Treating little hearts for over three decades

Rema Chandramohan, director, Institute of Child Health and Hospital for Children, with the team of doctors who treated a newborn who was diagnosed with heart block and received a pacemaker recently.
| Photo Credit: Akhila Easwaran

Egmore is home to one of the busiest government hospitals in the State: the Institute of Child Health (ICH) and Hospital for Children. While the paediatric facility in itself is one of its kind in the government sector, it houses the State’s only stand-alone Paediatric Cardiothoracic and Vascular Surgery (CTVS) Department. Established in 1986, the department draws patients from across the State as well as from neighbouring Andhra Pradesh. All complex paediatric surgeries are performed here: from newborns to children aged up to 12. A five-day-old baby, who had a heart block, was among the latest to be treated by the surgeons as she underwent a surgery to receive a permanent pacemaker.

“This is the only stand-alone paediatric CTVS department in the government sector in Tamil Nadu. In the last 12 years, we have performed 3,660 surgeries. They include surgeries for Patent Ductus Arteriosus, coarctation of aorta, Atrial Septal Defect and Ventricular Septal Defect repairs, Transposition of the Great Arteries, Tetralogy of Fallot and Total Anomalous Pulmonary Venous Connection, aortic arch repair, and other complex procedures,” says G. K. Jaikaran, professor and head, Paediatric Cardiothoracic and Vascular Surgery, ICH.

On an average, the department performs 30 surgeries and handles about 300 outpatients a month. Operating on paediatric hearts meant that the team needed to be more careful, with surgeries taking at least four to 10 hours. “There are times when the team starts the surgery at 9 a.m. and finishes by 6 p.m. Heart surgeries in the paediatric age group are complex, especially with newborns, and have their own set of challenges,” says K. Dhanasekaran, professor of anaesthesia. As ICH director Rema Chandramohan points out, there is an exclusive team for paediatric cardiothoracic surgeries that includes anaesthetists, theatre staff, and perfusionists.

In fact, the department was upgraded as a Centre of Excellence in 2018 following which two modular operation theatres and a dedicated Intensive Care Unit were opened. Dr. Jaikaran points out that during the first phase of COVID-19, this was the only centre in the government sector to have performed 200 surgeries.

Over a month ago, ICH doctors received the baby of Anandhi, a resident of Gummidipoondi, soon after her delivery at the Government Raja Sir Ramaswamy Mudaliar Lying-in Hospital, Royapuram. N. Muthukumaran, professor of neonatology, ICH, says the baby was diagnosed with a heart block in utero and was shifted to ICH after birth. “Newborns have a heart rate of 140 to 150. But this baby had a low heart rate of 40 (per minute). To start with, we tried medications to increase the heart rate, but it did not work. ECG confirmed complete heart block, and the permanent solution was implantation of pacemaker,” he says.

The baby was assessed for anaesthesia fitness and taken for surgery when she was five days old. With pacemakers available only in adult sizes, implanting it into the chest cavity of a newborn was challenging, Dr. Jaikaran notes. “This is the fifth newborn to have received a pacemaker at ICH. Overall, we have implanted pacemakers in 11 children,” he says.