* Baby has a rare combination of two cardiac lesions

* Body becomes blue because of the issues

* Emergency surgery done at KIMS Hospitals

* First-ever surgery on a 3-day-old for TGA and TAPVC in the world

Hyderabad, 10th November 2023: A 3-day-old neonate, who has an extremely rare combination of two major lesions in the heart was successfully operated on at KIMS Hospital. The baby hails from Zaheerabad, Sangareddy District, of Telangana, and is completely normal now.  Dr. Anil Kumar Dharmapuram, Senior Consultant Paediatric Cardiac Surgeon of KIMS Hospitals explained the case details and the surgery procedure done on the baby.

The baby has two very serious heart conditions known as transposition of great arteries (TGA) and total anomalous pulmonary venous connection (TAPVC). Both conditions require immediate surgery to save the baby’s life. With TGA, the two primary tubes (aorta and pulmonary artery) that carry blood from the heart to the body and lungs are switched. This causes the body to receive impure blood, leading to cyanosis and a blue appearance, as the blood is not oxygenated in the lungs and the heart’s chambers do not mix. This is only one of the problems that the baby is facing.

Furthermore, the presence of TAPVC further complicates the issue. TAPVC causes a reversal of the pulmonary veins that carry blood from the lungs to the heart. Essentially, the blood from the lungs flows into the right atrium instead of the left atrium as it normally would.

Both of these conditions are considered surgical emergencies, and immediate intervention is necessary for the baby’s survival. After being stabilized on a ventilator and receiving medication to improve heart function, the baby requires a surgical procedure known as an arterial switch operation to correct the lesions caused by the transposition of the great arteries (TGA). During this surgery, the aorta and pulmonary artery are switched to the appropriate ventricles of the heart – the aorta to the left ventricle and the pulmonary artery to the right ventricle. However, this procedure presents a significant surgical challenge that requires the transfer of the coronary arteries along with the aorta, which can be delicate and fragile in a three-day-old neonate. Even a small kink or misstep in this process can result in severe damage to the ventricle and could be fatal for the baby.

The baby has two conditions – TGA and TAPVC. TAPVC requires the pulmonary veins to be re-routed to the left atrium. The surgery for this rare combination requires delicate suturing of the pulmonary veins and coronary arteries to the atrium and aorta, respectively.

While a few cases of this condition have been reported in the literature, they were all above one week of age and had a hole in the heart that helped mix the blood. However, in the neonate we operated on, there was no such hole to help with mixing. Therefore, the surgery was an emergency.

After a long day of surgery, the baby successfully recovered in the ICU and was discharged in a healthy condition. Two months later, the family returned for a check-up and found that the baby was doing great – they were breastfed normally and had gained weight. The heart was evaluated and it showed normal patterns of blood flow in both circulations, indicating a successful repair that had restored normal ventricular function. This means that the baby can have a normal life like any other baby. However, the family needs to continue regular follow-ups for some time to monitor the heart and gradually wean off the medications that the baby is taking.”

The baby’s parents expressed their utmost happiness and gratitude to Dr. Anil Kumar and the management of KIMS Hospital for saving their baby from such a dangerous condition. They said they were unaware of why their baby’s body was becoming blue. They could know the severity only after coming to KIMS Hospital. They thanked Dr. Anil Kumar, and the entire cardiac team for their support.