The infant was suspected to have Congenital rubella syndrome resulting in Patent Ductus Arteriosus, a heart defect leading to heart failure
Navi Mumbai, 8 August 2022 : The parents of a four-month-old baby flew 5000 km. from Mauritius to Apollo Hospitals, Navi Mumbai for treatment of a life-threatening heart defect that had left the baby unable to feed and was leading to congestive cardiac failure. The baby was a suspected case of Congenital rubella syndrome that had caused Patent Ductus Arteriosus, a birth defect of the heart. As a result of the defect, the infant’s heart had a volume overload with congestive cardiac failure. Timely diagnosis and intervention by the specialist doctors at Apollo Hospitals, Navi Mumbai, who overcame multiple challenges in closing the heart defect gave the baby a new lease of life.
Dr Bhushan Chavan, Consultant, Paediatrics and Paediatric Cardiology, Apollo Hospitals, Navi Mumbai said, “The case was complicated. The infant had been in the NICU for two long months in Mauritius. He had failed to thrive and his weight at four months of age was the same as at birth, just 2.5 kilos. We were fortunate that he managed the long journey from Mauritius without any major issues. After admission, he was thoroughly evaluated and it was found that the PDA was of significant size for the baby. The standard of care for large PDAs with significant blood flow is closure using either surgical or transcatheter methods. Due to the low weight, it was decided to go in for a minimally invasive interventional closure of the PDA in our advanced Cath-Lab.”
The low weight of the baby and presence of thrombosed veins made the procedure more challenging. Dr Bhushan Chavan said, “While the approach is usually through the femoral vein in the leg, in this case, this was not possible. Due to the baby’s fragile condition, we did not have time and decided to use a new route. We went through the internal jugular vein on the right side of the neck. The margin of error is very low in handling tiny babies and the initial use of a wire through a sheath resulted in slipping and slowing of the heart rate. It was then immediately decided to innovate and use a flexible catheter to guide the wire with the occluding device. We used the smallest device available, a 3×5 mm Lifetech occlude and negotiated it through the guiding catheter and positioned it across the PDA to successfully close and block any flow across it.”
The position of the device was confirmed through an echocardiogram, a scan used to look at the heart and surrounding blood vessels, which showed complete closure of the heart defect. The two-hour-long procedure was followed by an uneventful recovery with the baby being able to take feeds comfortably. Besides Dr Bhushan Chavan, the clinical team at Apollo Hospitals, Navi Mumbai included Dr Leena Pawar, Anesthetist, and Dr Narjohan Meshram, Paediatric Intensive Care specialist.
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