From Hole in the Heart to Whole Heart

New therapies for non surgical correction of heart defects have brought great relief for heart patients, particularly children, says Pediatric Cardiologist, Dr. K Sivakumar.
Anitha’s parents were extremely happy. Their daughter a pretty 6 year old had secured admission in one of the city’s premier schools. Unfortunately their happiness was shortlived. The school had a unique health screening program where every student was screened by a paediatrician once a term. While examining Anitha the doctor detected a heart murmur and referred the case to a cardiologist. Her parents rushed to us in shock. “Please help us doctor ‘, they kept saying, ‘she is our only child!”

“Our little girl has a hole in the heart!”
First , we did a detailed echocardiogram on Anitha. We found Anita had a ventricular septal defect - an abnormal opening in the wall between the two ventricles. In Anitha’s case it was a 10 mm hole between the two lower chambers (ventricles) of her heart. Because of this, oxygenated pink blood from the left ventricle leaked into the right ventricle, mixed with the deoxygenated blue blood on the right side and caused increased flow of blood to lungs. When the parents were questioned, they admitted that Anitha had always suffered from repeated chest infections, but the parents had attributed it to dust or changing weather conditions.

“Does this mean open heart surgery?”
Anitha’s parents were deeply disturbed at the thought of open heart surgery for their 6 year old. They thought sadly of the long disfiguring scar that would mark her as a cardiac patient for life. So they were absolutely delighted when we suggested a non-surgical procedure for closure of these defects, without any cuts in the chest.

Under gentle sedation we would make a small puncture in the groin and through the blood vessels, pass a catheter (tube) carrying a collapsible sealing device (like a folded umbrella). We would advance it to the hole in the heart. There, the sealing device would be activated to close the defect. These devices are made of biocompatible material - non toxic agents that are friendly to native cells and tissues. In 6 months a smooth tissue will grow over them by the inner lining of the heart (called endothelium) sealing them permanently as a part of the heart.

“But, is this experimental?”
We explained to Anitha’s parents that this technology was not experimental, but had evolved over one decade of clinical experience. The long term safety of these devices have been sufficiently proven. The relieved couple immediately consented to the procedure. The entire procedure was completed in 35 minutes under mild sedation and the device was deployed in accurate precision. When examined again with our stethoscope, we were pleased to hear normal heart sounds. The Echocardiogram showed a satisfactory position of the device and complete sealing of the hole. She was followed up regularly for the next year, during which time parents were surprised to note that she never got a flu attack with cough and cold and she gained a good 5 kgs in weight.

Thanks to pinhole surgery, soon Anitha will be a fashionable teen never having to worry about chest scars while choosing her clothes!

Dr. K. Sivakumar, MD.DM.DNB
Chief Paediatric Cardiologist & Senior Consultant, MIOT Centre for Children’s Cardiac Care