein or IJV).
Then came the next big challenge. Because the child had such severe spinal deformity, the organs in the chest were also not in their normal position and the heart was rotated. Generally, we enter the PDA from the venous route from the right side but because of the rotated position of the heart, this was not possible. Hence, we had to perform the technique of snaring and creating a railroad after entering from the opposite side of PDA.
Dr.S.S Padhi (Consultant interventional cardiology) said “It was very important that duct should be closed by device therapy because of the severe spinal deformity which makes surgical closure a high-risk procedure. Especially when any procedure is done through internal jugular vein it requires utmost care, precision, and experience to handle the big tubes used during the procedure. The procedure was completed successfully without any complications by the Pediatric Cardiology team with active support from the cardiac anesthesia team.
Mr.Naveen Sharma (Facility Director, NHMMI Narayana Superspeciality Hospital- Raipur) said “Cardiac Procedures like these are very rare, especially in tier 2 cities like Raipur. The Pediatric Cardiology team and the interventional cardiology team has always lived up to the reputation of NH. Where Narayana Health is seen as an Icon in the field of cardiology, here our cardiac care team never fails to take rare cases like these.”
