The newborn was safely airlifted within 300 minutes to Manipal Hospital Old Airport Road, Bengaluru for emergency cardiac surgery, which would’ve been challenging via other transport modes.
On the night of May 20, 2024, an urgent call set into motion a remarkable chain of events, leading to the life-saving surgery of a one-day-old infant with a critical heart defect at Manipal Hospital Old Airport Road, Bengaluru.
Born in Goa, the infant showed signs of lower oxygen saturation and breathing difficulties shortly after birth. The parents, all excited to embrace their experience of parenthood, were left devastated looking at their baby’s deteriorated health. An echocardiogram on the same day after birth revealed that the baby had Obstructed Total Anomalous Pulmonary Venous Connection (Obstructed TAPVC) – an extremely rare and dangerous congenital heart condition that required immediate medical intervention. This, if untreated, often leads to potentially fatal outcomes within a few hours or days due to severe blood flow obstruction in the left ventricle that transports oxygenated blood from the heart to the entire body.
Given the urgency of prompt care and intervention, which was not feasible at the local facility, the family and doctors collectively agreed to airlift the baby to Bangalore for emergency surgery. After a discussion with the medical team at Manipal Hospitals, the air transfer of the newborn, in an incubator with a ventilator, from the point where it was born using the Manipal Advanced Response Service (MARS) Ambulance and the airlift team supported by International Critical-Care Air Transfer Team (ICATT) was efficiently coordinated from Goa to Bangalore HAL airport in the late evening of 21 May, 2024. This facilitated the safe transport of the child to the intensive care unit, which would have been challenging via road or commercial flights.
The medical team, led by Dr. Devananda N S, Head & Consultant – Cardiothoracic Vascular Surgery Heart And Lung Transplant Surgery, quickly sprang into action and performed a complex five-hour procedure using deep hypothermic circulatory arrest to repair the TAPVC. This technique involved cooling the infant’s body temperature to 18° Celsius to significantly reduce metabolic demands, allowing the surgeons a 45-50-minute window period to perform the necessary repairs by stopping the blood circulation. TAPVC in essence will have pure blood coming from both lungs to enter to a separate chamber behind the heart (instead of normally draining to the left-sided chamber) which in turn drains the blood back to the right side of the heart (impure blood). Additionally, the draining vein was narrowed to complicate the matter. In surgery, this is anatomically corrected to establish normal circulation of blood.
Dr. Devananda N S noted, “Despite the high risks associated with the procedure on a newborn that was just a day old, the surgery went well. Remarkably, the recovery was smoother than anticipated. By the 3rd day, the ventilator was removed, and the baby was discharged on 14 June, 2024 after a stay of 25 days in the Intensive Therapy Unit (ITU).
Early diagnosis and the correct treatment in time go a long way in saving many of these children. With the kind of expertise, we have in this country today, both technical as well as technological advancements, most of the birth defects are not very difficult to treat. Age and weight are never a contraindication for any kind of cardiac surgery. It is time that remains crucial in managing these cases.”
The baby is now flown back to Goa and will be monitored by the neonatologist there. This case is a testament to the importance of early diagnosis, early management, rapid coordination for long-distance transport, and the availability of specialized surgical care for complex heart defects. Advancements in medical technology and coordinated care can offer these children a chance at a normal, healthy life.
