Complex cardiac surgery performed on a 2-day-old neonatal who was diagnosed with Congenital Heart Block

About the Patient and condition

A 2-day-old female child (baby of Ms. Nishad), who was born at another hospital and was referred to Apollo Hospitals, Indore with heart failure and severe respiratory distress.

Case Scenario

On examining the baby at Apollo Hospitals, Indore, she was diagnosed with Congenital Heart Block and her heart rate was less than 50 beats per min. An adult heart normally beats from 65-80 times every minute. In children, this is much faster and depending on their age it may vary from 120-160 per minute. The 50 beat per min heart rate of the baby was less than normal which was further causing cardiac failure. This condition was diagnosed in a timely manner by Pediatric Cardiologist, Dr Sanjukta Bhargava. The baby was further seen by Paediatric Cardiac Surgeon, Dr. Nishith Bhargava and surgery was planned.

“The team faced major problems regarding the unavailability of pacemaker leads for the child in the city as well as in the state. “But, fortunately we got it from Nagpur and within 36 hours it reached us,” said Dr Nishith Bhargava.

During the surgery, the pacemaker was fitted in the abdominal cavity with its leads attached to the surface of heart. The doctors have followed similar procedure followed during surgery to reach her heart, said Dr. Bhargava. “Normally, the pacemaker is put in the chest cavity but as the child had no space for an adult sized pacemaker, we used a specially designed pacemaker compatible with child’s size,” said Dr. Bhargava.

Dr. Sanjukta Bhargava also mentioned that the biggest challenge during surgery was to convince the parents for surgical repair in a child who was just 2kg in weight. We are very happy the team was able to overcome the challenges and the child is safe and healthy now’

Worldwide Scenario

CHB (Congenital Heart Block) is a rare disorder with incidence of 1 in 22,000 and with a very high morbidity and mortality. It mostly occurs because of maternal antibodies crossing the placenta and reaching the foetal circulation. These antibodies attach to the heart’s muscle cells (Cardiomyocytes) of the foetus and damage the conduction tissue. Additional structural defects of heart may also be present. In its most severe forms, the foetus dies within the womb and is aborted.

Only 2-3% of offspring’s of mothers with these antibodies develop CHB but rate of recurrence in subsequent pregnancies is 17-20%. If left untreated leads to 100% mortality of the child.

Expertise at Apollo Hospitals

The timely diagnosis by Paediatric Cardiologist, Dr. Sanjukta Bhargava and prompt intervention by Paediatric Cardiac Surgeon, Dr. Nishith Bhargava prevented an otherwise certain mortality. Pacemaker implantation was the only treatment option for the child. Special epicardial leads were arranged and pacemaker was implanted to restore the heart rate compatible with life. The parents were counselled and they had full faith in the team of Apollo Hospitals. They readily agreed and gave consent for the procedure. Dr. Bipin Arya, Cardiac Anaesthesiologist, took care of the baby during anaesthesia. The team consisting Dr. Nishit Bhargava, Dr. Sanjukta Bhargava, Dr. Zafar Khan, Dr. Bipin Arya at Apollo Hospitals, Indore successfully performed the surgery and implanted the permanent pacemaker.

Apollo Hospitals – Touching Lives

It was a challenging case, yet with the support of the parents and expertise of the Cardiology team, Apollo Hospitals was successful in giving new life to the baby. Apollo Hospitals, Vijaynagar, Indore is a centre of excellence in Cardiology and provides 360-degree care in Cardiology and Cardiac Surgery, including diagnostics, interventional cardiology, cardiac surgery, paediatric cardiac surgery and preventive cardiology.

Dr. Ashok Bajpai, Director, Apollo Rajshree Hospital, Indore said, “36 years ago, Apollo started with the vision of providing cutting edge treatment to the patients in India. This is another step towards that vision. I congratulate the whole team and wish them all the best in their pursuit of excellence.”

Patient’s testimonial

“Our child was terribly sick when we brought her to Apollo. Now she is discharged, with no problem in breathing and is accepting feeds, thanks to the Apollo Team” said the patient’s parents Mohd. Had and Nishad.