WHEN IS PDA LIGATED?

Usually PDA is closed without surgery by device closure. There are only 3 scenarios where PDA is operated:

1.Premature babies with large PDA and developing heart failure

2. PDA with infective endocarditis

3. Large PDA in babies <5kg causing recurrent chest infections or poor weight gain

Author: Dr Bhasker Semitha

Pediatric Cardiothoracic Surgeon

Author: Dr Bhasker Semitha

Pediatric Cardiothoracic Surgeon

During robot-assisted valve surgery, the surgeon makes two to four tiny cuts (about 1/2 inch to 3/4 inch) in the chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a three-dimensional view of the surgery on the computer. This method is very precise.

Author: Dr Bhasker Semitha

Pediatric Cardiothoracic Surgeon

www.babyheart.in

Most heart surgery is performed under general anesthesia, requiring that the patient be intubated and put on a ventilator(artificial breathing machine). Some less invasive procedures, such as placing stents or a pacemaker, may be performed with monitored anesthesia care, known as twilight sleep.

Author: Dr Bhasker Semitha

Pediatric Cardiothoracic Surgeon

www.babyheart.in

Dr Bhasker Semitha, Pediatric Cardiothoracic Surgeon

contact @www.babyheart.in

Dr. Bhasker Semitha

MS, MCh

Consultant Pediatric Cardiothoracic Surgeon,

Manipal Hospitals, Bangalore

Her family took her to Bangalore for check up. There she was diagnosed to have born with a serious heart disease called “Corrected Transposition of Great Arteries”. The four chambers of her heart were connected abnormally to each other and the arteries were also attached to the wrong chambers. On the top of that, her heart was on right side.
It was shocking to learn that Indira had such a major problem. But the doctor explained that many times congenital heart diseases present late in adolescence and often the symptoms are so subtle that a child may not be aware of it.
Although of limited socioeconomic status, Indira’s parents and brother decided to fight this out. Indira was too lovely a child to simply let go. They brought the child to Bangalore again and discussed with the doctor. Indira required operation called open heart surgery. As she was already late, her body will not tolerate drastic operation in a single sitting. So, they planned to do two operations. The first was done to train her heart and called “PA banding”. After one year, the doctors again evaluated Indira and decided she is now ready for her final operation. This is called the “Double Switch Operation” where again all her heart chambers and arteries will be brought back to the normal connection.
The family requested the medical team for help for finances. Indira’s condition was certified and letters were written to various NGOs, Prime Minister Relief Fund and Chief Minister Relief Fund. Everyone donated something and the doctors waived off their own charges. The hospital agreed to give a subsidized package for Indira. Finally Indira’s finances were ready.
Indira is a brave girl. At every step, she was frank and asked her doctors exactly what will happen to her. On the morning of 10th August, 2008, Indira was wheeled into the operation theatre with a team of 8 doctors, 6 nurses and 5 technicians. It was a 12 hour operation and everyone outside was praying for her success. At 10 pm in night, Indira successfully came out of the operation theatre and was kept in intensive care unit.

When her mother went to see Indira inside ICU, she broke down. Her beautiful daughter was all covered with tubes, saline drips, blood transfusion sets, catheters and innumerable monitors. However, she seemed to be sleeping peacefully under anesthesia. The next morning Indira was conscious and taken out of artificial breathing machine or ventilator. However, she had a long way to go.
Indira stayed in ICU for a total of 14 days and then shifted to ward. On the 25th day of hospitalization, doctors were confident that Indira has recovered enough and sent her home. Two years have passed since Indira successfully underwent two complicated open heart surgeries. She comes for regular visits in the hospital. She is happy to have again resumed her school and meanwhile has taken up drawing as a hobby.
Her mother still says that Indira is a fighter and nothing could have stopped her. Lack of money, remote areas or complicated heart disease : Indira defeated all successfully. It was the continuous self belief and perseverance of her family and faith in a higher entity that saw them through.
Most of the times, we are defeated because we accept failure too easily.
“God helps those who help themselves”

Ø  8-10 children/1000 live births are born with congenital heart disease

Ø  Most common heart diseases are holes in heart, blue babies, rheumatic fever etc.

Ø  Malnutrition(poor weight, growth and development)  is very common in them.

Why heart kids have poor nutrition?

Ø  Heart disease causes fast metabolism and burns up their calories.

Ø  Frequent cough, cold, pneumonia are all catabolic processes which increase the energy demand by body .

Ø  During infections, baby is irritable and does not want to take food

Ø  Faulty nutrition practices like delayed starting of semisolids, giving liquids and not solids, diluting milk etc

Ø  Poor economic status of parents.

What should you do?

Follow your  pediatric cardiologist’s advice regarding  type of heart disease and treatment necessary

Nutritional advice:

Birth – 4months

Ø  Exclusive breast feeding is best

Ø  However, if baby is not able to suck, express the breast milk and give it by a clean katori(bowl) and spoon

Ø  Don’t dilute milk with too much water

Ø  Usually for formula feeds, recommended is 30 ml water(1 ounce) for every spoon of milk

Ø  High caloric formula feeds(eg. Lactogen LBW) can be started after discussing with doctor

Ø  Iron, vitamin, zinc and calcium supplementation according to doctor’s advise

Ø  If any pneumonia or infection, you have to give extra feeds in the 2 weeks following recovery (CATCH-UP FEED)

4 Months – 1Yr

Ø  Start weaning

Ø  Weaning means giving semisolid food

Ø  It can be either artificial food like cerelac, lactogen 2 etc

Ø  Or better is to give home available foods like mashed potato, mashed banana, khichdi(pongal), mung daal, idli, ragi, chura powder etc

Ø  If necessary, cook in pressure cooker and then use a mixie-grinder to make it semisolid.

Ø  Start with two-three spoons and then slowly increase

Ø  Start with one food and once baby is tolerating this, approximately two- three weeks, start the next food

Ø  Don’t give too much of liquids(milk, juice, water etc)

Ø  Remember , it is easier for the baby to take liquids and he will refuse semisolids

Ø  Little bit of semisolids give more nutrition and calories to baby than liquids

Older Children

Ø  Give more solids than liquids.

Ø  Avoid junk food like chips, samosa etc.

Ø  Give butter/ ghee to your child.

Ø  One egg a day is a very good source of protein.

Ø  If you are vegetarian, please use soyabeans, sprouts etc.

POINTS TO REMEMBER

1. Children with heart disease often  have poor weight and growth.

2. Parents have to take special care for then

3. High-caloric, protein rich, vitamin-iron supplemented diet helps.

4. Often, weight gain is an indicator that heart disease is serious.

5. After correction of heart disease(surgery or medicines), weight improves

6. However, children with good weight have better surgical results.

7. Always, measure your child’s weight and height when visiting your child specialist.