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Since birth Baby Rizan had always suffered from persistent cough and cold. At two months, he was found to have upper respiratory tract infection and ‘murmur’, and was referred to a cardiologist. An echo cardiogram was advised and it came as a shock to his parents: it showed that their baby had a very rare kind of heart defect called ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery) coupled with severe dysfunction of the left ventricle.
Normally, the left coronary artery arises from the aorta. However, in an individual with ALCAPA, it arises from the pulmonary artery. This condition requires surgery to correct it, without which the baby’s chances of survival are slim.
When his parents brought little Rizan to Dr Devananda N. S., HOD, Cardio-thoracic and Vascular Surgery, Manipal Hospital, they had almost given up hope of their baby’s recovery. On April 30, Dr Devananda carried out the ALCAPA repair surgery, attaching the left coronary artery to the aorta. However, there were complications. Following persistent bleeding, the baby had to be put back on CPB or cardiopulmonary bypass (a technique that temporarily takes over the function of the heart and lungs during surgery), and a small injury in the left auricle roof was repaired. The sternum or breastbone was not closed ” only the skin was ” and the baby was moved to the ICU. The chest was closed 48 hours after the surgery.
However, there were more hurdles. On the second post-op day, the baby suffered from lung collapse, and required continued ventilation and other supportive measures. Thereafter however, Rizan gradually recovered, and on the fourth post-op day was started on oral feeds.
When he was discharged, Rizan was gurgling like any other four-and-a-half-month old and feeding well; his chest was clear and the wound was healing well. The congenital heart defect that had brought so much suffering to his tiny body was finally a thing of the past.
Despite all odds and challenges they had to face almost every day since his birth, 14 year old Mohammed Arshad Sheikh’s parents never gave up hope. He was born with a rare congenital heart defect (with only about 30% of his left ventricle functioning and both arteries arising from right ventricle) and was surviving with a blue baby syndrome. His case was very complicated and out of surgical limits. No surgeon wanted to touch the boy’s heart for fear of making the situation worse. The parents were so persistent that after much deliberation, we decided to take up the case, said Dr Devananda N S, HOD and Consultant, Cardiothoracic and Vascular Surgeon, Manipal Heart Institute.
Dr. Devanand: Both his arteries rise from the right ventricle. In a regular normal heart, the pulmonary artery which carries impure blood to the lungs arises from the right ventricle, while the aorta, which carries pure blood to all parts of the body, arises from the left.
During surgery, the failing left ventricle was switched to low pressure lung circulation and the trained right ventricle was made to take the load of the entire body circulation (the reverse of what happens in a regular person). In addition, load on the sick left ventricle was reduced even further by diverting one third of the impure blood directly to the lungs.
An elated Mohammad Sheik, Arshad’s father says, “For the past fourteen years, it wasn’t easy to watch my son get bluer day by day. After countless appointments with top cardiac surgeons in the country, finally a hospital in Chennai agreed to operate on Arshad. He was four years old then. But within four months, his condition deteriorated and he was constantly breathless”
“We consulted almost every renowned cardiac surgeon in the country. They asked us to wait and watch for some time. Finally we came to Manipal Hospital and the surgery was done successfully.” Dr Devananda said, “This is a unique case and it took us almost 8 hours to complete the entire surgical procedure. Arshad is now doing fine after undergoing strenuous surgery at Manipal Hospital.