Surgeon uses inventive thinking to work-around limited resources!
After the initial shock of the diagnosis of a complex congenital cardiac defect at birth, things seemed to be going on the right track for Baby of Rejina. The heart defect in the form of transposition of the great arteries (TGA) that occurs when the positions of the two main arteries going out of the heart, the pulmonary artery and the aorta, are switched or “transposed”, could be repaired by surgery.
Dr. Biswa Ranjan Panda, Consultant Paediatric Cardiac Surgeon at Aster MIMS said, ‘Transposition of the Great Arteries or TGA is a cyanotic heart defect wherein the main connections are reversed. The pulmonary artery arises from the left side instead of the right, and carries oxygen-rich blood returning from the lungs back to the lungs. The aorta arises from the right side instead of the left, and carries oxygen-poor blood out to the body. As a result, there is too little oxygen in the blood that is pumped to the body. This condition can however be permanently treated through an open-heart surgical procedure known as the Jatene procedure or more simply arterial switch operation. In this, the aorta and pulmonary artery are detached and reattached to the correct positions. The procedure was carried out successfully on Baby of Rejina on the 6th day after birth.’
After the successful corrective arterial ‘Switch’ operation, everything was going well when on the second day after the surgery; the baby went into cardiac arrest. The medical team immediately swung into action and tried to revive the baby. But even heart massage did not give a positive result. The situation was critical. The team knew that in 99% of such cases, the doctors cannot perform a miracle and the patient dies. But the doctors did not want Baby of Rejina to be counted in the 99% ! There was only one chance left, and that was to support the heart of the baby using a mechanical circulatory support system like the ECMO (Extracorporeal Membrane Oxygenation) which would pump and oxygenate the baby’s blood and allow the heart and lungs to rest and recover. Unlike standard cardiopulmonary bypass, which is used for short-term support like during cardiac surgeries, ECMO is used for long-term support, sometimes upto 30 days also.
But getting an ECMO had its own problems. For one, an ECMO was not available immediately in North Kerala and secondly, the cost of ECMO is around Rs.3, 00,000/- per day. Over the days, the cost would not be affordable for the parents.
Surgeon uses inventive thinking to work-around limited resources!
It was then that Dr. Biswa Ranjan Panda came up with an innovative idea to modify the conventional cardiopulmonary bypass machine. The modification was done and the modified cardiopulmonary bypass machine was used to support the heart and lungs for 96hours till these critical organs recovered. The cost to the parents was less than one-fourth of an ECMO machine.
Dr. Biswa Ranjan Panda said, ‘As doctors, we need to be open to all alternatives to provide the best available treatment to the patients. Many a times, patients cannot afford expensive treatment options. In these cases, one needs to think innovative to modify available treatment options. This was a serious case and we are glad that we could work fast and adapt the existing cardiopulmonary bypass machine to save the baby!’
Dr. Rahul Menon, CEO, Aster MIMS said, ‘We are proud that the Aster family has doctors who don’t give up and are ready to think out of the box for solutions that save lives. This example of inventive thinking that helps save lives while cutting costs is what makes Aster MIMS stand apart from the rest.’
