Dawn Of A New Era: Hybrid Procedure For Complex CHD

Doctor from MAX Super Speciality Hospital, Saket, successfully performed a futuristic procedure to save a child from a certain demise. - The Hybrid Stage I. This is cutting edge, where multidisciplinary teams work in tandem to achieve what individual stand-alone teams would struggle to accomplish.

A 5-month-old severely malnourished child presented in extremis with a rare complex life-threatening cardiac defect, which was present since birth. The condition is called Double Outlet Right Ventricle (DORV) with Ventricular Septal Defect (VSD) with an interrupted aortic arch in which the child had multiple holes in the heart and both the lung and major Artery to the body, Aorta, arising from the right side of the heart (DORV) instead of the right and left respectively. This led to extreme blueness. This was further compounded by the fact that the Aorta, which is the main pipeline that carries oxygen-rich blood to the lungs, was not formed completely - Interrupted Aortic Arch. Dr Kulbhushan Singh Dagar, Principal Director and Chief Surgeon of Pediatric Cardiac Surgery, explained that before birth, these organs are preserved because the Aorta beyond the gap is perfused through a normally present temporary blood vessel called the ductus arteriosus. This normally closes after birth within the first few days or thereafter.

The presence of severe malnutrition, lung Infection and bleeding, along with critically damaged liver and kidneys, made surgical outcomes very guarded. To optimise the outcomes in such a challenging case a multidisciplinary team of Radiologist, Cardiologists, Intensive Care, and Surgery brainstormed the best possible solution, and it was decided to undertake the rarely performed Hybrid Stage I as it offered unique advantages complimenting both the Surgical and Cardiology Teams.

In the cardiac catheterisation suite, access to the heart was surgically achieved by dividing the breast bone. Access to the closing duct was surgically achieved via the lung artery and it was stented by the Cardiology Teams led by Dr Neeraj Awasthy. The stenting re-established the connection to the Aorta, and the body’s circulation was re-established. Further to this, the individual pulmonary arteries were banded (narrowed) to restrict the blood flow to the lungs, thereby balancing the circulation to the body and the lungs.

The post-operative period was extremely challenging, and the child had to be nurtured for over a month before he could be discharged home. The child will need two further surgeries to separate the Aortic and the Pulmonary circuits.