Srini Child heart

Dear friends, this is an initiative by department of pediatrics for PG teaching. Kindly encourage your PGs to attend this. I will be discussing history taking in a child with CHD. Part 1

Less than 24 hrs ago our anaesthetist was doing cardiac masssage on this baby!! ❤️❤️ Thanks to an emergency balloon pulmonary valvotomy, he is munching his way home and mother is all smiles...... They will take those smiles home......all the way to Beed to spread.
He is a victorious warrior today.
This baby was diagnosed to have critical pulmonary stenosis. A rather common condition for a pediatric Cardiologist. This condition Needs a simple procedure called balloon pulmonary valvotomy; but what made matters critical was that his right ventricle pressure had reached 160mmHg!! Yes. Normal pressure is less than 25mmHg. His RV had sustained more than 6 times it's limit for 8 months. Infact there was hardly any blood that crossed his pulmonary valve and filled his left ventricle. He was in low cardiac output. Though family was not all in the best of the elements to comprehend my counselling about criticality of illness and need for high risk procedure, they still consented to death on table. Parents knew how sick the baby was.....
Thanks to our Donors and CSR partners, Fermenta Biotech, funds could be arranged immediately for the procedure. Baby reached cathlab the next day morning.
Our anesthesia team was all prepared to handle any event that could go wrong. My Cardiology colleagues and whole team had a cricket style huddle before procedure. All checks and check lists were done. And the final hours to execute all our years of skills, advancement of medical technology, showdown of team work finally arrived. BPV means, crossing pulmonary valve with a wire passed from femoral vein, taking a balloon across the valve and rapid inflation followed by deflation. The narrow pulmonary valve will then be open. In our kid the problem was it was so narrow that even passing a wire across resulted to complete cessation of any blood flow to lungs and child just arrested......

This was expected!!!!

There was no place for panic though. While chest compression was going on, the wire position was kept secured. Initially a small balloon was taken across, valve was dilated enough for a larger balloon to pass. The procedure was repeated with a larger balloon..... While the chest compression was continued. The total duration of CPR lasted about 2 minutes, but as soon as second balloon dilatation was done, everything settled. It was as if there was nothing wrong with the heart!!!
By grace of God almighty, this baby went home the next day! It was moment of pride and joy for the team.
I don't miss an opportunity to ask parents if they noticed any difference before and after procedure? Just because I am curious to know how parents pursue severe right heart obstruction which is usually asymptomatic. Mother could not express well but said baby was in his best health since birth. His fast and laborer breathing had disappeared, he was able to feed well for the first time.
Thanks to so many people involved who got this baby all the way from Beed to the cathlab table of Jupiter hospital. Also thanks to my excellent team who are always ready to take up challenges and win them.

Dr. SRINIVAS L
Jupiter hospital, Thane
Team Cardiology

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